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Nakano Y, Hirai T, Murata M, Yasukochi H, Ura K, Sueyasu Y, Shimono N, Hasuwa H. Impact of pharmacist-driven antimicrobial stewardship interventions in a secondary care facility in Japan: A pragmatic quasi-experimental study. J Infect Chemother 2024:S1341-321X(24)00234-4. [PMID: 39214387 DOI: 10.1016/j.jiac.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/17/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Efforts to promote antimicrobial stewardship aimed at reducing antimicrobial resistance are necessary regardless of hospital scale owing to delays in new antimicrobial development. We aimed to evaluate the effects of pharmacist-driven interventions on broad-spectrum antimicrobial usage and the prognosis of patients with bacteremia in a medium-sized hospital lacking infectious disease physicians and a microbiology laboratory. METHODS This single-center, retrospective, pragmatic, quasi-experimental study was conducted to compare pre- and post-intervention effects at Saiseikai Futsukaichi Hospital. We analyzed the days of therapy (DOT) for carbapenems and days of antibiotic spectrum coverage (DASC) for antimicrobials using an interrupted time series analysis. Cox proportional hazards analysis was performed to assess 30-day mortality using propensity score and inverse probability of treatment weighting in patients with bacteremia. RESULTS Pharmacist-driven interventions significantly reduced the DOT (incidence rate ratio [IRR]: 0.53, 95 % confidence intervals [CI]: 0.33-0.81, p = 0.003) and DASC (IRR: 0.87, 95 % CI: 0.78-0.97, p = 0.016). The 30-day mortality due to bacteremia did not significantly differ between pre- and post-intervention in all patients (adjusted hazard ratio [HR]: 0.92, 95 % CI: 0.56-1.51, p = 0.74). Conversely, pharmacist-driven interventions significantly reduced the 30-day mortality owing to bacteremia with Pitt bacteremia score (PBS) ≥4 (adjusted HR: 0.52, 95 % CI: 0.28-0.99, p = 0.047). CONCLUSIONS Pharmacist-driven interventions may represent a valuable approach for optimizing antimicrobial treatment and improving prognosis, especially in patients with PBS ≥4, which will potentially benefit patients in similar healthcare environments facing challenges related to antimicrobial stewardship and patient prognosis.
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Affiliation(s)
- Yuki Nakano
- Department of Pharmacy, Saiseikai Futsukaichi Hospital, Fukuoka, Japan.
| | - Toshinori Hirai
- Department of Pharmacy, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masayuki Murata
- Department of Environmental Medicine and Infectious Disease, Kyushu University, Fukuoka, Japan
| | | | - Kazuya Ura
- Department of General Internal Medicine, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Yoshiko Sueyasu
- Department of Respiratory Medicine, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Nobuyuki Shimono
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hirotsugu Hasuwa
- Department of Pharmacy, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
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Al Shaqri EJ, Balkhair A. Relationship of C-reactive Protein/Serum Albumin Ratio and qPitt Bacteremia Score With An All-Cause In-Hospital Mortality in Patients With Bloodstream Infections. Cureus 2024; 16:e66584. [PMID: 39252713 PMCID: PMC11382806 DOI: 10.7759/cureus.66584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Bloodstream infections remain a major cause of morbidity and mortality despite notable advances in their diagnosis and treatment. C-reactive protein/serum albumin ratio and the quick Pitt bacteremia score are two useful tools for clinicians to assess severity and predict mortality risk in patients with sepsis attributable to bloodstream infections. This study examined the relationship between C-reactive protein/serum albumin ratio and Q Pitt bacteremia score with all-cause in-hospital mortality in patients with bloodstream infections. METHODS Hospitalized adult patients with bacteremic bloodstream infections between January 1, 2020, and December 31, 2021, were retrospectively reviewed. Patients' demographics and clinical and laboratory data were retrieved from patient electronic records. C-reactive protein/albumin ratio was calculated using CRP (mg/L) and serum albumin (g/L) values obtained within 24 hours of blood culture collection and quick Pitt bacteremia score was calculated for each patient with each of the five variables of the score determined within 24 hours of blood culture collection and each patient was assigned a numerical score of 0-5 accordingly. The relationship between C-reactive protein/albumin ratio and quick Pitt bacteremia score with all-cause in-hospital mortality was determined. RESULTS A total of 187 hospitalized adult patients with non-repeat bacteremic bloodstream infections were identified. Escherichia coli was the most common Gram-negative blood isolate while Staphylococcus aureus was the predominant Gram-positive isolate. One hundred and five (56.1%) patients were male with a cohort mean age of 56.9 ± 2.7 years. All-cause in-hospital mortality was 27.3%. The mean CRP/albumin ratio (8.6 ±1.7) and mean quick Pitt bacteremia score (2.8 ±0.4) were significantly higher in patients with bloodstream infections who died during their hospitalization compared to those who survived. The all-cause in-hospital mortality was 8%, 12%, 22%, 46%, 93%, and 100% for patients with quick Pitt scores of 0, 1, 2, 3, 4, and 5, respectively. CONCLUSION In hospitalized patients with bacteremic bloodstream infections, an incremental increase in quick Pitt bacteremia score and mean C-reactive protein/albumin ratio of >8 was associated with higher mortality.
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Affiliation(s)
- Eyad J Al Shaqri
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
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Khurana MP, Curran-Sebastian J, Bhatt S, Knight GM. Modelling the implementation of narrow versus broader spectrum antibiotics in the empiric treatment of E. coli bacteraemia. Sci Rep 2024; 14:16986. [PMID: 39043719 PMCID: PMC11266692 DOI: 10.1038/s41598-024-66193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
The implementation of new antimicrobial resistance stewardship programs is crucial in optimizing antibiotic use. However, prescription choices can be difficult during empiric therapy; clinicians must balance the survival benefits of broader spectrum antibiotics with associated increases in resistance. The aim of this study was to evaluate the overall feasibility of switching to narrow spectrum antibiotics during the empiric treatment of E. coli bacteraemia by quantifying changes in resistance rates, antibiotic usage, and mortality using a deterministic state-transition model. Three unique model scenarios (A, B, and C), each representing a progressively broader spectrum empiric treatment regimen, were used to compare outcomes at 5 years. We show that the empiric use of the narrowest spectrum (first-line) antibiotics can lead to reductions in resistance to second-line antibiotics and the use of third-line antibiotics, but they also lead to increases in resistance to first-line therapy and higher mortality. Crucially, we find that shortening the duration of empiric and overall treatment, as well as reducing the baseline mortality rate, are important for increasing the feasibility of switching to narrow spectrum antibiotics in the empiric treatment of E. coli bacteraemia. We provide a flexible model design to investigate optimal treatment approaches for other bacterial infections.
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Affiliation(s)
- Mark P Khurana
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1352, Copenhagen, Denmark.
| | - Jacob Curran-Sebastian
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1352, Copenhagen, Denmark
| | - Samir Bhatt
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1352, Copenhagen, Denmark
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, SW7 2AZ, UK
| | - Gwenan M Knight
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, AMR Centre, Centre for Mathematical Modeling of Infectious Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Lê-Bury P, Echenique-Rivera H, Pizarro-Cerdá J, Dussurget O. Determinants of bacterial survival and proliferation in blood. FEMS Microbiol Rev 2024; 48:fuae013. [PMID: 38734892 PMCID: PMC11163986 DOI: 10.1093/femsre/fuae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/29/2024] [Accepted: 05/10/2024] [Indexed: 05/13/2024] Open
Abstract
Bloodstream infection is a major public health concern associated with high mortality and high healthcare costs worldwide. Bacteremia can trigger fatal sepsis whose prevention, diagnosis, and management have been recognized as a global health priority by the World Health Organization. Additionally, infection control is increasingly threatened by antimicrobial resistance, which is the focus of global action plans in the framework of a One Health response. In-depth knowledge of the infection process is needed to develop efficient preventive and therapeutic measures. The pathogenesis of bloodstream infection is a dynamic process resulting from the invasion of the vascular system by bacteria, which finely regulate their metabolic pathways and virulence factors to overcome the blood immune defenses and proliferate. In this review, we highlight our current understanding of determinants of bacterial survival and proliferation in the bloodstream and discuss their interactions with the molecular and cellular components of blood.
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Affiliation(s)
- Pierre Lê-Bury
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Yersinia Research Unit, 28 rue du Dr Roux, 75015 Paris, France
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Autoimmune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92260 Fontenay-aux-Roses, France
| | - Hebert Echenique-Rivera
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Yersinia Research Unit, 28 rue du Dr Roux, 75015 Paris, France
| | - Javier Pizarro-Cerdá
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Yersinia Research Unit, 28 rue du Dr Roux, 75015 Paris, France
- Institut Pasteur, Université Paris Cité, Yersinia National Reference Laboratory, WHO Collaborating Research & Reference Centre for Plague FRA-146, 28 rue du Dr Roux, 75015 Paris, France
| | - Olivier Dussurget
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Yersinia Research Unit, 28 rue du Dr Roux, 75015 Paris, France
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Matsumoto T, Yuasa A, Matsuda H, Ainiwaer D, Yonemoto N. Burden of Antimicrobial Resistance in Japan: A Systematic Literature Review and Meta-Analysis. Infect Dis Ther 2024; 13:1105-1125. [PMID: 38662332 PMCID: PMC11098996 DOI: 10.1007/s40121-024-00960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is one of the most serious public health challenges worldwide, including in Japan. However, there is limited evidence assessing the AMR burden in Japan. Thus, this systematic literature review (SLR) and meta-analysis (MA) were conducted to assess the clinical and economic burden of AMR in Japan. METHODS Comprehensive literature searches were performed on EMBASE, MEDLINE, the Cochrane Library, and ICHUSHI between 2012 and 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. MA estimated a pooled effect between the two comparative arms (AMR vs. non-AMR). The results were reported in measures of odds ratios (ORs) for in-hospital mortality and in standardized mean differences (SMDs) for length of stay (LOS) and direct medical costs. RESULTS Literature searches identified 1256 de-duplicated records, of which 56 observational studies (English, n = 35; Japanese, n = 21) were included. Of note, twenty-two studies (39.3%) compared the AMR group with non-AMR group. In the SLR, in-hospital mortality, LOS, and direct medical costs were higher in the AMR group compared to the non-AMR group. Eight studies were selected for the MA. In the AMR group, the pooled estimate showed a statistically higher in-hospital mortality [random effect (RE)-OR 2.25, 95% CI 1.34-3.79; I2 = 89%; τ2 = 0.2257, p < 0.01], LOS (RE-SMD 0.37, 95% CI - 0.09-0.84; I2 = 99%; τ2 = 0.3600, p < 0.01), and direct medical cost (RE-SMD 0.53, 95% CI 0.43-0.62; I2 = 0.0%; τ2 = 0.0, p = 0.88) versus the non-AMR group. CONCLUSION Our study presents an overview of the clinical and economic burden of AMR in Japan. Patients with AMR infections experience significantly higher in-hospital mortality, LOS, and direct medical costs compared with patients without AMR infections.
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Affiliation(s)
- Tetsuya Matsumoto
- Department of Infectious Diseases, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Akira Yuasa
- Japan Access & Value, Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| | - Hiroyuki Matsuda
- Real World Evidence Solutions & HEOR, IQVIA Solutions Japan G.K., Tokyo, Japan
| | - Dilinuer Ainiwaer
- Real World Evidence Solutions & HEOR, IQVIA Solutions Japan G.K., Tokyo, Japan
| | - Naohiro Yonemoto
- Japan Access & Value, Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
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Khan S, Das A, Mishra A, Vidyarthi AJ, Nandal M, Yadav H, Roy S, Singh M. Evaluation of three protocols for direct susceptibility testing for Gram-negative rods from flagged positive blood culture bottles. Microbiol Spectr 2024; 12:e0308123. [PMID: 38446069 PMCID: PMC10986540 DOI: 10.1128/spectrum.03081-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Bloodstream infections are associated with high mortality, which can be reduced by targeted antibiotic therapy in the early stages of infection. Direct antibiotic susceptibility testing (AST) from flagged positive blood cultures may facilitate the administration of early effective antimicrobials much before the routine AST. This study aimed to evaluate three different direct AST protocols for Gram-negative rods from flagged positive blood culture broths. Blood culture broths showing Gram-negative rods only were subjected to direct AST by Clinical and Laboratory Standards Institute-recommended direct disk diffusion (protocol A). Additionally, automated AST (protocol B) and Kirby-Bauer disk diffusion (protocol C) were performed with standard inoculum prepared from bacterial pellets obtained by centrifuging blood culture broths in serum separator vials. For comparison, conventional AST of isolates from solid media subculture was also performed with Kirby-Bauer disk diffusion (reference standard) and the automated method. Overall, categorical agreements of protocols A, B, and C were 97.6%, 95.7%, and 95.9%, respectively. Among Enterobacterales, minor error, major error, and very major error rates of protocol B were 3.5%, 0.36%, and 0.43%, respectively, whereas minor error, major error, and very major error rates of protocol C were 3.4%, 0.72%, and 0.21%, respectively, and among non-fermenters, protocol B had a minor error rate of 6.5%, and protocol C had a minor error rate of 4.1% and major error rate of 1.9%. All three direct AST protocols demonstrated excellent categorical agreements with the reference method. Performance of protocols B and C between Enterobacterales and non-fermenters was not statistically different. IMPORTANCE Bloodstream infections are associated with high mortality that can be reduced by targeted antibiotic therapy in the early stages of infection. Direct antibiotic susceptibility testing (AST) from flagged positive blood cultures may facilitate the administration of early effective antimicrobials much before the routine AST. Clinical and Laboratory Standards Institute-recommended direct AST can be performed with a limited number of antibiotic disks only. On the other hand, using an automated system for direct AST will not only allow effective laboratory workflow with reduced turnaround time but also provide the minimum inhibitory concentration values of tested antibiotics. However, using expensive automated systems for direct AST may not be feasible for resource-limited laboratories. Therefore, in this study, we aimed to evaluate the CLSI-recommended method and two other direct AST protocols (one with an automated system and the other with disk diffusion) for Gram-negative rods from flagged positive blood cultures.
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Affiliation(s)
- Salman Khan
- Department of Microbiology, National Cancer Institute, All India Institute of Medical Sciences (Jhajjar-campus), New Delhi, India
| | - Arghya Das
- Department of Microbiology, All India Institute of Medical Sciences, Madurai, India
| | - Anwita Mishra
- Department of Microbiology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Homi Bhabha Cancer Hospital, Varanasi, India
| | - Ashima Jain Vidyarthi
- Department of Microbiology, National Cancer Institute, All India Institute of Medical Sciences (Jhajjar-campus), New Delhi, India
| | - Mukesh Nandal
- Department of Emergency Medicine, National Cancer Institute, All India Institute of Medical Sciences (Jhajjar-campus), New Delhi, India
| | - Himanshu Yadav
- Department of Microbiology, National Cancer Institute, All India Institute of Medical Sciences (Jhajjar-campus), New Delhi, India
| | - Shayak Roy
- Department of Oncoanaesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences (Jhajjar-campus), New Delhi, India
| | - Mahipal Singh
- Department of Microbiology, National Cancer Institute, All India Institute of Medical Sciences (Jhajjar-campus), New Delhi, India
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Tsai YW, Zhang B, Chou HY, Chen HJ, Hsu YC, Shiue YL. Clinical impacts of the rapid diagnostic method on positive blood cultures. Lab Med 2024; 55:179-184. [PMID: 37352545 DOI: 10.1093/labmed/lmad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the impact of short-term incubation (STI) protocol on clinical outcomes of bloodstream infection (BSI) patients. METHODS A total of 1363 positive blood culture records from January 2019 to December 2021 were included. The main clinical outcomes included pathogen identification turnaround time (TAT), antimicrobial susceptibility testing (AST) TAT, and length of total hospital stay. RESULTS The TAT of pathogen identification and AST significantly decreased after implementing the STI protocol (2.2 vs 1.4 days and 3.4 vs 2.5 days, respectively, with P < .001 for both). Moreover, for patients with Gram-negative bacteria (GNB)-infected BSIs, the length of total hospital stay decreased from 31.9 days to 27.1 days, indicating that these patients could be discharged 5 days earlier after implementing the STI protocol (P < .01). CONCLUSION The protocol led to a significant reduction in TAT and improved clinical outcomes, particularly for GNB organisms. The findings suggest that the STI protocol can improve patient outcomes and hospital resource utilization in the management of BSIs.
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Affiliation(s)
- Ya-Wen Tsai
- Center for Integrative Medicine, Tainan City, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, US
| | - Hsiu-Yin Chou
- Center for Integrative Medicine, Tainan City, Taiwan
| | - Hung-Jui Chen
- Division of Infectious Diseases, Department of Internal Medicine, Tainan City, Taiwan
| | - Yu-Chi Hsu
- Information Systems Office, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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Kurabayashi M, Yamada T, Tomita M, Matsumoto M, Mizutani R, Uesugi K, Niino H, Yamada H, Isobe T, Edagawa S. Impact of antimicrobial stewardship implementation on the antibiotic use and susceptibility in a Japanese long-term care hospital. J Infect Chemother 2024; 30:134-140. [PMID: 37793545 DOI: 10.1016/j.jiac.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Antimicrobial use (AMU) is closely related to the emergence of antimicrobial-resistant (AMR) bacteria. Meanwhile, long-term care hospitals (LTCHs) have been pointed out to be important reservoirs for AMR. However, evidence illustrating the association between AMU and AMR in LTCHs is lacking compared to that of acute care hospitals. METHODS We evaluated the impact of an antimicrobial stewardship (AS) program implementation, in a LTCH on AMU and antibiotic susceptibility between three periods: the pre-AS-period (pre-AS); the first period after AS implementation (post-AS 1), in which initiated recommendation the blood culture collection and definitive therapy by AS team; and the second period (post-AS 2), implementation of a balanced use of antibiotics was added. RESULTS After the AS implementation, a significant increase in the number of blood cultures collected was observed. Conversely, the AMU of piperacillin-tazobactam (PIPC/TAZ), which has activity against Pseudomonas aeruginosa, was increased and occupied 43.0% of all injectable AMU in post-AS 1 compared with that in pre-AS (35.5%). In the post-AS 2 period, we analyzed the %AUD and recommended hospital-wide PIPC/TAZ sparing; this resulted in the significant reduction in %AUD of PIPC/TAZ, which was associated with improved susceptibility of P. aeruginosa to PIPC/TAZ. CONCLUSIONS These results suggest that AS programs aimed at implementing antibiotic sparing may lead to improve AMR, highlighting the necessity of correcting overuse of a single class of antibiotics and usefulness of AMU monitoring in the LTCH setting.
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Affiliation(s)
- Makoto Kurabayashi
- Department of Pharmacy, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Takehiro Yamada
- Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1, Maeda 7-jo, Teine-ku, Sapporo, 006-8585, Japan.
| | - Masashi Tomita
- Department of Pharmacy, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Minami Matsumoto
- Department of Pharmacy, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Ryunosuke Mizutani
- Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1, Maeda 7-jo, Teine-ku, Sapporo, 006-8585, Japan.
| | - Koichi Uesugi
- Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1, Maeda 7-jo, Teine-ku, Sapporo, 006-8585, Japan.
| | - Hideki Niino
- Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Clinical Laboratory, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Hidetoshi Yamada
- Department of Pharmacy, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Takeshi Isobe
- Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Medical, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Shunji Edagawa
- Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Infectious Diseases, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Neurology, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
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Drago L, Fidanza A, Giannetti A, Ciuffoletti A, Logroscino G, Romanò CL. Bacteria Living in Biofilms in Fluids: Could Chemical Antibiofilm Pretreatment of Culture Represent a Paradigm Shift in Diagnostics? Microorganisms 2024; 12:259. [PMID: 38399663 PMCID: PMC10892178 DOI: 10.3390/microorganisms12020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Biofilms are multicellular aggregates of bacteria immersed in an extracellular matrix that forms on various surfaces, including biological tissues and artificial surfaces. However, more and more reports point out the fact that even biological fluids and semifluid, such as synovial liquid, blood, urine, or mucus and feces, harbor "non-attached" biofilm aggregates of bacteria, which represent a significant phenomenon with critical clinical implications that remain to be fully investigated. In particular, biofilm aggregates in biological fluid samples have been shown to play a relevant role in bacterial count and in the overall accuracy of microbiological diagnosis. In line with these observations, the introduction in the clinical setting of fluid sample pretreatment with an antibiofilm chemical compound called dithiothreitol (DTT), which is able to dislodge microorganisms from their intercellular matrix without killing them, would effectively improve the microbiological yield and increase the sensitivity of cultural examination, compared to the current microbiological techniques. While other ongoing research continues to unveil the complexity of biofilm formation in biological fluids and its impact on infection pathogenesis and diagnosis, we here hypothesize that the routine use of a chemical antibiofilm pretreatment of fluid and semi-solid samples may lead to a paradigm shift in the microbiological approach to the diagnosis of biofilm-related infections and should be further investigated and eventually implemented in the clinical setting.
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Affiliation(s)
- Lorenzo Drago
- Laboratory of Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- UOC Laboratory of Clinical Medicine, MultiLab Department, IRCCS Multimedica, 20138 Milan, Italy
| | - Andrea Fidanza
- Mininvasive Orthopaedic Surgery—Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.F.); (G.L.)
- Unit of Orthopaedics and Traumatology, “SS Filippo e Nicola” Hospital, 67051 Avezzano, Italy
| | - Alessio Giannetti
- Unit of Orthopaedics and Traumatology, “G. Mazzini” Hospital, 64100 Teramo, Italy; (A.G.); (A.C.)
| | - Alessio Ciuffoletti
- Unit of Orthopaedics and Traumatology, “G. Mazzini” Hospital, 64100 Teramo, Italy; (A.G.); (A.C.)
| | - Giandomenico Logroscino
- Mininvasive Orthopaedic Surgery—Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.F.); (G.L.)
| | - Carlo Luca Romanò
- Romano Institute, Rruga Deshmoret e 4 Shkurtit, 1001 Tirana, Albania;
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Cai J, Yang M, Deng H, Bai H, Zheng G, He J. Acute kidney injury should not be neglected - optimization of quick Pitt bacteremia score for predicting mortality in critically ill patients with bloodstream infection: a retrospective cohort study. Ther Adv Infect Dis 2024; 11:20499361241231147. [PMID: 38410828 PMCID: PMC10896049 DOI: 10.1177/20499361241231147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
Background Considering the therapeutic difficulties and mortality associated with bloodstream infection (BSI), it is essential to investigate other potential factors affecting mortality in critically ill patients with BSI and examine the utility of the quick Pitt bacteremia (qPitt) score to improve the survival rate. Objectives To improve the predictive accuracy of the qPitt scoring system by evaluating the five current components of qPitt and including other potential factors influencing mortality in critically ill patients with BSI. Design This was a retrospective cohort study. Methods Medical information from the Medical Information Mart for Intensive Care IV database was used in this retrospective cohort study. The risk factors associated with mortality were examined using a multivariate logistic regression model. The area under the receiver operating characteristic curve (AUC) was used to assess the discriminatory capability of the prediction models. Results In total, 1240 eligible critically ill patients with BSI were included. After adjustment for age, community-onset BSI, indwelling invasive lines, and Glasgow Coma Scale (GCS) ⩽ 8, acute kidney injury (AKI) was identified as a notable risk factor for 14-day mortality. Except for altered mental status, the four other main components of the original qPitt were significantly associated with 14-day mortality. Hence, we established a modified qPitt (m-qPitt) by adding AKI and replacing altered mental status with GCS ⩽ 8. The AUCs for m-qPitt and qPitt were 0.723 [95% confidence interval (CI): 0.683-0.759] and 0.708 (95% CI: 0.669-0.745) in predicting 14-day mortality, respectively. Moreover, m-qPitt also had acceptable performance and discrimination power [0.700 (95% CI: 0.666-0.732)] in predicting 28-day mortality. Conclusion AKI significantly influenced the survival of critically ill patients with BSIs. Compared with the original qPitt, our new m-qPitt was proven to have a better predictive performance for mortality in critically ill patients with BSI. Further studies should be conducted to validate the practicality of m-qPitt.
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Affiliation(s)
- Jiaqi Cai
- Department of Pharmacy, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Laboratory, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan, China
| | - Ming Yang
- The 2nd Department of Tuberculosis, Zhongshan Second People’s Hospital, Zhongshan, China
| | - Han Deng
- Department of International Medical Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Hao Bai
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Guanhao Zheng
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Juan He
- Department of Pharmacy, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Room 202, 2nd Floor, 12 Building, 197 Ruijin No. 2 Road, Huangpu, Shanghai 200025, China
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Fidalgo B, Morata L, Cardozo C, Del Río A, Morales J, Fernández-Pittol M, Martínez JA, Mensa J, Vila J, Soriano A, Casals-Pascual C. Information Delay of Significant Bloodstream Isolates and Patient Mortality: A Retrospective Analysis of 6225 Adult Patients With Bloodstream Infections. Clin Infect Dis 2023; 77:680-686. [PMID: 37099685 DOI: 10.1093/cid/ciad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/08/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Our aim in this study was to evaluate the clinical and prognostic impact of communicating microbiological information in real time for adult patients with bloodstream infections (BSIs). METHODS We retrospectively reviewed 6225 clinical episodes of bacteremia in a teaching hospital from January 2013 to December 2019. Bacteremia-associated mortality was compared when blood culture results were relayed to the infectious diseases specialist (IDS) in real time and periods when results were relayed the following morning. The impact of information availability using mortality at 30 days was used as the main outcome of the study. RESULTS The initial analysis (all microorganisms included) did not show an association of mortality and information delay to the IDS (odds ratio [OR], 1.18; 95% confidence interval [CI], .99-1.42). However, information delay of BSIs caused by fast-growing microorganisms such as Enterobacterales was associated with a significant increase in the odds of death at 30 days both in the univariate (OR, 1.76; 95% CI, 1.30-2.38) and multivariate analysis (OR, 2.22; 95% CI, 1.50-3.30). Similar results were found with mortality at 14 days and 7 days in the univariate (OR, 1.54; 95% CI, 1.08-2.20 and OR, 1.56; 95% CI, 1.03-2.37, respectively) and the multivariate analysis (OR, 2.05; 95% CI, 1.27-3.32 and OR, 1.92; 95% CI, 1.09-3.40, respectively). CONCLUSIONS Information delivered in real time has prognostic relevance and is likely to improve survival of patients with documented BSIs. Future studies should address the prognostic impact of adequate resource allocation (microbiologist/IDS with 24/7 coverage) in BSIs.
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Affiliation(s)
- Berta Fidalgo
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
| | - Laura Morata
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
| | - Ana Del Río
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
| | - Javier Morales
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
| | - Mariana Fernández-Pittol
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
| | - José Antonio Martínez
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto Salud Carlos III, Madrid, Spain
| | - Josep Mensa
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
- Institute for Global Health, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto Salud Carlos III, Madrid, Spain
| | - Alex Soriano
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto Salud Carlos III, Madrid, Spain
| | - Climent Casals-Pascual
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
- Institute for Global Health, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto Salud Carlos III, Madrid, Spain
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Kim K, Park S. Validation of the Accuracy of Automatic Measurement of Blood Volume in Culture Bottles for Blood Culture. Diagnostics (Basel) 2023; 13:2685. [PMID: 37627944 PMCID: PMC10453367 DOI: 10.3390/diagnostics13162685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Several manufacturers have developed systems that automatically measure the amount of blood in culture bottles. We compared the volumes measured automatically by the Virtuo instrument (bioMérieux, France) (height-based volumes) and those calculated by weighing the bottles. In all, 150 pairs of aerobic and anaerobic blood culture bottles (BacT/ALERT FA/FN Plus, bioMérieux) were randomly selected over two periods to compare the height- and weight-based volumes and analyze the effect of foam. We also estimated the limit of detection (LOD) and the cut-off value for 5 mL equine blood. The mean height-based volume was approximately 0.67 mL greater than the weight-based volume, particularly in anaerobic culture bottles. Foam did not have a significant effect. The LOD for the automatic height-based volume of equine blood was 0.2-0.4 mL. The 5 mL cut-off was 4-4.2 mL. Therefore, when reporting or monitoring blood volume within culture bottles in the laboratory, these performance characteristics should be adequately considered.
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Affiliation(s)
| | - Sunggyun Park
- Departments of Laboratory Medicine, Keimyung University School of Medicine, Daegu 42601, Republic of Korea;
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Akaishi T, Tokuda K, Katsumi M, Fujimaki SI, Aoyagi T, Harigae H, Ishii T. Blood Culture Result Profile in Patients With Central Line-Associated Bloodstream Infection (CLABSI): A Single-Center Experience. Cureus 2023; 15:e40202. [PMID: 37435240 PMCID: PMC10331171 DOI: 10.7759/cureus.40202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
Background Central line-associated bloodstream infection (CLABSI) is among the most common bloodstream infections in the university hospital and intensive care unit settings. This study evaluated the routine blood test findings and microbe profiles of bloodstream infection (BSI) by the presence and types of central vein (CV) access devices (CVADs). Methods A total of 878 inpatients at a university hospital who were clinically suspected for BSI and underwent blood culture (BC) testing between April 2020 and September 2020 were enrolled. Data regarding age at BC testing, sex, WBC count, serum C-reactive protein (CRP) level, BC test results, yielded microbes, and usage and types of CVADs were evaluated. Results The BC yields were detected in 173 patients (20%), suspected contaminating pathogens in 57 (6.5%), and 648 (74%) with a negative yield. The WBC count (p=0.0882) and CRP level (p=0.2753) did not significantly differ between the 173 patients with BSI and the 648 patients with negative BC yields. Among the 173 patients with BSI, 74 used CVADs and met the diagnosis of CLABSI; 48 had a CV catheter, 16 had CV access ports, and 10 had a peripherally inserted central catheter (PICC). Patients with CLABSI showed lower WBC counts (p=0.0082) and serum CRP levels (p=0.0024) compared to those with BSI who did not use CVADs. The most commonly yielded microbes in those with CV catheters, CV-ports, and PICC were Staphylococcus epidermidis (n=9; 19%), Staphylococcus aureus (n=6; 38%), and S. epidermidis (n=8; 80%), respectively. Among those with BSI who did not use CVADs, Escherichia coli (n=31; 31%) was the most common pathogen, followed by S. aureus (n=13; 13%). Conclusion Patients with CLABSI showed lower WBC counts and CRP levels than those with BSI who did not use CVADs. Staphylococcus epidermidis was among the most common microbes in CLABSI and accounted for the majority of yielded microbes in patients who used PICC.
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Affiliation(s)
| | | | - Makoto Katsumi
- Laboratory Medicine, Tohoku University Hospital, Sendai, JPN
| | | | - Tetsuji Aoyagi
- Microbiology and Infectious Diseases, Toho University, Tokyo, JPN
| | | | - Tadashi Ishii
- Kampo and Integrative Medicine, Tohoku University Hospital, Sendai, JPN
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Kassaian N, Nematbakhsh S, Yazdani M, Rostami S, Nokhodian Z, Ataei B. Epidemiology of Bloodstream Infections and Antimicrobial Susceptibility Pattern in ICU and Non-ICU Wards: A Four-Year Retrospective Study in Isfahan, Iran. Adv Biomed Res 2023; 12:106. [PMID: 37288028 PMCID: PMC10241621 DOI: 10.4103/abr.abr_320_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 06/09/2023] Open
Abstract
Background Bloodstream infections (BSIs) are one of the causes of morbidity and mortality in hospitalised patients. This study evaluated BSI's incidence, trend, antimicrobial susceptibility patterns and mortality in AL Zahra Hospital in Isfahan, Iran. Materials and Methods This retrospective study was conducted in AL Zahra Hospital from March 2017 to March 2021. The Iranian nosocomial infection surveillance system was used for data gathering. The data included demographic and hospital data, type of bacteria, and antibiotic susceptibility findings and were analysed in SPSS-18 software. Results The incidence of BSIs was 1.67% and 0.47%, and the mortality was 30% and 15.2% in the intensive care unit (ICU) and non-ICU wards, respectively. In the ICU, the mortality was correlated with the use of the catheter, type of organism and year of study, but in non-ICU, correlated with age, gender, use of the catheter, ward, year of study and duration between the incidence of BSIs and discharging/death. Staphylococcus epidermidis, Acinetobacter spp. and Klebsiella spp. were the most frequent germs isolated in all wards. Vancomycin (63.6%) and Gentamycin (37.7%) for ICU and Vancomycin (55.6%) and Meropenem (53.3) for other wards were the most sensitive antibiotics. Conclusion Despite the few rate of BSI in the last four years in AL Zahra Hospital, our data showed that its incidence and mortality in the ICU ward are significantly more than in other hospital wards. We recommend prospective multicentre studies to know the total incidence of BSI, local risk factors and patterns of pathogens causing BSI.
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Affiliation(s)
- Nazila Kassaian
- Nosocomial Infection Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadnosh Nematbakhsh
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Yazdani
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soodabeh Rostami
- Nosocomial Infection Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zary Nokhodian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Nosocomial Infection Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Saavedra JC, Fonseca D, Abrahamyan A, Thekkur P, Timire C, Reyes J, Zachariah R, Agudelo LG. Bloodstream infections and antibiotic resistance at a regional hospital, Colombia, 2019-2021. Rev Panam Salud Publica 2023; 47:e18. [PMID: 37082533 PMCID: PMC10105591 DOI: 10.26633/rpsp.2023.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 04/22/2023] Open
Abstract
Objectives To assess antibiotic susceptibility of World Health Organization (WHO) priority bacteria (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus, and Streptococcus pneumoniae) in blood cultures at the Orinoquía regional hospital in Colombia. Methods This was cross-sectional study using routine laboratory data for the period 2019-2021. Data on blood samples from patients suspected of a bloodstream infection were examined. We determined: the total number of blood cultures done and the proportion with culture yield; the characteristics of patients with priority bacteria; and the type of bacteria isolated and antibiotic resistance patterns. Results Of 25 469 blood cultures done, 1628 (6%) yielded bacteria; 774 (48%) of these bacteria were WHO priority pathogens. Most of the priority bacteria isolated (558; 72%) were gram-negative and 216 (28%) were gram-positive organisms. Most patients with priority bacteria (666; 86%) were hospitalized in wards other than the intensive care unit, 427 (55%) were male, and 321 (42%) were ≥ 60 years of age. Of the 216 gram-positive bacteria isolated, 205 (95%) were Staphylococcus aureus. Of the 558 gram-negative priority bacteria isolated, the three most common were Escherichia coli (34%), Klebsiella pneumoniae (28%), and Acinetobacter baumannii (20%). The highest resistance of Staphylococcus aureus was to oxacillin (41%). For gram-negative bacteria, resistance to antibiotics ranged from 4% (amikacin) to 72% (ampicillin). Conclusions Bacterial yield from blood cultures was low and could be improved. WHO priority bacteria were found in all hospital wards. This calls for rigorous infection prevention and control standards and continued surveillance of antibiotic resistance.
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Affiliation(s)
- Julio C. Saavedra
- Regional hospital of OrinoquiaYopalColombiaRegional hospital of Orinoquia, Yopal, Colombia.
| | - Deisy Fonseca
- Regional hospital of OrinoquiaYopalColombiaRegional hospital of Orinoquia, Yopal, Colombia.
| | - Arpine Abrahamyan
- Tuberculosis Research and Prevention CenterYerevanArmeniaTuberculosis Research and Prevention Center, Yerevan, Armenia.
| | - Pruthu Thekkur
- Centre for Operational ResearchInternational Union Against Tuberculosis and Lung DiseaseSouth-East Asia OfficeNew DelhiIndiaCentre for Operational Research, International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India.
| | - Collins Timire
- International Union Against Tuberculosis and Lung DiseaseParisFranceInternational Union Against Tuberculosis and Lung Disease, Paris, France.
| | - Jorge Reyes
- Central University of EcuadorQuitoEcuadorCentral University of Ecuador, Quito, Ecuador.
| | - Rony Zachariah
- UNICEF, UNDP, World BankWHO Special Programme for Research and Training in Tropical DiseasesGenevaSwitzerlandUNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland.
| | - Lorena G. Agudelo
- Regional hospital of OrinoquiaYopalColombiaRegional hospital of Orinoquia, Yopal, Colombia.
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Lau MT, Wong OF. Risk factors associated with bacteremia with drug-resistant organisms: Review of blood culture results in emergency department of a regional hospital. HONG KONG J EMERG ME 2023. [DOI: 10.1177/10249079231151518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Early antibiotic administration in sepsis improves patient survival. Treatment with antibiotics should cover potential pathogens and should avoid overusing broad-spectrum antibiotics. We have to identify patients who have high risks of infection with drug-resistant organisms. Objectives: A retrospective cohort study was conducted to identify potential risk factors associated with bloodstream infections with drug-resistant organisms to help the choice of empirical antibiotics in the emergency department. Methods: Adult patients with bloodstream infection diagnosed by blood culture in the emergency department in the period of 1 January 2020 to 31 December 2020 were included. Clinical features including chronic medical illnesses, clinical presentation and severity, and patients’ outcomes were identified in the electronic medical records. Bloodstream infection with drug-resistant organisms is defined as positive blood culture with bacteria resistant to either (1) amoxicillin/ clavulanic acid AND ceftriaxone or (2) amoxicillin/ clavulanic acid or ceftriaxone PLUS amikacin or levofloxacin. Univariate and multivariate analyses were conducted to identify risk factors associated with the study outcome. Results: Among 105 patients with bloodstream infection, 17% were caused by drug-resistant organisms. Multivariate analysis showed that age is a risk factor associated with bloodstream infection with drug-resistant organisms (odds ratio: 1.04, 95% confidence interval: 1.0–1.08, p = 0.03). Conclusion: In conclusion, age is a significant risk factor for drug-resistant bloodstream infection in emergency department patients. Further research may be needed to find out the relationship between frailty and infection with drug-resistant organisms.
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Affiliation(s)
- Man Ting Lau
- Accident and Emergency Department, North Lantau Hospital, Lantau, Hong Kong
| | - Oi Fung Wong
- Accident and Emergency Department, North Lantau Hospital, Lantau, Hong Kong
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Multicenter Surveillance of Antimicrobial Resistance among Gram-Negative Bacteria Isolated from Bloodstream Infections in Ghana. Antibiotics (Basel) 2023; 12:antibiotics12020255. [PMID: 36830166 PMCID: PMC9951917 DOI: 10.3390/antibiotics12020255] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) in Gram-negative bacteria-causing bloodstream infections (BSIs), such as Klebsiella pneumoniae and non-typhoidal Salmonella (NTS), is a major public health concern. Nonetheless, AMR surveillance remains scarce in sub-Saharan Africa, where BSI treatment is largely empirical. The aim of the study was to determine the distribution and AMR patterns of BSI-causing NTS, K. pneumoniae, and other Gram-negative bacteria in Ghana. METHODS A cross-sectional study was conducted between April and December 2021 at eleven sentinel health facilities across Ghana as part of a pilot study on the feasibility and implementation of the human sector AMR surveillance harmonized protocol in sub-Saharan Africa. Gram-negative bacteria recovered from blood specimens of febrile patients were identified using MALDI-TOF and evaluated for antimicrobial resistance using the BD Phoenix M50 analyzer and Kirby-Bauer disc diffusion. The Department of Medical Microbiology at the University of Ghana served as the reference laboratory. RESULTS Out of 334 Gram-negative blood isolates, there were 18 (5.4%) NTS, 85 (25.5%) K. pneumoniae, 88 (26.4%) Escherichia coli, 40 (12.0%) Acinetobacter baumannii, 25 (7.5%) Pseudomonas aeruginosa, and 77 (23.1%) other Gram-negative bacteria. As a composite, the isolates displayed high resistance to the antibiotics tested-amoxicillin (89.3%), tetracycline (76.1%), trimethoprim-sulfamethoxazole (71.5%), and chloramphenicol (59.7%). Resistance to third-generation cephalosporins [ceftriaxone (73.7%), cefotaxime (77.8%), and ceftazidime (56.3%)] and fluoroquinolones [ciprofloxacin (55.3%)] was also high; 88% of the isolates were multidrug resistant, and the rate of extended-spectrum beta-lactamase (ESBL) production was 44.6%. Antibiotic resistance in K. pneumoniae followed the pattern of all Gram-negative isolates. Antibiotic resistance was lower in NTS blood isolates, ranging between 16.7-38.9% resistance to the tested antibiotics. Resistance rates of 38.9%, 22.2%, and 27.8% were found for cefotaxime, ceftriaxone, and ceftazidime, respectively, and 27.8% and 23.8% for ciprofloxacin and azithromycin, respectively, which are used in the treatment of invasive NTS. The prevalence of multidrug resistance in NTS isolates was 38.9%. CONCLUSIONS Multicenter AMR surveillance of Gram-negative blood isolates from febrile patients was well-received in Ghana, and the implementation of a harmonized protocol was feasible. High resistance and multidrug resistance to first- or second-choice antibiotics, including penicillins, third-generation cephalosporins, and fluoroquinolones, were found, implying that these antibiotics might have limited effectiveness in BSI treatment in the country. Continuation of AMR surveillance in Gram-negative blood isolates is essential for a better understanding of the extent of AMR in these pathogens and to guide clinical practice and policymaking.
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Oussalah A, Callet J, Manteaux AE, Thilly N, Jay N, Guéant JL, Lozniewski A. Usefulness of procalcitonin at admission as a risk-stratifying biomarker for 50-day in-hospital mortality among patients with community-acquired bloodstream infection: an observational cohort study. Biomark Res 2023; 11:4. [PMID: 36647149 PMCID: PMC9843889 DOI: 10.1186/s40364-023-00450-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To assess the association between plasma procalcitonin concentration at hospital admission and the risk of 50-day in-hospital mortality among patients with community-acquired bloodstream infections. METHODS We carried out a retrospective, observational cohort study with all consecutive patients with bacteriologically confirmed community-acquired bloodstream infections hospitalized between 2006 and 2012. We aimed to assess the association between plasma procalcitonin at admission and 50-day in-hospital mortality. Patients were included in the analysis if they had undergone a blood culture test within 48 hours of hospitalization with a concomitant procalcitonin assay (time < 12 hours between the two tests). Inclusion in the study began on the day of hospital admission, and each patient was followed until death, discharge from the hospital, or last known follow-up in the 50 days following hospital admission. The endpoint was the occurrence of all-cause in-hospital mortality during the 50 days following hospital admission. RESULTS During the 7-year study period, 1593 patients were admitted to one of the healthcare facilities of the University Hospital of Nancy from home or through the emergency department and had positive blood cultures and concomitant procalcitonin assays. Among the patients, 452 met the selection criteria and were analyzed. In ROC analysis, procalcitonin at baseline was significantly associated with 50-day in-hospital mortality, with an optimal threshold > 4.24 ng/mL. A baseline procalcitonin > 4.24 ng/mL was independently associated with an increased risk of in-hospital mortality (multivariable logistic regression: odds ratio, 2.58; 95% CI, 1.57-4.25; P = 0.0002; Cox proportional hazard regression: hazard ratio, 2.01; 95% CI, 1.30-3.11; P = 0.002). In sensitivity analyses, baseline procalcitonin quartiles were independently associated with 50-day in-hospital mortality (multivariable logistic regression: odds ratio, 1.47; 95% CI, 1.17-1.85; P = 0.001; Cox proportional hazard regression: hazard ratio, 1.31; 95% CI, 1.07-1.60; P = 0.008). The independent associations between baseline procalcitonin and the risk of 50-day in-hospital mortality were maintained after adjusting for C-reactive protein and sepsis status at admission. CONCLUSION Our data provide the first evidence of the usefulness of plasma procalcitonin at admission as a risk-stratifying biomarker for predicting 50-day in-hospital mortality among patients with community-acquired bloodstream infections.
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Affiliation(s)
- Abderrahim Oussalah
- grid.410527.50000 0004 1765 1301Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Rue du Morvan, F-54511 Vandoeuvre-lès-Nancy, France ,Nutrition, Genetics, and Environmental Risk Exposure (NGERE, INSERM UMR_S 1256), Faculty of Medicine of Nancy, University of Lorraine, INSERM, 9, Avenue de la Forêt de Haye, F-54511 Vandoeuvre-lès-Nancy, France
| | - Jonas Callet
- grid.410527.50000 0004 1765 1301Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Rue du Morvan, F-54511 Vandoeuvre-lès-Nancy, France
| | - Anne-Elisabeth Manteaux
- grid.410527.50000 0004 1765 1301Department of Microbiology, University Hospital of Nancy, Rue du Morvan, F-54511 Vandoeuvre-lès-Nancy, France
| | - Nathalie Thilly
- grid.410527.50000 0004 1765 1301Department of Methodology, Promotion and Investigation, University Hospital of Nancy, Rue du Morvan, F-54511 Vandoeuvre-lès-Nancy, France
| | - Nicolas Jay
- grid.410527.50000 0004 1765 1301Department of Medical Informatics, University Hospital of Nancy, Rue du Morvan, F-54000 Vandoeuvre-lès-Nancy, France ,grid.462764.50000 0001 2179 5429Orpailleur, LORIA UMR 7503, Vandoeuvre-lès-Nancy, F-54000 Nancy, France
| | - Jean-Louis Guéant
- grid.410527.50000 0004 1765 1301Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, University Hospital of Nancy, Rue du Morvan, F-54511 Vandoeuvre-lès-Nancy, France ,Nutrition, Genetics, and Environmental Risk Exposure (NGERE, INSERM UMR_S 1256), Faculty of Medicine of Nancy, University of Lorraine, INSERM, 9, Avenue de la Forêt de Haye, F-54511 Vandoeuvre-lès-Nancy, France
| | - Alain Lozniewski
- Nutrition, Genetics, and Environmental Risk Exposure (NGERE, INSERM UMR_S 1256), Faculty of Medicine of Nancy, University of Lorraine, INSERM, 9, Avenue de la Forêt de Haye, F-54511 Vandoeuvre-lès-Nancy, France ,grid.29172.3f0000 0001 2194 6418Stress Immunity Pathogens Laboratory (EA7300), Faculty of Medicine of Nancy, University of Lorraine, 9, Avenue de la Forêt de Haye, F-54511 Vandoeuvre-lès-Nancy, France
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Ohmagari N, Choi WS, Tang HJ, Atanasov P, Jiang X, Hernandez Pastor L, Nakayama Y, Chiang J, Lim K, Nievera MC. Targeted literature review of the burden of extraintestinal pathogenic Escherichia Coli among elderly patients in Asia Pacific regions. J Med Econ 2023; 26:168-178. [PMID: 36647596 DOI: 10.1080/13696998.2023.2169447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Extraintestinal Pathogenic Escherichia coli (ExPEC) is a leading cause of invasive disease, including bacteremia and sepsis. Invasive ExPEC disease (IED) has the potential to complicate the clinical treatment of other conditions and is associated with an increased mortality, hospitalization, and worse outcomes. Older adults and individuals with comorbid conditions are at higher risk of IED. ExPEC is of particular concern in the Asia Pacific region due to aging populations and rising antimicrobial resistance. OBJECTIVES This study aimed to synthesize most recent data on the epidemiology, clinical and economic burden of IED in the elderly/high risk populations in China, Japan, South Korea, Taiwan, and Australia. METHODS A targeted literature review was conducted using Embase, Medline, as well as local scientific databases. We included studies published in English and local languages published from January 1, 2010 to October 7, 2020 that were relevant to the research objectives. Studies were narratively synthesized. RESULTS A total of 1,047 studies were identified and 34 of them were included in this review. ExPEC accounted for 46.0% (1,238/2,692) of bacteria-related invasive diseases in patients aged above 60 years in South Korea, followed by China (44.4% (284/640)), Taiwan (39.0% (1,244/3,194)), and Japan (18.1% (581/3,206)), while Australia reported ExPEC out of all pathogens (54.7% (4,006/7,330)) in general adults. Comorbidities such as diabetes or cancer were common in these patients. Studies reported increases in length-of-stay, and in-hospital 30-day all-cause mortality related to ExPEC associated bacteremia was between 9% to 12%. From a cost perspective, a 3-fold increase in sepsis-associated cost was reported in South Korea between 2005 and 2012. In Australia, antimicrobial resistance contributed to an additional cost of AUD $5.8 million per year (95% uncertainty interval [UI], $2.2-$11.2 million) in the treatment of bloodstream infections (BSIs). CONCLUSION ExPEC was a major cause of blood stream infection across China, Japan, South Korea, Taiwan, and Australia. Both the clinical and economic burden associated to ExPEC infections as well as the antimicrobial resistance observed in the elderly call for preventive and curative actions in these regions.
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Affiliation(s)
- Norio Ohmagari
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Won Suk Choi
- Korea University Ansan Hospital, Ansan, South Korea
| | | | - Petar Atanasov
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Xiaobin Jiang
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
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Maeda M, Nakata M, Naito Y, Yamaguchi K, Yamada K, Kinase R, Takuma T, On R, Tokimatsu I. Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study. Antibiotics (Basel) 2022; 11:1745. [PMID: 36551402 PMCID: PMC9774691 DOI: 10.3390/antibiotics11121745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
The antibiotic spectrum is not reflected in conventional antimicrobial metrics. Days of antibiotic spectrum coverage (DASC) is a novel quantitative metric for antimicrobial consumption developed with consideration of the antibiotic spectrum. However, there were no data regarding disease and pathogen-specific DASC. Thus, this study aimed to evaluate the DASC trend in patients with bloodstream infections (BSIs). DASC and days of therapy (DOT) of in-patients with positive blood culture results during a 2-year interval were evaluated. Data were aggregated to calculate the DASC, DOT, and DASC/DOT per patient stratified by pathogens. During the 2-year study period, 1443 positive blood culture cases were identified, including 265 suspected cases of contamination. The overall DASC, DASC/patient, DOT, DOT/patient, and DASC/DOT metrics were 226,626; 157.1; 28,778; 19.9; and 7.9, respectively. A strong correlation was observed between DASC and DOT, as well as DASC/patient and DOT/patient. Conversely, DASC/DOT had no correlation with other metrics. The combination of DASC and DOT would be a useful benchmark for the overuse and misuse evaluation of antimicrobial therapy in BSIs. Notably, DASC/DOT would be a robust metric to evaluate the antibiotic spectrum that was selected for patients with BSIs.
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Affiliation(s)
- Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Mari Nakata
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Yuika Naito
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Kozue Yamaguchi
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Kaho Yamada
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Ryoko Kinase
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Takahiro Takuma
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Rintaro On
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Issei Tokimatsu
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
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Sepsityper ® Kit versus In-House Method in Rapid Identification of Bacteria from Positive Blood Cultures by MALDI-TOF Mass Spectrometry. Life (Basel) 2022; 12:life12111744. [PMID: 36362899 PMCID: PMC9693840 DOI: 10.3390/life12111744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
In order to further accelerate pathogen identification from positive blood cultures (BC), various sample preparation protocols to identify bacteria with MALDI-TOF MS directly from positive BCs have been developed. We evaluated an in-house method in comparison to the Sepsityper® Kit (Bruker Daltonics, Bremen, Germany) as well as the benefit of an on-plate formic acid extraction step following positive signal by the BACTECTM FX system. Confirmation of identification was achieved using subcultured growing biomass used for MALDI-TOF MS analysis. A total of 113 monomicrobial positive BCs were analyzed. The rates of Gram-positive bacteria correctly identified to the genus level using in-house method and Sepsityper® Kit were 63.3% (38/60) and 81.7% (49/60), respectively (p = 0.025). Identification rates at species level for Gram-positive bacteria with in-house method and Sepsityper® kit were 30.0% (18/60) and 66.7% (40/60), respectively (p < 0.001). Identification rates of Gram-negative bacteria were similar with the in-house method and Sepsityper® Kit. Additional on-plate formic acid extraction demonstrated significant improvement in the identification rate of Gram-positive bacteria at both genus and species level for both in-house (p = 0.001, p < 0.001) and Sepsityper® Kit methods (p = 0.007, p < 0.001). Our in-house method is a candidate for laboratory routines with Sepsityper® Kit as a back-up solution when identification of Gram-positive bacteria is unsuccessful.
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The association of ESBL Escherichia coli with mortality in patients with Escherichia coli bacteremia at the emergency department. Drug Target Insights 2022; 16:12-16. [PMID: 36304435 PMCID: PMC9589459 DOI: 10.33393/dti.2022.2422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Escherichia coli is a common bloodstream infection pathogen in the emergency department (ED). Patients with extended-spectrum beta-lactamase (ESBL) E. coli have a higher risk of morbidity. However, there is still debate surrounding ESBL E. coli-associated mortality in community, intensive care unit, and tertiary care settings. In addition, there have been few studies regarding mortality in ESBL E. coli in ED settings, and results have been contradictory.
Methods: This was a retrospective cohort study conducted at the Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University in Thailand aimed at evaluating the possible association between ESBL E. coli bacteremia and mortality in the ED. The inclusion criteria were age 18 years or over, clinical presentation suspicious of infection, and positive blood culture for E. coli. Predictors for mortality were analyzed by logistic regression analysis.
Results: During the study period, 273 patients presented at the ED with hemoculture positive for E. coli. Of those, 27 (9.89%) died. Five factors remained in the final model, of which plasma glucose levels, serum lactate levels, and ESBL E. coliwere significantly associated with 28-day mortality in the ED with adjusted odds ratios of 0.970, 1.258, and 12.885, respectively. Plasma glucose of less than 113 mg/dL yielded a sensitivity of 80.95% and specificity of 64.29%, while serum lactate over 2.4 mmol/L had a sensitivity of 81.48% and specificity of 45.50%.
Conclusion: ESBL E. coli, plasma glucose, and serum lactate levels were associated with 28-day mortality in patients with E. coli bacteremia presenting at the ED.
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Holmbom M, Andersson M, Grabe M, Peeker R, Saudi A, Styrke J, Aljabery F. Community-onset urosepsis: incidence and risk factors for 30-day mortality - a retrospective cohort study. Scand J Urol 2022; 56:414-420. [PMID: 36127849 DOI: 10.1080/21681805.2022.2123039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression. OBJECTIVES To identify risk factors associated with 30-day mortality in patients with urosepsis. METHODS From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019-2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression. RESULTS Urosepsis was found in 18% (n = 282) of all CO-BSIs. The 30-day all-cause mortality was 14% (n = 38). After multivariable analysis, radiologically detected urinary tract disorder was the predominant risk factor for mortality (OR = 4.63, 95% CI = 1.47-14.56), followed by microbiologically inappropriate empirical antibiotic therapy (OR = 4.19, 95% CI = 1.41-12.48). Time to radiological diagnosis and decompression of obstruction for source control were also important prognostic factors for survival. Interestingly, 15% of blood cultures showed gram-positive species associated with a high 30-day mortality rate of 33%. CONCLUSION The 30-day all-cause mortality from urosepsis was 14%. The two main risk factors for mortality were hydronephrosis caused by obstructive stone in the ureter and inappropriate empirical antibiotic therapy. Therefore, early detection of any urinary tract disorder by imaging followed by source control as required, and antibiotic coverage of both gram-negative pathogens and gram-positive species such as E. faecalis to optimise management, is likely to improve survival in patients with urosepsis.
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Affiliation(s)
- Martin Holmbom
- Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Maria Andersson
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Grabe
- Department of Translational Medicine, Urologic Cancer Research, Lund University, Malmö, Sweden
| | - Ralph Peeker
- Department of Urology, University of Gothenburg, Gothenburg, Sweden
| | - Aus Saudi
- Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Johan Styrke
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Firas Aljabery
- Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Ülkü Tüzemen N, Payaslioğlu M, Özakin C, Ener B, Akalin H. Trends of Bloodstream Infections in a University Hospital During 12 Years. Pol J Microbiol 2022; 71:443-452. [DOI: 10.33073/pjm-2022-039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
Abstract
This study aims to investigate trends in bloodstream infections and their antimicrobial susceptibility profiles over 12 years in our hospital. This retrospective study was carried out in the Bursa Uludag University Hospital, Turkey, during 2008–2019. Blood cultures from patients were performed using BACTEC System. Isolates were identified with Phoenix System until 2018 and “matrix-assisted laser desorption ionization time-of-flight mass spectrometry” (MALDI-TOF MS) in 2019. Antibiotic susceptibility testing was performed with Phoenix System. Patient data came from the BD EpiCenter™ data management system. Escherichia coli was found to be the most common Gram-negative (11.6%), and coagulase-negative staphylococci were the most common Gram-positive (10.1%) monomicrobial growth. Overall, there was a significant increase in rates of extended-spectrum β-lactamase positive E. coli (p = 0.014) and Klebsiella pneumonia (p < 0.001), carbapenem-resistant E. coli (p < 0.001), and K. pneumoniae (p < 0.001) and colistin-resistant K. pneumoniae (p < 0.001) and Acinetobacter baumannii (p < 0.001) over 12 years. Carbapenem and colistin resistance has increased dramatically in recent years. We believe that regular monitoring of the distribution of pathogens and antibiotic susceptibility profiles, especially in intensive care units, can contribute to evidence for the increase in resistant microorganisms and help prevent their spread with antimicrobial stewardship and infection control policies.
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Affiliation(s)
- Nazmiye Ülkü Tüzemen
- Bursa Uludag University, Faculty of Medicine, Department of Medical Microbiology , Bursa , Turkey
| | - Melda Payaslioğlu
- Bursa Uludag University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Bursa , Turkey
| | - Cüneyt Özakin
- Bursa Uludag University, Faculty of Medicine, Department of Medical Microbiology , Bursa , Turkey
| | - Beyza Ener
- Bursa Uludag University, Faculty of Medicine, Department of Medical Microbiology , Bursa , Turkey
| | - Halis Akalin
- Bursa Uludag University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Bursa , Turkey
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Kontula KS, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. Early deaths associated with community-acquired and healthcare-associated bloodstream infections: a population-based study, Finland, 2004 to 2018. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 36082683 PMCID: PMC9461309 DOI: 10.2807/1560-7917.es.2022.27.36.2101067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Bloodstream infections (BSI) cause substantial morbidity and mortality. Aim We explored the role of causative pathogens and patient characteristics on the outcome of community-acquired (CA) and healthcare-associated (HA) BSI, with particular interest in early death. Methods We used national register data to identify all BSI in Finland during 2004–18. We determined the origin of BSI, patients´ underlying comorbidities and deaths within 2 or 30 days from specimen collection. A time-dependent Cox model was applied to evaluate the impact of patient characteristics and causative pathogens on the hazard for death at different time points. Results A total of 173,715 BSI were identified; 22,474 (12.9%) were fatal within 30 days and, of these, 6,392 (28.4%) occurred within 2 days (7.9 deaths/100,000 population). The 2-day case fatality rate of HA-BSI was higher than that of CA-BSI (5.4% vs 3.0%). Patients who died within 2 days were older than those alive on day 3 (76 vs 70 years) and had more severe comorbidities. Compared with other BSI, infections leading to death within 2 days were more often polymicrobial (11.8% vs 6.3%) and caused by Pseudomonas aeruginosa (6.2% vs 2.0%), fungi (2.9% vs 1.4%) and multidrug-resistant (MDR) pathogens (2.2% vs 1.8%), which were also predictors of death within 2 days in the model. Conclusions Overrepresentation of polymicrobial, fungal, P. aeruginosa and MDR aetiology among BSI leading to early death is challenging concerning the initial antimicrobial treatment. Our findings highlight the need for active prevention and prompt recognition of BSI and appropriate antimicrobial treatment.
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Affiliation(s)
- Keiju Sk Kontula
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kirsi Skogberg
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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Opperman CJ, Baloyi B, Dlamini S, Samodien N. Blood culture contamination rates at different level healthcare institutions in the Western Cape, South Africa. S Afr J Infect Dis 2021; 35:222. [PMID: 34485484 PMCID: PMC8378204 DOI: 10.4102/sajid.v35i1.222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/22/2020] [Indexed: 11/02/2022] Open
Abstract
Sterile blood culture (BC) collection procedures are important to prevent the consequences of contamination, namely, prolonged patient hospitalisation, unnecessary antimicrobial exposure and an increase in hospital costs. Blood culture contamination rates were determined at different hospitals in the Cape Metropole over a 3-year period. Study findings showed that contaminated BCs have a financial impact on the healthcare system and contamination rates remain above accepted international standards, except in the presence of a phlebotomist team. High BC contamination rates might be reduced by the implementation of cost-effective educational intervention programmes, which reminds healthcare workers to collect BC samples aseptically.
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Affiliation(s)
- Christoffel J Opperman
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, National Health Laboratory Service, University of Cape Town, Cape Town, South Africa
| | - Banyana Baloyi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sipho Dlamini
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nazlee Samodien
- Division of Medical Microbiology, National Health Laboratory Service, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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27
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Maeda M. [A Study of Outcome Measures and Establishment of Benchmarks for Antimicrobial Stewardship Programs]. YAKUGAKU ZASSHI 2021; 141:995-1000. [PMID: 34334551 DOI: 10.1248/yakushi.21-00111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over the past few decades, the effectiveness of antibiotics has been diminished owing to the emergence of antimicrobial resistance resulting from the overuse of antibiotics. Antimicrobial stewardship aims to improve the appropriateness of antibiotic use to reduce antimicrobial resistance and benefit patients. Antimicrobial stewardship requires structural prerequisites for implementing antimicrobial stewardship programs (ASPs), such as the presence of a multidisciplinary antimicrobial stewardship team (AST), to ensure appropriate antimicrobial use at healthcare facilities. However, manpower shortage for ASTs in most Japanese hospitals has resulted in limited implementation of ASPs. Our study provided a directive for promotion of comprehensive ASPs including various outcome measures. Our findings would provide useful benchmarks for hospitals planning to implement ASPs in Japan as well as around the world. This review provides a framework for evaluating the outcome measures and benchmarks of ASPs based on our study.
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Affiliation(s)
- Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University.,Department of Infection Prevention and Control, Showa University Hospital
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Prevalence and Impact of Biofilms on Bloodstream and Urinary Tract Infections: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10070825. [PMID: 34356749 PMCID: PMC8300799 DOI: 10.3390/antibiotics10070825] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 02/07/2023] Open
Abstract
This study sought to assess the prevalence and impact of biofilms on two commonly biofilm-related infections, bloodstream and urinary tract infections (BSI and UTI). Separated systematic reviews and meta-analyses of observational studies were carried out in PubMed and Web of Sciences databases from January 2005 to May 2020, following PRISMA protocols. Studies were selected according to specific and defined inclusion/exclusion criteria. The obtained outcomes were grouped into biofilm production (BFP) prevalence, BFP in resistant vs. susceptible strains, persistent vs. non-persistent BSI, survivor vs. non-survivor patients with BSI, and catheter-associated UTI (CAUTI) vs. non-CAUTI. Single-arm and two-arm analyses were conducted for data analysis. In vitro BFP in BSI was highly related to resistant strains (odds ratio-OR: 2.68; 95% confidence intervals-CI: 1.60–4.47; p < 0.01), especially for methicillin-resistant Staphylococci. BFP was also highly linked to BSI persistence (OR: 2.65; 95% CI: 1.28–5.48; p < 0.01) and even to mortality (OR: 2.05; 95% CI: 1.53–2.74; p < 0.01). Candida spp. was the microorganism group where the highest associations were observed. Biofilms seem to impact Candida BSI independently from clinical differences, including treatment interventions. Regarding UTI, multi-drug resistant and extended-spectrum β-lactamase-producing strains of Escherichia coli, were linked to a great BFP prevalence (OR: 2.92; 95% CI: 1.30–6.54; p < 0.01 and OR: 2.80; 95% CI: 1.33–5.86; p < 0.01). More in vitro BFP was shown in CAUTI compared to non-CAUTI, but with less statistical confidence (OR: 2.61; 95% CI: 0.67–10.17; p < 0.17). This study highlights that biofilms must be recognized as a BSI and UTI resistance factor as well as a BSI virulence factor.
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Yoo IY, Han J, Ha SI, Cha YJ, Pil SD, Park YJ. Clinical performance of ASTA SepsiPrep kit in direct bacterial identification and antimicrobial susceptibility test using MicroIDSys Elite and VITEK-2 system. J Clin Lab Anal 2021; 35:e23744. [PMID: 33939213 PMCID: PMC8183931 DOI: 10.1002/jcla.23744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Rapid and accurate microbial identification and antimicrobial susceptibility testing (AST) are essential for timely use of appropriate antimicrobial agents for bloodstream infection. To shorten the time for isolating colonies from the positive blood culture, various preparation methods for direct identification using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) system were developed. Here, we evaluated the SepsiPrep kit (ASTA Corp.) for direct identification of microorganisms and AST from positive blood cultures using MicroIDSys Elite MALDI-TOF MS system (ASTA Corp.) and VITEK-2 system (bioMérieux). METHODS For direct identification, a total of 124 prospective monomicrobial positive blood culture bottles were included. For direct identification, the pellet was prepared by centrifugation and washing twice. For direct AST, the pellet was suspended in 0.45% saline and adjusted to McFarland 0.5. The results from the direct identification and AST using MicroIDSys Elite and VITEK-2 system were compared to those from the conventional method performed with pure colony subcultured on agar plate. RESULTS Compared to the conventional method using pure colony, correct direct identification rate was 96.5% and 98.5% for 57 gram-positive isolates and 67 gram-negative isolates, respectively. For direct AST, among the 55 gram-positive isolates, the categorical agreement (CA) for staphylococci, streptococci, and enterococci was 96.7%, 98.4%, and 94.1%, respectively. For 66 gram-negative isolates, the CA for Enterobacterales and non-fermentative gram-negative rods was 99.0% and 96.6%, respectively. CONCLUSIONS The SepsiPrep kit was easy to use combined with MicroIDSys Elite and VITEK-2 system and also, the correct identification and AST rate were very high.
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Affiliation(s)
- In Young Yoo
- Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jayho Han
- Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sung Il Ha
- Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Jong Cha
- Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Shin Dong Pil
- Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Weber S, Magh A, Hogardt M, Kempf VAJ, Vehreschild MJGT, Serve H, Scheich S, Steffen B. Profiling of bacterial bloodstream infections in hematological and oncological patients based on a comparative survival analysis. Ann Hematol 2021; 100:1593-1602. [PMID: 33942127 PMCID: PMC8116230 DOI: 10.1007/s00277-021-04541-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
Bloodstream infections (BSI) are a frequent complication in patients with hematological and oncological diseases. However, the impact of different bacterial species causing BSI and of multiple BSI remains incompletely understood. We performed a retrospective study profiling 637 bacterial BSI episodes in hematological and oncological patients. Based on the 30-day (30d) overall survival (OS), we analyzed different types of multiple BSI and grouped BSI-associated bacteria into clusters followed by further assessment of clinical and infection-related characteristics. We discovered that polymicrobial BSI (different organisms on the first day of a BSI episode) and sequential BSI (another BSI before the respective BSI episode) were associated with a worse 30d OS. Different bacterial groups could be classified into three BSI outcome clusters based on 30d OS: favorable (FAV) including mainly common skin contaminants, Escherichia spp. and Streptococcus spp.; intermediate (INT) including mainly Enterococcus spp., vancomycin-resistant Enterococcus spp., and multidrug-resistant gram-negative bacteria (MDRGN); and adverse (ADV) including MDRGN with an additional carbapenem-resistance (MDRGN+CR). A polymicrobial or sequential BSI especially influenced the outcome in the combination of two INT cluster BSI. The presence of a polymicrobial BSI and the assignment into the BSI outcome clusters were identified as independent risk factors for 30d mortality in a Cox multivariate regression analysis. The assignment to a BSI outcome cluster and the differentiated perspective of multiple BSI open new insights into the prognosis of patients with BSI and should be further validated in other patient cohorts.
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Affiliation(s)
- Sarah Weber
- Department of Medicine, Hematology/Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany. .,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.
| | - Aaron Magh
- Department of Medicine, Hematology/Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michael Hogardt
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt, Germany.,University Center of Competence for Infection Control, Frankfurt, State of Hesse, Germany
| | - Volkhard A J Kempf
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt, Germany.,University Center of Competence for Infection Control, Frankfurt, State of Hesse, Germany
| | - Maria J G T Vehreschild
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.,Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Hubert Serve
- Department of Medicine, Hematology/Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Sebastian Scheich
- Department of Medicine, Hematology/Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany. .,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.
| | - Björn Steffen
- Department of Medicine, Hematology/Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany. .,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.
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Michelson K, Löffler B, Höring S. Time to positivity as a prognostic factor in bloodstream infections with Enterococcus spp. Diagn Microbiol Infect Dis 2021; 101:115396. [PMID: 34325178 DOI: 10.1016/j.diagmicrobio.2021.115396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
Time to positivity (TTP) is the delay of time from incubation to blood culture positivity. Short TTP can predict mortality and source of infection. The aim of this study was to investigate the value of TTP of patients with bloodstream infections with enterococci (E-BSI).In a single centre retrospective cohort study in Germany, the data of 244 patients with monomicrobial E-BSI were analyzed with hospital mortality as the primary outcome of interest from January 1 2014 to December 31 2016. Mortality rate of patients with bloodstream infections (BSI) with E. faecalis was 16.7%, Vancomycin sensitive E. faecium (VSEfm) 26.7% and Vancomycin resistant E. faecium (VREfm) 38.2%. Cut-offs showed a significantly higher mortality rate when compared to longer TTP (E. faecalis: P=0.047; VSEfm: P=0.02), but were not risk factors in survival analysis (E.faecalis: HR (hazard ratio): 2.73; P=0.17; VSEfm: HR: 1.63; P=0.15; VREfm: HR: 1.24; P=0.63). TTP≤10.5 hours with E. faecalis BSI was a discriminator for cardiovascular source of infection (AUC: 0.75). A short TTP could predict mortality rates and source of infection but was not an independent parameter for risk of death in survival analysis.
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Affiliation(s)
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Germany; Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany
| | - Steffen Höring
- Institute of Medical Microbiology, Jena University Hospital, Germany; Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany
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32
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Habyarimana T, Murenzi D, Musoni E, Yadufashije C, N Niyonzima F. Bacteriological Profile and Antimicrobial Susceptibility Patterns of Bloodstream Infection at Kigali University Teaching Hospital. Infect Drug Resist 2021; 14:699-707. [PMID: 33654414 PMCID: PMC7914060 DOI: 10.2147/idr.s299520] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Worldwide, bacterial bloodstream infections (BSIs) constitute an important cause of morbidity and mortality in clinical settings. Due to the limited laboratory facilities in sub-Saharan Africa, poor diagnosis of BSIs results in poor clinical outcomes and leads to a risk of antimicrobial resistance. The present work was carried out to describe the microbiological features of BSIs using the data collected from Centre Hospitalier Universitaire de Kigali (CHUK). METHODS A retrospective study was carried out at CHUK. The blood culture results of 2,910 cases - from adults, children and infants - were reviewed in the Microbiology service from October 2017 to October 2018. The following variables were considered: age, gender, admitting department, blood culture results, and antimicrobials sensitivity test results. Data were entered and analyzed using Microsoft Excel 2013. RESULTS Twelve percent (341/2,910) of blood culture results reviewed were positive with 108 (31.7%) Gram positive bacteria and 233 (68.3%) Gram negative bacteria. The most prevalent pathogens were Klebsiella pneumoniae 108 (31.7%) and Staphylococcus aureus 100 (29.3%). This study revealed a high resistance to commonly prescribed antibiotics such as penicillin, trimethoprim sulfamethoxazole, and Ampicillin with 91.8, 83.3, and 81.8% of resistance, respectively. However, bacteria were sensitive to imipenem and vancomycin with 98.1 and 94.3% of sensitivity, respectively. The pediatrics and neonatology departments showed a high number of positive culture with 97/341 (28.4%), and 93/341 (27%) respectively. The overall prevalence of multidrug resistance was 77.1%. CONCLUSION The prevalence of bacterial pathogens in BSIs was found to be high. The antibiotic resistance to the commonly used antibiotics was high. Appropriate treatment of BSIs should be based on the current knowledge of bacterial resistance pattern. This study will help in formulating management of diagnostic guidelines and antibiotic policy.
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Affiliation(s)
| | - Didier Murenzi
- Pathology Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Emile Musoni
- Pathology Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
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Wang Z, Wei X, Qin T, Chen S, Liao X, Guo W, Hu P, Wu Y, Li J, Liao Y, Wang S. Prognostic value of central venous-to-arterial carbon dioxide difference in patients with bloodstream infection. Int J Med Sci 2021; 18:929-935. [PMID: 33456350 PMCID: PMC7807196 DOI: 10.7150/ijms.51447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Bloodstream infection (BSI) are prone to circulation disorders, which portend poor outcome. The central venous-to-arterial carbon dioxide difference (Pcv-aCO2) is a biomarker for circulation disorders, but the prognostic value of Pcv-aCO2 in BSI patients remains unclear. This study was to investigate the association of Pcv-aCO2 with adverse events in BSI patients. Methods: The patients with BSI between August 2014 and August 2017 were prospectively enrolled. Clinical characteristic and laboratory results were collected. We analyzed the association of the level of Pcv-aCO2 with clinical variables and 28-day mortality. Results: A total of 152 patients were enrolled. The Pcv-aCO2 was positively correlated with white blood cell count (r=0.241, p=0.003), procalcitonin (r=0.471, p<0.001), C-reactive protein (r=0.192, p=0.018), lactate (r=0.179, p=0.027), Sequential Organ Failure Assessment (r=0.318, p<0.001) and Acute Physiology And Chronic Health Evaluation II score (r=0.377, p<0.001), while that was negatively correlated with central venous oxygen saturation (r=-0.242, p<0.001) and platelet (r=-0.205, p=0.011). Kaplan-Meier curves demonstrated that patients with Pcv-aCO2 >6mmHg had a worse prognosis than those without (log rank=32.10, p<0.001). Multivariate analysis showed Level of Pcv-aCO2 was an independent risk factor for 28-day mortality (HR: 3.10, 95% CI: 1.43-6.74, p=0.004). The area under the receiver operating characteristic curve of Pcv-aCO2 for prediction of 28-day mortality in patients with BSI was 0.794. Pcv-aCO2>6 mmHg had 81.1% sensitivity and 78.8% specificity for predicting 28-day mortality. Conclusion: Pcv-aCO2 may be a simple and valuable biomarker to assessment of 28-day mortality in patients with BSI.
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Affiliation(s)
- Zhonghua Wang
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Xuebiao Wei
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Tiehe Qin
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Shenglong Chen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Xiaolong Liao
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Weixin Guo
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Peihang Hu
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Yan Wu
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Jie Li
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Youwan Liao
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Shouhong Wang
- Department of Critical Care Medicine, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
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Santella B, Folliero V, Pirofalo GM, Serretiello E, Zannella C, Moccia G, Santoro E, Sanna G, Motta O, De Caro F, Pagliano P, Capunzo M, Galdiero M, Boccia G, Franci G. Sepsis-A Retrospective Cohort Study of Bloodstream Infections. Antibiotics (Basel) 2020; 9:antibiotics9120851. [PMID: 33260698 PMCID: PMC7760988 DOI: 10.3390/antibiotics9120851] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/08/2020] [Accepted: 11/25/2020] [Indexed: 12/29/2022] Open
Abstract
Bloodstream infections (BSIs) are among the leading causes of morbidity and mortality worldwide, among infectious diseases. Local knowledge of the main bacteria involved in BSIs and their associated antibiotic susceptibility patterns is essential to rationalize the empiric antimicrobial therapy. The aim of this study was to define the incidence of infection and evaluate the antimicrobial resistance profile of the main pathogens involved in BSIs. This study enrolled patients of all ages and both sexes admitted to the University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy between January 2015 to December 2019. Bacterial identification and antibiotic susceptibility testing were performed with Vitek 2. A number of 3.949 positive blood cultures were included out of 24,694 total blood cultures from 2015 to 2019. Coagulase-negative staphylococci (CoNS) were identified as the main bacteria that caused BSI (17.4%), followed by Staphylococcus aureus (12.3%), Escherichia coli (10.9%), and Klebsiella pneumoniae (9.4%). Gram-positive bacteria were highly resistant to Penicillin G and Oxacillin, while Gram-negative strains to Ciprofloxacin, Cefotaxime, Ceftazidime, and Amoxicillin-clavulanate. High susceptibility to Vancomycin, Linezolid, and Daptomycin was observed among Gram-positive strains. Fosfomycin showed the best performance to treatment Gram-negative BSIs. Our study found an increase in resistance to the latest generation of antibiotics over the years. This suggests an urgent need to improve antimicrobial management programs to optimize empirical therapy in BSI.
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Affiliation(s)
- Biagio Santella
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (B.S.); (E.S.); (M.G.)
| | - Veronica Folliero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.)
| | - Gerarda Maria Pirofalo
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica E Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy; (G.M.P.); (F.D.C.); (M.C.)
| | - Enrica Serretiello
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (B.S.); (E.S.); (M.G.)
| | - Carla Zannella
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.)
| | - Giuseppina Moccia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.M.); (E.S.); (O.M.); (P.P.)
| | - Emanuela Santoro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.M.); (E.S.); (O.M.); (P.P.)
| | - Giuseppina Sanna
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, 09042 Cagliari, Italy;
| | - Oriana Motta
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.M.); (E.S.); (O.M.); (P.P.)
| | - Francesco De Caro
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica E Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy; (G.M.P.); (F.D.C.); (M.C.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.M.); (E.S.); (O.M.); (P.P.)
| | - Pasquale Pagliano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.M.); (E.S.); (O.M.); (P.P.)
| | - Mario Capunzo
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica E Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy; (G.M.P.); (F.D.C.); (M.C.)
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, 09042 Cagliari, Italy;
| | - Massimiliano Galdiero
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (B.S.); (E.S.); (M.G.)
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.F.); (C.Z.)
| | - Giovanni Boccia
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica E Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy; (G.M.P.); (F.D.C.); (M.C.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.M.); (E.S.); (O.M.); (P.P.)
- Correspondence: (G.B.); (G.F.)
| | - Gianluigi Franci
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica E Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy; (G.M.P.); (F.D.C.); (M.C.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.M.); (E.S.); (O.M.); (P.P.)
- Correspondence: (G.B.); (G.F.)
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Pathogenic spectrum of blood stream infections and resistance pattern in Gram-negative bacteria from Aljouf region of Saudi Arabia. PLoS One 2020; 15:e0233704. [PMID: 32516308 PMCID: PMC7282660 DOI: 10.1371/journal.pone.0233704] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background The pathogenic spectrum of bloodstream infections (BSIs) varies across regions. Monitoring the pathogenic profile and antimicrobial resistance is a prerequisite for effective therapy, infection control and for strategies aimed to counter antimicrobial resistance. The pathogenic spectrum of BSIs in blood cultures was analysed, focusing on the resistance patterns of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae, in Aljouf region. Methods This descriptive cross-sectional study analysed the culture reports of all non-duplicate blood samples collected from January 1 to December 31, 2019. Antibiograms of A. baumannii, E. coli, and K. pneumoniae were analysed for antibiotic resistance. The frequency and percentages of multi-drug, extensively-drug, pan-drug and carbapenem resistance were calculated. Results Of the 222 bloodstream infections, 62.2% and 36.4% were caused by gram-negative and gram-positive bacteria, respectively. Most BSIs occurred in patients aged ≥60 years (59.5%). Among the 103 isolates of the studied Gram-negative bacteria (GNB), 47.6%, 38.8%, and 2.9% were multi-drug, extensively drug and pan-drug resistant respectively. 46% of K. pneumoniae isolates were carbapenemase producers. Resistance to gentamycin, 1st–4th generation cephalosporins, and carbapenems was observed for A. baumannii. More than 70% of E. coli isolates were resistant to 3rd- and 4th-generation cephalosporins. Klebsiella pneumoniae presented a resistance rate of >60% to imipenems. Conclusions Gram-negative bacteria dominate BSIs, with carbapenem-resistant K. pneumoniae most frequently detected in this region. Resistant GNB infections make it challenging to treat geriatric patients. Regional variations in antimicrobial resistance should be continually monitored.
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Holmbom M, Möller V, Nilsson LE, Giske CG, Rashid MU, Fredrikson M, Hällgren A, Hanberger H, Balkhed ÅÖ. Low incidence of antibiotic-resistant bacteria in south-east Sweden: An epidemiologic study on 9268 cases of bloodstream infection. PLoS One 2020; 15:e0230501. [PMID: 32218575 PMCID: PMC7100936 DOI: 10.1371/journal.pone.0230501] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/03/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this study was to investigate the epidemiology of bloodstream infections (BSI) in a Swedish setting, with focus on risk factors for BSI-associated mortality. Methods A 9-year (2008–2016) retrospective cohort study from electronic records of episodes of bacteremia amongst hospitalized patients in the county of Östergötland, Sweden was conducted. Data on episodes of BSI including microorganisms, antibiotic susceptibility, gender, age, hospital admissions, comorbidity, mortality and aggregated antimicrobial consumption (DDD /1,000 inhabitants/day) were collected and analyzed. Multidrug resistance (MDR) was defined as resistance to at least three groups of antibiotics. MDR bacteria and MRSA, ESBL-producing Enterobacteriaceae, vancomycin-resistant enterococci not fulfilling the MDR criteria were all defined as antimicrobial-resistant (AMR) bacteria and included in the statistical analysis of risk factors for mortality Results In all, 9,268 cases of BSI were found. The overall 30-day all-cause mortality in the group of patients with BSI was 13%. The incidence of BSI and associated 30-day all-cause mortality per 100,000 hospital admissions increased by 66% and 17% respectively during the nine-year study period. The most common species were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae and Enterococcus faecalis. Independent risk factors for 30-day mortality were age (RR: 1.02 (CI: 1.02–1.03)) and 1, 2 or ≥3 comorbidities RR: 2.06 (CI: 1.68–2.52), 2.79 (CI: 2.27–3.42) and 2.82 (CI: 2.31–3.45) respectively. Almost 3% (n = 245) of all BSIs were caused by AMR bacteria increasing from 12 to 47 per 100,000 hospital admissions 2008–2016 (p = 0.01), but this was not associated with a corresponding increase in mortality risk (RR: 0.89 (CI: 0.81–0.97)). Conclusion Comorbidity was the predominant risk factor for 30-day all-cause mortality associated with BSI in this study. The burden of AMR was low and not associated with increased mortality. Patients with BSIs caused by AMR bacteria (MDR, MRSA, ESBL and VRE) were younger, had fewer comorbidities, and the 30-day all-cause mortality was lower in this group.
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Affiliation(s)
- Martin Holmbom
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Urology in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Vidar Möller
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lennart E. Nilsson
- Department of Clinical Microbiology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Christian G. Giske
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mamun-Ur Rashid
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Occupational and Environmental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Forum Östergötland, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anita Hällgren
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- * E-mail:
| | - Åse Östholm Balkhed
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Yoon EJ, Kim D, Lee H, Lee HS, Shin JH, Park YS, Kim YA, Shin JH, Shin KS, Uh Y, Jeong SH. Mortality dynamics of Pseudomonas aeruginosa bloodstream infections and the influence of defective OprD on mortality: prospective observational study. J Antimicrob Chemother 2019; 74:2774-2783. [DOI: 10.1093/jac/dkz245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/12/2019] [Accepted: 05/13/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
To assess the mortality dynamics of patients with Pseudomonas aeruginosa bloodstream infections (BSIs) and the influence of OprD deficiencies of the microorganism on early mortality.
Methods
A prospective multicentre observational study was conducted with 120 patients with P. aeruginosa BSIs occurring between May 2016 and April 2017 in six general hospitals in South Korea. PCR and sequencing were carried out to identify the alterations in oprD and the presence of virulence factors. Cox regression was used to estimate the risk factors for mortality at each timepoint and Kaplan–Meier survival analyses were performed to determine the mortality dynamics.
Results
During the 6 week follow-up, 10.8% (13/120) of the patients with P. aeruginosa BSIs died in 2 weeks, 14.2% (17/120) in 4 weeks and 20.0% (24/120) in 6 weeks, revealing a steep decrease in cumulative survival between the fourth and sixth weeks. ICU admission and SOFA score were risk factors for mortality in any weeks after BSI onset and causative OprD-defective P. aeruginosa had a risk tendency for mortality within 6 weeks. Among the 120 P. aeruginosa blood isolates, 14 were XDR, nine produced either IMP-6 or VIM-2 MBL, and 21 had OprD deficiency.
Conclusions
BSIs caused by OprD-defective P. aeruginosa resulted in a 2-fold higher 6 week mortality rate (33.3%) than that of BSIs caused by OprD-intact P. aeruginosa (17.2%), likely due to the decreased susceptibility to carbapenems and bacterial persistence in clinical settings.
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Affiliation(s)
- Eun-Jeong Yoon
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Dokyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyukmin Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine and Paik Institute for Clinical Research, Inje University College of Medicine, Busan, South Korea
| | - Yoon Soo Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyeong Seob Shin
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
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Tian L, Zhang Z, Sun Z. Antimicrobial resistance trends in bloodstream infections at a large teaching hospital in China: a 20-year surveillance study (1998-2017). Antimicrob Resist Infect Control 2019; 8:86. [PMID: 31161033 PMCID: PMC6540536 DOI: 10.1186/s13756-019-0545-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background Bacterial bloodstream infections (BSIs) cause high morbidity and mortality worldwide in humans, but the pathogenic spectrum varies from region to region. Long-term monitoring of the pathogenic spectrum and changes in bacterial antibiotic resistance is hugely important for effective clinical therapy and infection control. This study examined the data for BSIs in Tongji Hospital, one of the largest teaching hospitals in China, in an attempt to gain better understanding of bacterial antibiotic resistance in China, focusing on central China. Methods Data from Tongji Hospital for a 20-year period (1998–2017) were used for a retrospective analysis to understand the pathogenic spectrum of BSIs and the changes occurring in antimicrobial resistance in central China. The disk diffusion and E test methods were used for antimicrobial susceptibility testing according to Clinical & Laboratory Standards Institute methodologies, and the data were analyzed by WHONET 5.6 software. Results The isolated pathogens mainly came from hospitalized patients not treated in intensive care units (ICUs), and accounted for 81.5% of the total (9130/11200). The most common Gram-negative and Gram-positive bacterial BSI-causing pathogens were Escherichia coli and Staphylococcus aureus, respectively. The detection rate for methicillin-resistant S. aureus (MRSA) in the hospitalized non-ICU patients increased from 8.4% in 1998–2002 to 63% in 2013–2017, while the detection rate for carbapenem-resistant (CR) Klebsiella pneumoniae was below 5% in 1998–2012 but increased to 34.9% in 2013–2017. In contrast, worryingly, the detection rate for CR K. pneumoniae in ICU patients increased from 0% in 2013 to 75% in 2016. E. coli displayed the highest sensitivity rates to imipenem, meropenem and amikacin, all of which were > 90%, followed by cefoxitin at > 80%, and cefoperazone/sulbactam at > 70%. K. pneumoniae isolates were most sensitive to imipenem, meropenem and amikacin antibiotics, with sensitivity rates exceeding 60%. S. aureus isolates were most sensitive to vancomycin, teicoplanin and trimethoprim/sulfamethoxazole, with sensitivity rates exceeding 90%. Conclusions BSIs caused by CR K. pneumoniae clearly posed a severe challenge to infection control and treatment of ICU and non-ICU patients in this retrospective study, while MRSA was an issue for non-ICU patients.
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Affiliation(s)
- Lei Tian
- 1Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Zhen Zhang
- 2Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Ziyong Sun
- 1Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
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Infections with Carbapenem-Resistant Gram-Negative Bacteria are a Serious Problem Among Critically Ill Children: A Single-Centre Retrospective Study. Pathogens 2019; 8:pathogens8020069. [PMID: 31117259 PMCID: PMC6630812 DOI: 10.3390/pathogens8020069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 01/27/2023] Open
Abstract
Children in paediatric intensive care units (PICUs) are vulnerable to infections because invasive devices are frequently used during their admission. We aimed to determine the prevalence, associated factors, and prognosis of infections in our PICU. This retrospective study evaluated culture results from 477 paediatric patients who were treated in the PICU between January 2014 and March 2019. Ninety patients (18.9%) had bacterial infections, with gram-negative bacteria being the predominant infectious agents. Culture-positive patients were younger than culture-negative patients, and age was related to mortality and various clinical factors. Culture-positive bacterial infections in the PICU were associated with increased use of invasive mechanical ventilation (odds ratio(OR); 2.254), red blood cell (RBC) transfusions (OR:2.624), and inotropic drugs (OR:2.262). Carbapenem resistance was found in approximately one-third of gram-negative bacteria, and was most common in tracheal aspirate specimens and cases involving Klebsiella spp. Total parenteral nutrition was a significant risk factor (OR:5.870). Positive blood culture results were associated with poorer patient survival than other culture results. These findings indicate that infections, especially those involving carbapenem-resistant bacteria, are an important issue when treating critically ill children.
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40
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Candida sp. Infections in Patients with Diabetes Mellitus. J Clin Med 2019; 8:jcm8010076. [PMID: 30634716 PMCID: PMC6352194 DOI: 10.3390/jcm8010076] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 12/27/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023] Open
Abstract
Candidiasis has increased substantially worldwide over recent decades and is a significant cause of morbidity and mortality, especially among critically ill patients. Diabetes mellitus (DM) is a metabolic disorder that predisposes individuals to fungal infections, including those related to Candida sp., due to a immunosuppressive effect on the patient. This review aims to discuss the latest studies regarding the occurrence of candidiasis on DM patients and the pathophysiology and etiology associated with these co-morbidities. A comprehensive review of the literature was undertaken. PubMed, Scopus, Elsevier’s ScienceDirect, and Springer’s SpringerLink databases were searched using well-defined search terms. Predefined inclusion and exclusion criteria were applied to classify relevant manuscripts. Results of the review show that DM patients have an increased susceptibility to Candida sp. infections which aggravates in the cases of uncontrolled hyperglycemia. The conclusion is that, for these patients, the hospitalization periods have increased and are commonly associated with the prolonged use of indwelling medical devices, which also increase the costs associated with disease management.
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