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Marosi B, Kádár B, Bruzsa A, Kocsis L, Kamotsay K, Sinkó J, Szabó BG, Lakatos B. Characteristics of Enterococcus species bloodstream infections among adults with and without onco-hematological malignancies: Experiences from the national center of Hungary. Eur J Microbiol Immunol (Bp) 2024; 14:134-142. [PMID: 38536399 PMCID: PMC11097792 DOI: 10.1556/1886.2024.00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/17/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Over the past decade, enterococcal bloodstream infection (BSI) shows increasing incidence globally among the elderly and in patients with comorbidities. In this study, we aimed to assess microbiological and clinical characteristics and long-term outcomes of BSIs caused by Enterococcus spp. in adult patients with and without active onco-hematological malignancies hospitalized at a national referral institute. Methods A prospective analysis of consecutive enterococcal BSI cases was conducted in the National Institute of Hematology and Infectious Diseases (Budapest, Hungary) between December 2019 and April 2022. We compared characteristics and outcomes at 30-days and 1 year after diagnosis among patients with and without onco-hematological malignancies. Results In total, 141 patients were included (median age 68 ± 21 years, female sex 36.9%), 37% (52/141) had active onco-hematological malignancies. The distribution of species was as follows: 50.4% Enterococcus faecalis, 46.1% Enterococcus faecium, 1.4% Enterococcus avium and Enterococcus gallinarum, and 0.7% Enterococcus raffinosus. No statistically significant differences in all-cause mortality rates were observed between patient subgroups at 30 days (32.7 vs. 28.1%; P = 0.57) and 1 year (75.0 vs. 60.7%; P = 0.09). Conclusion Enterococcal bloodstream infections yielded a relevant burden of morbidity, but with no statistical difference in long-term outcomes of adult patients with and without active onco-hematological malignancies.
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Affiliation(s)
- Bence Marosi
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., H-1085, Budapest, Hungary
| | - Béla Kádár
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Anna Bruzsa
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Laura Kocsis
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Katalin Kamotsay
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - János Sinkó
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Bálint Gergely Szabó
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., H-1085, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., H-1085, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
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Young AM, Tanaka MM, Yuwono C, Wehrhahn MC, Zhang L. Clinical Setting Comparative Analysis of Uropathogens and Antibiotic Resistance: A Retrospective Study Spanning the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2024; 11:ofad676. [PMID: 38333882 PMCID: PMC10853000 DOI: 10.1093/ofid/ofad676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
Background Antimicrobial resistance (AMR) in uropathogens has been increasing in Australia. Many nations observed heightened AMR during the coronavirus disease 2019 (COVID-19) pandemic, but it is not known how this may vary across clinical settings and in nations with lower infection rates. Methods We investigated the uropathogen composition and corresponding antibiotic resistance of 775 559 Australian isolates from the community, hospitals, and aged care facilities before (2016-2019) and during (2020-2022) the COVID-19 pandemic. A mathematical model was developed to predict the likelihood of resistance to currently recommended antibiotics for treating urinary tract infections (UTIs). Results Among uropathogens originating from the community, hospitals, and aged care facilities, Escherichia coli accounted for 71.4%, 57.6%, and 65.2%, respectively. During the COVID-19 pandemic period, there was an increase in UTIs caused by E coli across all settings. Uropathogens from aged care and hospitals frequently showed higher resistance to antibiotics compared to those isolated from the community. Interestingly, AMR among uropathogens showed a declining trend during the COVID-19 pandemic. Based on the resistance patterns of the past 3 years, our modeling predicted that 30%, 42.6%, and 38.8% of UTIs in the community, hospitals, and aged care facilities, respectively, would exhibit resistance to trimethoprim treatment as empirical therapy. In contrast, resistance to nitrofurantoin was predicted to be 14.6%, 26%, and 24.1% from these 3 respective settings. Conclusions Empirical therapy of UTIs in Australia with trimethoprim requires evaluation due to high rates of resistance observed across clinical settings.
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Affiliation(s)
- Alexandra M Young
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark M Tanaka
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Yuwono
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C Wehrhahn
- Douglass Hanly Moir Pathology, a Sonic Healthcare Australia Pathology Practice, Macquarie Park, New South Wales, Australia
| | - Li Zhang
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Cai L, Chen H, Wei Y, Guo X, Zheng H, Jiang X, Zhang Y, Yu G, Dai M, Ye J, Zhou H, Xu D, Huang F, Fan Z, Xu N, Shi P, Xuan L, Feng R, Liu X, Sun J, Liu Q, Wei X. Changing epidemiology, microbiology and mortality of bloodstream infections in patients with haematological malignancies before and during SARS-CoV-2 pandemic: a retrospective cohort study. BMJ Open 2023; 13:e078510. [PMID: 38159939 PMCID: PMC10759088 DOI: 10.1136/bmjopen-2023-078510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE This study was to explore the changes in bacterial bloodstream infection (BSI) in patients with haematological malignancies (HMs) before and during SARS-CoV-2 pandemic. DESIGN Retrospective cohort study between 2018 and 2021. SETTING The largest haematological centre in southern China. RESULTS A total of 599 episodes of BSI occurring in 22 717 inpatients from January 2018 to December 2021 were analysed. The frequencies of the total, Gram-negative and Gram-positive BSI before and during the pandemic were 2.90% versus 2.35% (p=0.011), 2.49% versus 1.77% (p<0.001) and 0.27% versus 0.44% (p=0.027), respectively. The main isolates from Gram-negative or Gram-positive BSI and susceptibility profiles also changed. The 30-day mortality caused by BSI was lower during the pandemic (21.1% vs 14.3%, p=0.043). Multivariate analysis revealed that disease status, pulmonary infection and shock were independent predictors of 30-day mortality. CONCLUSION Our data showed that the incidence of total and Gram-negative organisms BSI decreased, but Gram-positive BSI incidence increased in patients with HMs during the pandemic along with the changes of main isolates and susceptibility profiles. Although the 30-day mortality due to BSI was lower during the pandemic, the new infection prevention strategy should be considered for any future pandemics.
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Affiliation(s)
- Linjing Cai
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Huan Chen
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Yongqiang Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Xutao Guo
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Haiqing Zheng
- Nosocomial Infection Management, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuejie Jiang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Yu Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Guopan Yu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Min Dai
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Jieyu Ye
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Hongsheng Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Dan Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Zhiping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Pengcheng Shi
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Ru Feng
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Xiaoli Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Xiaolei Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
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Hojat LS, Wilson BM, Perez F, Mojica MF, Singer ME, Bonomo RA, Epstein LH. Association of COVID-19 coinfection with increased mortality among patients with Pseudomonas aeruginosa bloodstream infection in the Veterans Health Administration system. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e237. [PMID: 38156202 PMCID: PMC10753479 DOI: 10.1017/ash.2023.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 12/30/2023]
Abstract
Objective Pseudomonas aeruginosa bloodstream infection (PA-BSI) and COVID-19 are independently associated with high mortality. We sought to demonstrate the impact of COVID-19 coinfection on patients with PA-BSI. Design Retrospective cohort study. Setting Veterans Health Administration. Patients Hospitalized patients with PA-BSI in pre-COVID-19 (January 2009 to December 2019) and COVID-19 (January 2020 to June 2022) periods. Patients in the COVID-19 period were further stratified by the presence or absence of concomitant COVID-19 infection. Methods We characterized trends in resistance, treatment, and mortality over the study period. Multivariable logistic regression and modified Poisson analyses were used to determine the association between COVID-19 and mortality among patients with PA-BSI. Additional predictors included demographics, comorbidities, disease severity, antimicrobial susceptibility, and treatment. Results A total of 6,714 patients with PA-BSI were identified. Throughout the study period, PA resistance rates decreased. Mortality decreased during the pre-COVID-19 period and increased during the COVID-19 period. Mortality was not significantly different between pre-COVID-19 (24.5%, 95% confidence interval [CI] 23.3-28.6) and COVID-19 period/COVID-negative (26.0%, 95% CI 23.5-28.6) patients, but it was significantly higher in COVID-19 period/COVID-positive patients (47.2%, 35.3-59.3). In the modified Poisson analysis, COVID-19 coinfection was associated with higher mortality (relative risk 1.44, 95% CI 1.01-2.06). Higher Charlson Comorbidity Index, higher modified Acute Physiology and Chronic Health Evaluation score, and no targeted PA-BSI treatment within 48 h were also predictors of higher mortality. Conclusions Higher mortality was observed in patients with COVID-19 coinfection among patients with PA-BSI. Future studies should explore this relationship in other settings and investigate potential SARS-CoV-2 and PA synergy.
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Affiliation(s)
- Leila S. Hojat
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brigid M. Wilson
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH, USA
- Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Federico Perez
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH, USA
- Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Case Western Reserve University, Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
| | - Maria F. Mojica
- Case Western Reserve University, Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
- Departments of Pathology, Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mendel E. Singer
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Robert A. Bonomo
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH, USA
- Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Case Western Reserve University, Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Departments of Pathology, Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lauren H. Epstein
- Infectious Diseases, US Department of Veterans Affairs Medical Center, Decatur, GA, USA
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5
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Driedger M, Daneman N, Brown K, Gold WL, Jorgensen SC, Maxwell C, Schwartz KL, Morris AM, Thiruchelvam D, Langford B, Leung E, MacFadden D. The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections. Microbiol Spectr 2023; 11:e0263023. [PMID: 37975711 PMCID: PMC10783801 DOI: 10.1128/spectrum.02630-23] [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: 06/26/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
IMPORTANCE Bacterial infections are a significant cause of morbidity and mortality worldwide. In the wake of the COVID-19 pandemic, previous studies have demonstrated pandemic-related shifts in the epidemiology of bacterial bloodstream infections (BSIs) in the general population and in specific hospital systems. Our study uses a large, comprehensive data set stratified by setting [community, long-term care (LTC), and hospital] to uniquely demonstrate how the effect of the COVID-19 pandemic on BSIs and testing practices varies by healthcare setting. We showed that, while the number of false-positive blood culture results generally increased during the pandemic, this effect did not apply to hospitalized patients. We also found that many infections were likely under-recognized in patients in the community and in LTC, demonstrating the importance of maintaining healthcare for these groups during crises. Last, we found a decrease in infections caused by certain pathogens in the community, suggesting some secondary benefits of pandemic-related public health measures.
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Affiliation(s)
- Matt Driedger
- Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Daneman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Kevin Brown
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Wayne L. Gold
- The University Health Network, Toronto, Ontario, Canada
| | | | | | - Kevin L. Schwartz
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | | | | | - Bradley Langford
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | | | - Derek MacFadden
- Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Abubakar U, Awaisu A, Khan AH, Alam K. Impact of COVID-19 Pandemic on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:1600. [PMID: 37998802 PMCID: PMC10668951 DOI: 10.3390/antibiotics12111600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023] Open
Abstract
This study investigated how the Coronavirus Disease 2019 (COVID-19) pandemic has affected the rate of healthcare-associated infections (HAIs). PubMed, Scopus and Google Scholar were searched to identify potentially eligible studies published from December 2019 to September 2022. A random effect model was used to determine the changes in the rate of HAIs during the pandemic. Thirty-seven studies, mostly from the United States (n = 13), were included. Fifteen studies described how the pandemic affected the rate of CLABSIs and CAUTIs, and eight of them showed a significant increase in CLABSIs. The risk of CLABSIs and CDIs was 27% (pooled odds ratio [OR]: 0.73; confidence interval [CI]: 0.61-0.89; p < 0.001) and 20% (pooled OR: 1.20; CI: 1.10-1.31; p < 0.001) higher during the pandemic compared to before the COVID-19 pandemic period, respectively. However, the overall risk of HAIs was unaffected by the pandemic (pooled OR: 1.00; 95 CI: 0.80-1.24; p = 0.990). Furthermore, there were no significant changes in the risk of CAUTIs (pooled OR: 1.01; 95 CI: 0.88-1.16; p = 0.890), and SSIs (pooled OR: 1.27; CI: 0.91-1.76; p = 0.16) between the two periods. The COVID-19 pandemic had no effect on the overall risk of HAIs among hospitalized patients, but an increased risk of CLABSIs and CDI were observed during the pandemic. Therefore, more stringent infection control and prevention measures and prudent interventions to promote the rational use of antibiotics are warranted across all healthcare facilities to reduce the burden of HAIs.
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Affiliation(s)
- Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
| | - Khurshid Alam
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
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Taddei E, Pafundi PC, Masciocchi C, Fiori B, Segala FV, Antenucci L, Guerriero S, Pastorino R, Scarsi N, Damiani A, Sanguinetti M, De Pascale G, Fantoni M, Murri R, De Angelis G. Epidemiology, time course, and risk factors for hospital-acquired bloodstream infections in a cohort of 14,884 patients before and during the COVID-19 pandemic. Infect Dis (Lond) 2023; 55:776-785. [PMID: 37750316 DOI: 10.1080/23744235.2023.2243327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/24/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE COVID-19 pandemic has changed in-hospital care and was linked to superimposed infections. Here, we described epidemiology and risk factors for hospital-acquired bloodstream infections (HA-BSIs), before and during COVID-19 pandemic. METHODS This retrospective, observational, single-center real-life study included 14,884 patients admitted to hospital wards and intensive care units (ICUs) with at least one blood culture, drawn 48 h after admission, either before (pre-COVID, N = 7382) or during pandemic (N = 7502, 1203 COVID-19+ and 6299 COVID-19-). RESULTS Two thousand two hundred and forty-five HA-BSI were microbiologically confirmed in 14,884 patients (15.1%), significantly higher among COVID-19+ (22.9%; ptrend < .001). COVID-19+ disclosed a significantly higher mortality rate (33.8%; p < .001) and more ICU admissions (29.7%; p < .001). Independent HAI-BSI predictors were: COVID-19 (OR: 1.43, 95%CI: 1.21-1.69; p < .001), hospitalization length (OR: 1.04, 95%CI: 1.03-1.04; p < .001), ICU admission (OR: 1.38, 95%CI: 1.19-1.60; p < .001), neoplasms (OR:1.48, 95%CI: 1.34-1.65; p < .001) and kidney failure (OR: 1.81, 95%CI: 1.61-2.04; p < .001). Of note, HA-BSI IRs for Acinetobacter spp. (0.16 × 100 patient-days) and Staphylococcus aureus (0.24 × 100 patient-days) peaked during the interval between first and second pandemic waves in our National context. CONCLUSIONS Patients with HA-BSI admitted before and during pandemic substantially differed. COVID-19 represented a risk factor for HA-BSI, though not confirmed in the sole pandemic period. Some etiologies emerged between pandemic waves, suggesting potential COVID-19 long-term effect on HA-BSIs.
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Affiliation(s)
- Eleonora Taddei
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pia Clara Pafundi
- Epidemiology & Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlotta Masciocchi
- Real World Data Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Barbara Fiori
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Vladimiro Segala
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura Antenucci
- Real World Data Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Guerriero
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberta Pastorino
- Epidemiology & Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Life Sciences and Public Health, Hygiene Section, Catholic University of the Sacred Heart, Rome, Italy
| | - Nicolò Scarsi
- Department of Life Sciences and Public Health, Hygiene Section, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Damiani
- Real World Data Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gennaro De Pascale
- Department of Emergency, Anesthesiological and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Biotechnological, Intensivologic and Perioperative Clinics, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Fantoni
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia De Angelis
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Ryder M, deLancey-Pulcini E, Parker AE, James GA. Bacterial transfer and biofilm formation in needleless connectors in a clinically simulated in vitro catheter model. Infect Control Hosp Epidemiol 2023; 44:1760-1768. [PMID: 37088696 PMCID: PMC10665874 DOI: 10.1017/ice.2023.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Although needleless connectors (NCs) are widely used in clinical practice, they carry significant risk of bloodstream infection (BSI). In this study, we quantified differences in bacterial transfer and biofilm formation between various NCs. DESIGN Prospective, clinically simulated in vitro experimental study. METHODS We tested 20 NCs in a 5-day clinical simulation of Staphylococcus aureus inoculations onto NC septum surfaces, which were then flushed with saline and cultured for bacterial transfer. Biofilm formation was measured through destructive sampling of the connector-catheter system. Moreover, 8 NC design factors were evaluated for their influence on bacterial transfer and biofilm formation. This study was designed without a disinfection protocol to ascertain the intrinsic risk of each NC. RESULTS Clave Neutron and MicroClave had the lowest overall mean log density of bacteria in the flush compared to other NCs (P < .05), except there were no statistically significant differences between Clave Neutron, Microclave, SafeTouch, and SafeAccess (P ≥ .05). The amount of biofilm in the NC was positively associated with bacteria in the flush (P < .0005). Among 8 design factors, flow path was most important, with the internal cannula associated with a statistically significant 1 log reduction (LR) in bacteria in the flush (R2 = 49%) and 0.5-2 LR in the connector (R2 = 34%). All factors together best explained bacteria in the flush (R2 = 65%) and biofilm in the connector (R2 = 48%). CONCLUSIONS Bacterial transfer and biofilm formation in the connector-catheter system varied statistically significantly between the 20 NCs, suggesting that NC choice can lower the risk of developing catheter-related BSIs.
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Affiliation(s)
| | | | - Albert E. Parker
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana
- Department of Mathematical Sciences, Montana State University, Bozeman, Montana
| | - Garth A. James
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana
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9
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Yu KC, Ai C, Jung M, Johnson H, Smith S, LaJoie J, Denny G. Prevalence of Hospital-Onset Bacteremia Pre- and Post-Implementation of a Needleless Blood Sampling Device From Existing Peripheral Catheters. JOURNAL OF INFUSION NURSING 2023; 46:332-337. [PMID: 37490579 PMCID: PMC10629599 DOI: 10.1097/nan.0000000000000513] [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: 07/27/2023]
Abstract
Repeated access of peripheral intravenous (IV) devices theoretically increases the risk of bacterial exposure. PIVO™ (VelanoVascular) is a needleless, single-use device that enables blood sampling from an existing peripheral IV. The goal of this retrospective observational exploratory study was to evaluate the influence of PIVO use on rates of hospital-onset bacteremia and fungemia (HOB) by comparing HOB rates in the year before and after PIVO introduction in hospitals implementing PIVO and over similar time periods in "control" hospitals with no PIVO. Two hospitals implementing PIVO (Hospital 1, a large community hospital; Hospital 2, a tertiary oncology center), and 71 control hospitals were included. During the 1-year period before and after PIVO introduction, HOB rates decreased in hospitals 1 and 2 by 31.9% and 41.8%, respectively. Control hospitals that did not use PIVO had a 12.4% decrease in HOB rates. Multivariable logistic regression analyses found that PIVO was associated with a lower risk (Hospital 1 odds ratio [OR]: 0.63; 95% CI, 0.42-0.94) or no change (Hospital 2 OR: 1.05; 95% CI, 0.72-1.52) in HOB rates. Control hospitals also showed no change in HOB rates between the 2 time periods. These data do not support concerns about increased risk of bacteremia with PIVO.
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Affiliation(s)
- Kalvin C. Yu
- Corresponding Author: Kalvin C. Yu, MD, Becton, Dickinson and Company, 1 Becton Dr, Franklin Lakes, NJ 07417 ()
| | - ChinEn Ai
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Molly Jung
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Heather Johnson
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Scott Smith
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Judith LaJoie
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Gerald Denny
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
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10
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Kim JY, Lee WJ, Suh JW, Kim SB, Sohn JW, Yoon YK. Clinical impact of COVID-19 in patients with carbapenem-resistant Acinetobacter baumannii bacteraemia. Epidemiol Infect 2023; 151:e180. [PMID: 37814587 PMCID: PMC10644053 DOI: 10.1017/s0950268823001644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 10/11/2023] Open
Abstract
The aim of this study was to evaluate the impact of coronavirus disease 2019 (COVID-19) on treatment outcomes in critically ill patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI). This single-centre, retrospective cohort study was conducted in a 1,048-bed university-affiliated tertiary hospital in the Republic of Korea from January 2021 to March 2022. The study participants included consecutive hospitalised adult patients (aged ≥18 years) in the intensive care unit with CRAB monomicrobial BSI. During the study period, a total of 70 patients were included in our study, and 24 (34.3%) were diagnosed with COVID-19. The 28-day mortality rate was 64.3%. In the multivariate Cox proportional hazard regression analysis, diagnosis of COVID-19 (hazard ratio (HR), 2.91; 95% confidence interval (CI): 1.45-5.87), neutropenia (HR, 2.76; 95% CI: 1.04-7.29), Pitt bacteraemia score (per point; HR, 1.30; 95% CI: 1.19-1.41), and appropriate definite antibiotic therapy (HR, 0.31; 95% CI: 0.15-0.62) were independent predictors of 28-day mortality in patients with CRAB BSI. In conclusion, our findings suggested that COVID-19 has a negative prognostic impact on patients with CRAB BSI. Further study is needed to investigate the specific mechanisms of how COVID-19 worsens the prognosis of CRAB infection.
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Affiliation(s)
- Jeong Yeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Joo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Woong Suh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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11
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Pozza G, Casalini G, Ciubotariu CL, Giacomelli A, Galimberti M, Zacheo M, Rabbione A, Pieruzzi M, Oreni L, Galimberti L, Colombo R, Rizzardini G, Pagani C, Rimoldi SG, Bonazzetti C, Ridolfo AL, Antinori S. Bloodstream Infections in Intensive Care Unit during Four Consecutive SARS-CoV-2 Pandemic Waves. Antibiotics (Basel) 2023; 12:1448. [PMID: 37760744 PMCID: PMC10525187 DOI: 10.3390/antibiotics12091448] [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: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Critically ill COVID-19 patients are at an increased risk of bloodstream infections (BSIs). We performed a retrospective observational single-center study on COVID-19 patients admitted to intensive care unit (ICU) to assess the incidence of BSIs in four consecutive periods: 21 February-31 July 2020 (W1), 1 August 2020-31 January 2021 (W2), 1 February-30 September 2021 (W3) and 1 October 2021 and 30 April 2022 (W4). BSIs that occurred 48 h after ICU admission were included. The crude incidence of BSIs was estimated by means of Poisson distribution normalized to 1000 patient-days. A total of 404 critically ill COVID-19 patients were admitted to ICU, of whom 284 (61%) developed at least one episode of BSI with an overall crude incidence of 87 events every 1000 patient-days (95% CI 77-98) without a significant difference in consecutive epidemic periods (p = 0.357). Gram-positive bacteria were the most frequent etiological agents of BSIs, contributing to 74.6% episodes. A progressive decrease in BSIs due to Enterococcus spp. was observed (W1 57.4%, W2 43.7%, W3 35.7% and W4 32.7%; p = 0.004). The incidence of BSIs remained stable during different epidemic periods. Enterococcus spp. prevalence was significantly reduced, although still accounted for one third of BSIs in more recent epidemic periods.
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Affiliation(s)
- Giacomo Pozza
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
- Department of Biomedical Sciences and Clinics, Università degli Studi di Milano, 20157 Milan, Italy
| | - Giacomo Casalini
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
- Department of Biomedical Sciences and Clinics, Università degli Studi di Milano, 20157 Milan, Italy
| | - Cosmin Lucian Ciubotariu
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
- Department of Biomedical Sciences and Clinics, Università degli Studi di Milano, 20157 Milan, Italy
| | - Andrea Giacomelli
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
| | - Miriam Galimberti
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
- Department of Biomedical Sciences and Clinics, Università degli Studi di Milano, 20157 Milan, Italy
| | - Martina Zacheo
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
- Department of Biomedical Sciences and Clinics, Università degli Studi di Milano, 20157 Milan, Italy
| | - Andrea Rabbione
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
- Department of Biomedical Sciences and Clinics, Università degli Studi di Milano, 20157 Milan, Italy
| | - Margherita Pieruzzi
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
- Department of Biomedical Sciences and Clinics, Università degli Studi di Milano, 20157 Milan, Italy
| | - Letizia Oreni
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
| | - Laura Galimberti
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
| | - Riccardo Colombo
- Intensive Care Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy;
| | - Giuliano Rizzardini
- I Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy;
| | - Cristina Pagani
- Clinical Microbiology, Virology and Bioemergency, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.P.); (S.G.R.)
| | - Sara Giordana Rimoldi
- Clinical Microbiology, Virology and Bioemergency, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (C.P.); (S.G.R.)
| | - Cecilia Bonazzetti
- Infectious Diseases Unit IRCCS, Policlinico Sant’Orsola, Department Medical Surgical Science, University of Bologna, 40138 Bologna, Italy;
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
| | - Spinello Antinori
- III Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (G.P.); (G.C.); (C.L.C.); (M.G.); (M.Z.); (A.R.); (M.P.); (L.O.); (L.G.); (A.L.R.); (S.A.)
- Department of Biomedical Sciences and Clinics, Università degli Studi di Milano, 20157 Milan, Italy
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12
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Strelkova D, Rachina S, Fedina L, Vlasenko A, Tetevina M, Drogashevskaya D, Chesnokova M, Kuleshov V, Burmistrova E, Sychev I, Ananicheva N. Identification of risk factors and development of a predictive model for bloodstream infection in intensive care unit COVID-19 patients. J Hosp Infect 2023; 139:150-157. [PMID: 37478910 DOI: 10.1016/j.jhin.2023.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES To identify risk factors for nosocomial bloodstream infections (BSIs) in intensive care unit (ICU) patients with COVID-19 and to build a predictive model for BSIs. PATIENTS AND METHODS The retrospective case-control study included 236 ICU COVID-19 patients with BSIs group and 234 patients in the control group. Demographic and laboratory data, comorbidities, drug use, invasive procedures and identified pathogens were recorded separately for patients directly admitted and transferred to ICU. Fine and Gray's multi-variate competing risk model was used to build a predictive model for patients transferred to ICU. RESULTS The risk factors were: interleukin inhibitors (HR = 6.1 (95% CI: 2.0-18.5)) and dexamethasone (HR = 3.0 (95% CI: 1.3-7.1)) use in previous hospitalization, glomerular filtration rate <60 mL/min per 1.73 m2 (HR = 4.0 (95% CI: 2.1-7.6)) and blood glucose >9 mmol/L (HR = 2.5 (95% CI: 1.4-4.6)) in patients directly admitted to ICU; and dexamethasone use in previous hospitalization (HR = 4.5 (95% CI: 1.8-11)), the total dexamethasone dose before transfer to ICU (HR = 1.2 (95% CI: 1.06-1.37)), diabetes mellitus (HR = 1.4 (95% CI: 1.1-1.9)), alanine transaminase (ALT) ≥35.5 U/L on hospital admission (HR = 1.5 (95% CI: 1.1-2.1)), and the use of low-flow oxygen versus high-flow oxygen therapy or non-invasive mechanical ventilation on admission to ICU ((HR = 2.7 (95% CI: 5.6-11.1)) in patients transferred to ICU. A predictive model had sensitivity of 63-73% and specificity of 71-83% at different times of ICU stay. CONCLUSIONS Our findings may help clinicians detect patients at high risk of developing BSIs.
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Affiliation(s)
- D Strelkova
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
| | - S Rachina
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - L Fedina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - A Vlasenko
- Samara State Medical University, Samara, Russian Federation
| | - M Tetevina
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - D Drogashevskaya
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - M Chesnokova
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - V Kuleshov
- City Clinical Hospital S. S. Yudin, Moscow, Russian Federation
| | - E Burmistrova
- City Clinical Hospital S. S. Yudin, Moscow, Russian Federation
| | - I Sychev
- Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - N Ananicheva
- City Clinical Hospital S. S. Yudin, Moscow, Russian Federation
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13
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Bartles R, Moore A, Martin R, Clarkson R, Ebinger L. Using a Comprehensive On-Site Assessment Process to Reduce Central Line-Associated Bloodstream Infection Rates. JOURNAL OF INFUSION NURSING 2023; 46:266-271. [PMID: 37611284 DOI: 10.1097/nan.0000000000000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Central line-associated bloodstream infection (CLABSI) rates increased substantially in the United States following the emergence of COVID-19 and subsequent surges. The pandemic resulted in hospital capacities being exceeded and crisis standards of care being implemented for sustained periods. As COVID-19 rates in the United States began to stabilize, some facilities did not return to previous CLABSI rates, indicating a change in practices that had a longer-term impact on CLABSI prevention. The authors' large health care system observed similar increases in CLABSI following the emergence of COVID-19, prompting investigation and intervention in the form of a quality improvement project. To identify changes related to ongoing increases in CLABSI, an assessment team conducted standardized on-site assessments at 11 facilities. Site assessments were considered an intervention, as they involved rigorous preassessment investigations and interviews, case reviews, practice observations, on-site staff interviews, and postassessment support for additional interventions. Nine facilities had enough postassessment data to analyze the impact of intervention. The overall CLABSI rate (infections per 1000 line days) at the 9 facilities in the 6 months prior to intervention was 1.42, and the postassessment rate in the 6 months following intervention was 0.44. This indicates the effectiveness of facility-specific investigation followed by targeted performance improvements to reduce the rate of CLABSI.
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Affiliation(s)
- Rebecca Bartles
- Providence, Maple Valley, Washington
- Rebecca (Becca) Bartles, DrPH, MPH, CIC, FAPIC, is the executive director of infectious disease management and prevention for Providence. Dr Bartles has practiced infection prevention for the last 17 years in a variety of health care settings and has numerous publications focused on infection prevention staffing and endoscope safety. She received both her BS in Public Health, Health Education, and her MPH in Epidemiology from East Tennessee State University. She completed her Doctorate in Public Health in 2021 with a dissertation topic of "Assessing Efficacy of an Evidence-Based Clostridioides difficile Screening Tool Using Electronic Medical Record Data." Dr Bartles also teaches courses at the University of Providence for a Masters in Infection Prevention degree program that she founded in 2016. She has been CIC certified since 2008 and is an Association for Professionals in Infection Control and Epidemiology fellow. Most notably, though, Dr Bartles is the mother of 4 beautiful daughters, ages 8 to 23
- Andria Moore, MN, RN, CPHQ, CCRN-K, is a senior program manager for nursing practice and quality at Providence Health System. She completed her nursing degree at Georgetown University and her Master's in Nursing from the University of Washington. She holds credentials in both critical care nursing and health care quality. She has over a decade of experience in various health care settings. Currently she works in close partnership with interdisciplinary teams across Providence to drive system-wide quality and practice strategic initiatives. Her work focuses on reduction of nurse sensitive quality indicators, optimizing nursing workflows, and leading practice change to ensure alignment with the latest evidence-based care standards
- Rosemary Martin, ASCP (M)CM, CLSSBB, CIC, is the system infection prevention program manager for the Providence Health System, a 54-hospital system across 7 states. She has 20 years of experience as a careered clinical microbiologist and process improvement consultant; her projects currently focus on developing a process improvement program for system infection prevention and creating dashboards for the enterprise that aggregates various data at the system, regional, and local level. She provides support to the system team as a subject matter expert in leveraging technological platforms for governance and team management. She holds a degree in microbiology from the University of Washington, is certified as an Infection Preventionist (CIC), Clinical Microbiologist ASCP(M)CM, and Lean Six Sigma Black Belt (CLSSBB)
- Rebecca (Bex) Clarkson, RN, MSN, CIC, is a senior infection preventionist with Providence Health System. She is a registered nurse by background and has practiced since 2009 in multiple settings across the hospital, including emergency medicine, cardiac, oncology, acute observation, and charge nurse. Her nonacute experience includes work in home infusion, business consultation, envenomation and animal educational presentations, curriculum development, and filming set compliance officer. Ms Clarkson received her MSN with an emphasis in nursing education with an intent to teach nursing school when she fell into infection prevention in 2015 and realized that this is where she belongs. Her publications and national presentations revolve around topics related to central line-associated bloodstream infection and catheter-associated urinary tract infection prevention, displaying her passion and dedication to patient safety
- Laura Ebinger, CIC, is a system infection preventionist for Providence Health. Laura has practiced infection prevention and epidemiology for the last 17 years in several health care settings. She received her BS in psychology through the University of Washington. Ms Ebinger worked as an instructional designer for 4 years for a private university creating online modules for master-level programs. She also has her own infection prevention consulting business, which provides consultative expertise to health care facilities and businesses. She has been CIC-certified since 2007. Ms Ebinger has a passion for incorporating the latest technology with infection prevention practices, creating practical and efficient work processes
| | - Andria Moore
- Providence, Maple Valley, Washington
- Rebecca (Becca) Bartles, DrPH, MPH, CIC, FAPIC, is the executive director of infectious disease management and prevention for Providence. Dr Bartles has practiced infection prevention for the last 17 years in a variety of health care settings and has numerous publications focused on infection prevention staffing and endoscope safety. She received both her BS in Public Health, Health Education, and her MPH in Epidemiology from East Tennessee State University. She completed her Doctorate in Public Health in 2021 with a dissertation topic of "Assessing Efficacy of an Evidence-Based Clostridioides difficile Screening Tool Using Electronic Medical Record Data." Dr Bartles also teaches courses at the University of Providence for a Masters in Infection Prevention degree program that she founded in 2016. She has been CIC certified since 2008 and is an Association for Professionals in Infection Control and Epidemiology fellow. Most notably, though, Dr Bartles is the mother of 4 beautiful daughters, ages 8 to 23
- Andria Moore, MN, RN, CPHQ, CCRN-K, is a senior program manager for nursing practice and quality at Providence Health System. She completed her nursing degree at Georgetown University and her Master's in Nursing from the University of Washington. She holds credentials in both critical care nursing and health care quality. She has over a decade of experience in various health care settings. Currently she works in close partnership with interdisciplinary teams across Providence to drive system-wide quality and practice strategic initiatives. Her work focuses on reduction of nurse sensitive quality indicators, optimizing nursing workflows, and leading practice change to ensure alignment with the latest evidence-based care standards
- Rosemary Martin, ASCP (M)CM, CLSSBB, CIC, is the system infection prevention program manager for the Providence Health System, a 54-hospital system across 7 states. She has 20 years of experience as a careered clinical microbiologist and process improvement consultant; her projects currently focus on developing a process improvement program for system infection prevention and creating dashboards for the enterprise that aggregates various data at the system, regional, and local level. She provides support to the system team as a subject matter expert in leveraging technological platforms for governance and team management. She holds a degree in microbiology from the University of Washington, is certified as an Infection Preventionist (CIC), Clinical Microbiologist ASCP(M)CM, and Lean Six Sigma Black Belt (CLSSBB)
- Rebecca (Bex) Clarkson, RN, MSN, CIC, is a senior infection preventionist with Providence Health System. She is a registered nurse by background and has practiced since 2009 in multiple settings across the hospital, including emergency medicine, cardiac, oncology, acute observation, and charge nurse. Her nonacute experience includes work in home infusion, business consultation, envenomation and animal educational presentations, curriculum development, and filming set compliance officer. Ms Clarkson received her MSN with an emphasis in nursing education with an intent to teach nursing school when she fell into infection prevention in 2015 and realized that this is where she belongs. Her publications and national presentations revolve around topics related to central line-associated bloodstream infection and catheter-associated urinary tract infection prevention, displaying her passion and dedication to patient safety
- Laura Ebinger, CIC, is a system infection preventionist for Providence Health. Laura has practiced infection prevention and epidemiology for the last 17 years in several health care settings. She received her BS in psychology through the University of Washington. Ms Ebinger worked as an instructional designer for 4 years for a private university creating online modules for master-level programs. She also has her own infection prevention consulting business, which provides consultative expertise to health care facilities and businesses. She has been CIC-certified since 2007. Ms Ebinger has a passion for incorporating the latest technology with infection prevention practices, creating practical and efficient work processes
| | - Rosemary Martin
- Providence, Maple Valley, Washington
- Rebecca (Becca) Bartles, DrPH, MPH, CIC, FAPIC, is the executive director of infectious disease management and prevention for Providence. Dr Bartles has practiced infection prevention for the last 17 years in a variety of health care settings and has numerous publications focused on infection prevention staffing and endoscope safety. She received both her BS in Public Health, Health Education, and her MPH in Epidemiology from East Tennessee State University. She completed her Doctorate in Public Health in 2021 with a dissertation topic of "Assessing Efficacy of an Evidence-Based Clostridioides difficile Screening Tool Using Electronic Medical Record Data." Dr Bartles also teaches courses at the University of Providence for a Masters in Infection Prevention degree program that she founded in 2016. She has been CIC certified since 2008 and is an Association for Professionals in Infection Control and Epidemiology fellow. Most notably, though, Dr Bartles is the mother of 4 beautiful daughters, ages 8 to 23
- Andria Moore, MN, RN, CPHQ, CCRN-K, is a senior program manager for nursing practice and quality at Providence Health System. She completed her nursing degree at Georgetown University and her Master's in Nursing from the University of Washington. She holds credentials in both critical care nursing and health care quality. She has over a decade of experience in various health care settings. Currently she works in close partnership with interdisciplinary teams across Providence to drive system-wide quality and practice strategic initiatives. Her work focuses on reduction of nurse sensitive quality indicators, optimizing nursing workflows, and leading practice change to ensure alignment with the latest evidence-based care standards
- Rosemary Martin, ASCP (M)CM, CLSSBB, CIC, is the system infection prevention program manager for the Providence Health System, a 54-hospital system across 7 states. She has 20 years of experience as a careered clinical microbiologist and process improvement consultant; her projects currently focus on developing a process improvement program for system infection prevention and creating dashboards for the enterprise that aggregates various data at the system, regional, and local level. She provides support to the system team as a subject matter expert in leveraging technological platforms for governance and team management. She holds a degree in microbiology from the University of Washington, is certified as an Infection Preventionist (CIC), Clinical Microbiologist ASCP(M)CM, and Lean Six Sigma Black Belt (CLSSBB)
- Rebecca (Bex) Clarkson, RN, MSN, CIC, is a senior infection preventionist with Providence Health System. She is a registered nurse by background and has practiced since 2009 in multiple settings across the hospital, including emergency medicine, cardiac, oncology, acute observation, and charge nurse. Her nonacute experience includes work in home infusion, business consultation, envenomation and animal educational presentations, curriculum development, and filming set compliance officer. Ms Clarkson received her MSN with an emphasis in nursing education with an intent to teach nursing school when she fell into infection prevention in 2015 and realized that this is where she belongs. Her publications and national presentations revolve around topics related to central line-associated bloodstream infection and catheter-associated urinary tract infection prevention, displaying her passion and dedication to patient safety
- Laura Ebinger, CIC, is a system infection preventionist for Providence Health. Laura has practiced infection prevention and epidemiology for the last 17 years in several health care settings. She received her BS in psychology through the University of Washington. Ms Ebinger worked as an instructional designer for 4 years for a private university creating online modules for master-level programs. She also has her own infection prevention consulting business, which provides consultative expertise to health care facilities and businesses. She has been CIC-certified since 2007. Ms Ebinger has a passion for incorporating the latest technology with infection prevention practices, creating practical and efficient work processes
| | - Rebecca Clarkson
- Providence, Maple Valley, Washington
- Rebecca (Becca) Bartles, DrPH, MPH, CIC, FAPIC, is the executive director of infectious disease management and prevention for Providence. Dr Bartles has practiced infection prevention for the last 17 years in a variety of health care settings and has numerous publications focused on infection prevention staffing and endoscope safety. She received both her BS in Public Health, Health Education, and her MPH in Epidemiology from East Tennessee State University. She completed her Doctorate in Public Health in 2021 with a dissertation topic of "Assessing Efficacy of an Evidence-Based Clostridioides difficile Screening Tool Using Electronic Medical Record Data." Dr Bartles also teaches courses at the University of Providence for a Masters in Infection Prevention degree program that she founded in 2016. She has been CIC certified since 2008 and is an Association for Professionals in Infection Control and Epidemiology fellow. Most notably, though, Dr Bartles is the mother of 4 beautiful daughters, ages 8 to 23
- Andria Moore, MN, RN, CPHQ, CCRN-K, is a senior program manager for nursing practice and quality at Providence Health System. She completed her nursing degree at Georgetown University and her Master's in Nursing from the University of Washington. She holds credentials in both critical care nursing and health care quality. She has over a decade of experience in various health care settings. Currently she works in close partnership with interdisciplinary teams across Providence to drive system-wide quality and practice strategic initiatives. Her work focuses on reduction of nurse sensitive quality indicators, optimizing nursing workflows, and leading practice change to ensure alignment with the latest evidence-based care standards
- Rosemary Martin, ASCP (M)CM, CLSSBB, CIC, is the system infection prevention program manager for the Providence Health System, a 54-hospital system across 7 states. She has 20 years of experience as a careered clinical microbiologist and process improvement consultant; her projects currently focus on developing a process improvement program for system infection prevention and creating dashboards for the enterprise that aggregates various data at the system, regional, and local level. She provides support to the system team as a subject matter expert in leveraging technological platforms for governance and team management. She holds a degree in microbiology from the University of Washington, is certified as an Infection Preventionist (CIC), Clinical Microbiologist ASCP(M)CM, and Lean Six Sigma Black Belt (CLSSBB)
- Rebecca (Bex) Clarkson, RN, MSN, CIC, is a senior infection preventionist with Providence Health System. She is a registered nurse by background and has practiced since 2009 in multiple settings across the hospital, including emergency medicine, cardiac, oncology, acute observation, and charge nurse. Her nonacute experience includes work in home infusion, business consultation, envenomation and animal educational presentations, curriculum development, and filming set compliance officer. Ms Clarkson received her MSN with an emphasis in nursing education with an intent to teach nursing school when she fell into infection prevention in 2015 and realized that this is where she belongs. Her publications and national presentations revolve around topics related to central line-associated bloodstream infection and catheter-associated urinary tract infection prevention, displaying her passion and dedication to patient safety
- Laura Ebinger, CIC, is a system infection preventionist for Providence Health. Laura has practiced infection prevention and epidemiology for the last 17 years in several health care settings. She received her BS in psychology through the University of Washington. Ms Ebinger worked as an instructional designer for 4 years for a private university creating online modules for master-level programs. She also has her own infection prevention consulting business, which provides consultative expertise to health care facilities and businesses. She has been CIC-certified since 2007. Ms Ebinger has a passion for incorporating the latest technology with infection prevention practices, creating practical and efficient work processes
| | - Laura Ebinger
- Providence, Maple Valley, Washington
- Rebecca (Becca) Bartles, DrPH, MPH, CIC, FAPIC, is the executive director of infectious disease management and prevention for Providence. Dr Bartles has practiced infection prevention for the last 17 years in a variety of health care settings and has numerous publications focused on infection prevention staffing and endoscope safety. She received both her BS in Public Health, Health Education, and her MPH in Epidemiology from East Tennessee State University. She completed her Doctorate in Public Health in 2021 with a dissertation topic of "Assessing Efficacy of an Evidence-Based Clostridioides difficile Screening Tool Using Electronic Medical Record Data." Dr Bartles also teaches courses at the University of Providence for a Masters in Infection Prevention degree program that she founded in 2016. She has been CIC certified since 2008 and is an Association for Professionals in Infection Control and Epidemiology fellow. Most notably, though, Dr Bartles is the mother of 4 beautiful daughters, ages 8 to 23
- Andria Moore, MN, RN, CPHQ, CCRN-K, is a senior program manager for nursing practice and quality at Providence Health System. She completed her nursing degree at Georgetown University and her Master's in Nursing from the University of Washington. She holds credentials in both critical care nursing and health care quality. She has over a decade of experience in various health care settings. Currently she works in close partnership with interdisciplinary teams across Providence to drive system-wide quality and practice strategic initiatives. Her work focuses on reduction of nurse sensitive quality indicators, optimizing nursing workflows, and leading practice change to ensure alignment with the latest evidence-based care standards
- Rosemary Martin, ASCP (M)CM, CLSSBB, CIC, is the system infection prevention program manager for the Providence Health System, a 54-hospital system across 7 states. She has 20 years of experience as a careered clinical microbiologist and process improvement consultant; her projects currently focus on developing a process improvement program for system infection prevention and creating dashboards for the enterprise that aggregates various data at the system, regional, and local level. She provides support to the system team as a subject matter expert in leveraging technological platforms for governance and team management. She holds a degree in microbiology from the University of Washington, is certified as an Infection Preventionist (CIC), Clinical Microbiologist ASCP(M)CM, and Lean Six Sigma Black Belt (CLSSBB)
- Rebecca (Bex) Clarkson, RN, MSN, CIC, is a senior infection preventionist with Providence Health System. She is a registered nurse by background and has practiced since 2009 in multiple settings across the hospital, including emergency medicine, cardiac, oncology, acute observation, and charge nurse. Her nonacute experience includes work in home infusion, business consultation, envenomation and animal educational presentations, curriculum development, and filming set compliance officer. Ms Clarkson received her MSN with an emphasis in nursing education with an intent to teach nursing school when she fell into infection prevention in 2015 and realized that this is where she belongs. Her publications and national presentations revolve around topics related to central line-associated bloodstream infection and catheter-associated urinary tract infection prevention, displaying her passion and dedication to patient safety
- Laura Ebinger, CIC, is a system infection preventionist for Providence Health. Laura has practiced infection prevention and epidemiology for the last 17 years in several health care settings. She received her BS in psychology through the University of Washington. Ms Ebinger worked as an instructional designer for 4 years for a private university creating online modules for master-level programs. She also has her own infection prevention consulting business, which provides consultative expertise to health care facilities and businesses. She has been CIC-certified since 2007. Ms Ebinger has a passion for incorporating the latest technology with infection prevention practices, creating practical and efficient work processes
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Bao D, Xu X, Wang Y, Zhu F, Wu Y, Li H. Clostridium ramosum Bacteremia in an Immunocompetent Patient with SARS-CoV-2 Infection: A Case Report. Infect Drug Resist 2023; 16:4455-4461. [PMID: 37449246 PMCID: PMC10337682 DOI: 10.2147/idr.s421409] [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: 05/15/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
We report a case of Clostridium ramosum bacteremia in a 73-year-old patient with SARS-CoV-2 infection and right lower abdominal tenderness in China. The microbiological features and genomic epidemiological characteristics of C. ramosum worldwide were investigated to identify the possible sources of infection. Whole-genome sequencing of C. ramosum WD-I2 was performed using an Illumina NovaSeq 6000 platform. Phylogenetic analysis of C. ramosum WD-I2 and other publicly available C. ramosum isolates was performed and visualized using the interactive Tree of Life (iTOL) web server. The resistome of C. ramosum WD-I2 consists of two antimicrobial resistance genes (tetM and ermB), which explains the antimicrobial resistance trait to tetracycline and macrolides. Phylogenetic analysis showed that the strain closest to our isolated strain WD-I2 was SUG1069, recovered from a pig feces sample from Canada, which differed by 589 SNPs. To our knowledge, this is the first report of C. ramosum bacteremia in China. Our findings highlight the potential risk of invasive C. ramosum infections during the COVID-19 pandemic.
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Affiliation(s)
- Danni Bao
- Department of Clinical Laboratory, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of China
| | - Xiaohong Xu
- Department of Clinical Laboratory, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of China
| | - Yizhang Wang
- Department of Clinical Laboratory, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of China
| | - Fengjiao Zhu
- Department of Clinical Laboratory, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of China
| | - Yanhong Wu
- Department of Clinical Laboratory, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of China
| | - Hongzhang Li
- Department of Gastroenterology, Sanmen People’s Hospital, Taizhou, Zhejiang, People’s Republic of China
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15
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Mitchell BG, Stewardson AJ, Kerr L, Ferguson JK, Curtis S, Busija L, Lydeamore MJ, Graham K, Russo PL. The incidence of nosocomial bloodstream infection and urinary tract infection in Australian hospitals before and during the COVID-19 pandemic: an interrupted time series study. Antimicrob Resist Infect Control 2023; 12:61. [PMID: 37400858 PMCID: PMC10318831 DOI: 10.1186/s13756-023-01268-2] [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: 03/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on healthcare including increased awareness of infection prevention and control (IPC). The aim of this study was to explore if the heightened awareness of IPC measures implemented in response to the pandemic influenced the rates of healthcare associated infections (HAI) using positive bloodstream and urine cultures as a proxy measure. METHODS A 3 year retrospective review of laboratory data from 5 hospitals (4 acute public, 1 private) from two states in Australia was undertaken. Monthly positive bloodstream culture data and urinary culture data were collected from January 2017 to March 2021. Occupied bed days (OBDs) were used to generate monthly HAI incidence per 10,000 OBDs. An interrupted time series analysis was undertaken to compare incidence pre and post February 2020 (the pre COVID-19 cohort and the COVID-19 cohort respectively). A HAI was assumed if positive cultures were obtained 48 h after admission and met other criteria. RESULTS A total of 1,988 bloodstream and 7,697 urine positive cultures were identified. The unadjusted incident rate was 25.5 /10,000 OBDs in the pre-COVID-19 cohort, and 25.1/10,000 OBDs in the COVID-19 cohort. The overall rate of HAI aggregated for all sites did not differ significantly between the two periods. The two hospitals in one state which experienced an earlier and larger outbreak demonstrated a significant downward trend in the COVID-19 cohort (p = 0.011). CONCLUSION These mixed findings reflect the uncertainty of the effect the pandemic has had on HAI's. Factors to consider in this analysis include local epidemiology, differences between public and private sector facilities, changes in patient populations and profiles between hospitals, and timing of enhanced IPC interventions. Future studies which factor in these differences may provide further insight on the effect of COVID-19 on HAIs.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing, Avondale University, Cooranbong, NSW, 2265, Australia
- Nursing and Midwifery, Monash University, Frankston, VIC, 3199, Australia
- Gosford Hospital, Central Coast Local Health District, NSW, 2250, Australia
| | - Andrew J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Lucille Kerr
- Nursing and Midwifery, Monash University, Frankston, VIC, 3199, Australia
- Department of Nursing Research, Cabrini Institute, Malvern, VIC, 3144, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - John K Ferguson
- Division of Medicine, John Hunter Hospital, Newcastle Regional Mail Centre, 2310, NSW, Australia
- University of Newcastle, Callaghan, NSW, 2308, Australia
- Infection Prevention Service, Hunter New England Health, John Hunter Hospital, NSW, 2310, Australia
| | - Stephanie Curtis
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Ljoudmila Busija
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Michael J Lydeamore
- Department of Econometrics and Business Statistics, Monash University, Melbourne, 3800, Australia
| | - Kirsty Graham
- Infection Prevention and Control, Central Coast Local Health District, Gosford, NSW, 2250, Australia
| | - Philip L Russo
- School of Nursing, Avondale University, Cooranbong, NSW, 2265, Australia.
- Nursing and Midwifery, Monash University, Frankston, VIC, 3199, Australia.
- Department of Nursing Research, Cabrini Institute, Malvern, VIC, 3144, Australia.
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16
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Aslam S, Asrat H, Liang R, Qiu W, Sunny S, Maro A, Abdallah M, Fornek M, Episcopia B, Quale J. Methicillin-resistant Staphylococcus aureus bacteremia during the coronavirus disease 2019 (COVID-19) pandemic: Trends and distinguishing characteristics among patients in a healthcare system in New York City. Infect Control Hosp Epidemiol 2023; 44:1177-1179. [PMID: 36082528 DOI: 10.1017/ice.2022.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
During the pandemic, the rate of healthcare facility-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was 5 times greater in patients admitted with coronavirus disease 2019 (COVID-19). The presence of central lines and mechanical ventilation likely contribute to this increased rate. The number of central-line-associated bacteremia cases may be underestimated in patients with COVID-19.
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Affiliation(s)
- Saif Aslam
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Habtamu Asrat
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Rina Liang
- Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Wenqi Qiu
- School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York
| | - Subin Sunny
- Department of Pharmacy Services, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Anna Maro
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Marie Abdallah
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Mary Fornek
- Department of Infection Control and Prevention, NYC Health+Hospitals/Central Office, New York, New York
| | - Briana Episcopia
- Department of Infection Control and Prevention, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - John Quale
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
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17
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Garcia R. Moving Beyond Central Line-Associated Bloodstream Infections: Enhancement of the Prevention Process. JOURNAL OF INFUSION NURSING 2023; 46:217-222. [PMID: 37406336 DOI: 10.1097/nan.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The provision of medications and other treatments via intravenous (IV) therapy has provided millions of health care patients with extended benefits. IV therapy, however, is also associated with complications, such as associated bloodstream infections. Understanding the mechanisms of development and the factors that have contributed to the recent increases in such health care-acquired infections assists in formulating new preventive strategies that include the implementation of hospital-onset bacteremia, an innovative model that requires surveillance and prevention of bloodstream infections associated with all types of vascular access devices, expansion of vascular access service teams (VAST), and use of advanced antimicrobial dressings designed to reduce bacterial proliferation over the currently recommended time periods for maintenance of IV catheters.
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Affiliation(s)
- Robert Garcia
- Infection Prevention Consultant, Enhanced Epidemiology, Valley Stream, New York
- Robert Garcia, BS, MT(ASCP), CIC, FAPIC, has been an infection preventionist/consultant for 43 years and a member of the Association for Professionals in Infection Control & Epidemiology (APIC). He received a Bachelor of Science in Community Health from St. Joseph's College in 1982 and has been certified in infection control since 1984 by the Certification Board in Infection Control. Mr Garcia was elected in 2016 as a fellow in APIC 2016, a designation for experienced infection preventionists who have had significant contributions to the field of infection prevention. In addition, Mr Garcia has been an infection preventionist/director at 9 hospitals in New York, most recently as a senior instructional support specialist at the Healthcare Epidemiology Department, Stony Brook University Hospital (Stony Brook, NY). He is a principal national researcher on the effectiveness of silver-hydrogel urinary catheters, chlorhexidine skin antisepsis, and comprehensive oral care to prevent ventilator-associated pneumonia. Mr Garcia is an international speaker on infection prevention issues, such as health care-associated infections, microbiology, diagnostic and antibiotic stewardship, and environmental contamination
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18
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Freire MP, de Assis DB, Tavares BDM, Brito VOC, Marinho I, Lapchik M, Guedes AR, Madalosso G, Oliveira MS, de Lima ACP, Levin AS. Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance. Clinics (Sao Paulo) 2023; 78:100231. [PMID: 37348255 DOI: 10.1016/j.clinsp.2023.100231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/17/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. METHODS This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. RESULTS 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. CONCLUSIONS HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.
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Affiliation(s)
- Maristela Pinheiro Freire
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Denise Brandão de Assis
- Division of Hospital Infections, Center for Epidemiologic Surveillance "Prof. Alexandre Vranjac", Center for Disease Control, Sao Paulo State Health Department, São Paulo, SP, Brazil
| | - Bruno de Melo Tavares
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Valquiria O C Brito
- Núcleo Municipal de Controle de Infecção Hospitalar, São Paulo City Health Department, São Paulo, SP, Brazil
| | - Igor Marinho
- Department of Infectious Diseases, Laboratório de Investigacao Médica ‒ LIM 49, and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Milton Lapchik
- Núcleo Municipal de Controle de Infecção Hospitalar, São Paulo City Health Department, São Paulo, SP, Brazil
| | - Ana Rubia Guedes
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Geraldine Madalosso
- Division of Hospital Infections, Center for Epidemiologic Surveillance "Prof. Alexandre Vranjac", Center for Disease Control, Sao Paulo State Health Department, São Paulo, SP, Brazil
| | - Maura Salaroli Oliveira
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | - Anna S Levin
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Infectious Diseases, Laboratório de Investigacao Médica ‒ LIM 49, and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, SP, Brazil
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Bongiovanni M, Barda B. Pseudomonas aeruginosa Bloodstream Infections in SARS-CoV-2 Infected Patients: A Systematic Review. J Clin Med 2023; 12:jcm12062252. [PMID: 36983256 PMCID: PMC10056033 DOI: 10.3390/jcm12062252] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Bacterial co-infections increase the severity of respiratory viral infections and are frequent causes of mortality in COVID-19 infected subjects. During the COVID-19 period, especially at the beginning of the pandemic, an inappropriate use of broad-spectrum antibiotic treatments has been frequently described, mainly due to prolonged hospitalization, especially in intensive care unit departments, and the use of immune-suppressive treatments as steroids. This misuse has finally led to the occurrence of infections by multi-drug resistant (MDR) bacteria in hospitalized COVID-19 patients. Although different reports assessed the prevalence of Gram-negative infections in COVID-19 infected patients, scarce data are currently available on bloodstream infections caused by Pseudomonas aeruginosa in hospitalized COVID-19 patients. The aim of our systematic review is to describe data on this specific population and to discuss the possible implications that these co-infections could have in the management of COVID-19 pandemics in the future. We systematically analysed the current literature to find all the relevant articles that describe the occurrence of P. aeruginosa bloodstream infections in COVID-19 patients. We found 40 papers that described in detail P. aeruginosa HAIs-BSI in COVID-19 patients, including 756,067 patients overall. The occurrence of severe infections due to MDR bacteria had a significant impact in the management of hospitalized patients with COVID-19 infections, leading to a prolonged time of hospitalization and to a consequent increase in mortality. In the near future, the increased burden of MDR bacteria due to the COVID-19 pandemic might partially be reduced by maintaining the preventive measures of infection control implemented during the acute phase of the COVID-19 pandemic. Finally, we discuss how the COVID-19 pandemic changed the role of antimicrobial stewardship in healthcare settings, according to the isolation of MDR bacteria and how to restore on a large scale the optimization of antibiotic strategies in COVID-19 patients.
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Gandra S, Alvarez-Uria G, Stwalley D, Nickel KB, Reske KA, Kwon JH, Dubberke ER, Olsen MA, Burnham JP. Microbiology Clinical Culture Diagnostic Yields and Antimicrobial Resistance Proportions before and during the COVID-19 Pandemic in an Indian Community Hospital and Two US Community Hospitals. Antibiotics (Basel) 2023; 12:antibiotics12030537. [PMID: 36978404 PMCID: PMC10044523 DOI: 10.3390/antibiotics12030537] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Studies comparing the impact of the COVID-19 pandemic on diagnostic microbiology culture yields and antimicrobial resistance proportions in low-to-middle-income and high-income countries are lacking. A retrospective study using blood, respiratory, and urine microbiology data from a community hospital in India and two community hospitals (Hospitals A and B) in St. Louis, MO, USA was performed. We compared the proportion of cultures positive for selected multi-drug-resistant organisms (MDROs) listed on the WHO’s priority pathogen list both before the COVID-19 pandemic (January 2017–December 2019) and early in the COVID-19 pandemic (April 2020–October 2020). The proportion of blood cultures contaminated with coagulase-negative Staphylococcus (CONS) was significantly higher during the pandemic in all three hospitals. In the Indian hospital, the proportion of carbapenem-resistant (CR) Klebsiella pneumoniae in respiratory cultures was significantly higher during the pandemic period, as was the proportion of CR Escherichia coli in urine cultures. In the US hospitals, the proportion of methicillin-resistant Staphylococcus aureus in blood cultures was significantly higher during the pandemic period in Hospital A, while no significant increase in the proportion of Gram-negative MDROs was observed. Continuity of antimicrobial stewardship activities and better infection prevention measures are critical to optimize outcomes and minimize the burden of antimicrobial resistance among COVID-19 patients.
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Affiliation(s)
- Sumanth Gandra
- Department of Internal Medicine, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, USA
- Correspondence: ; Tel.: +1-314-454-8354; Fax: +1-314-454-8687
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur 515661, India
| | - Dustin Stwalley
- Department of Internal Medicine, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, USA
| | - Katelin B. Nickel
- Department of Internal Medicine, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, USA
| | - Kimberly A. Reske
- Department of Internal Medicine, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, USA
| | - Jennie H. Kwon
- Department of Internal Medicine, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, USA
| | - Erik R. Dubberke
- Department of Internal Medicine, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, USA
| | - Margaret A. Olsen
- Department of Internal Medicine, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, USA
| | - Jason P. Burnham
- Department of Internal Medicine, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, USA
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21
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Kwon JH, Nickel KB, Reske KA, Stwalley D, Dubberke ER, Lyons PG, Michelson A, McMullen K, Sahrmann JM, Gandra S, Olsen MA, Burnham JP. Risk factors for hospital-acquired infection during the SARS-CoV-2 pandemic. J Hosp Infect 2023; 133:8-14. [PMID: 36493966 PMCID: PMC9724556 DOI: 10.1016/j.jhin.2022.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate risk factors for hospital-acquired infection (HAI) in patients during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, including historical and concurrent cohorts. DESIGN Retrospective cohort. SETTING Three Missouri hospitals, data from 1st January 2017 to 30th September 2020. PARTICIPANTS Patients aged ≥18 years and admitted for ≥48 h. METHODS Univariate and multi-variate Cox proportional hazards models incorporating the competing risk of death were used to determine risk factors for HAI. A-priori sensitivity analyses were performed to assess the robustness of the urine-, blood- and respiratory-culture-based HAI definition. RESULTS The cohort included 254,792 admissions, with 7147 (2.8%) HAIs (1661 blood, 3407 urine, 2626 respiratory). Patients with SARS-CoV-2 had increased risk of HAI (adjusted hazards ratio 1.65, 95% confidence interval 1.38-1.96), and SARS-CoV-2 infection was one of the strongest risk factors for development of HAI. Other risk factors for HAI included certain admitting services, chronic comorbidities, intensive care unit stay during index admission, extremes of body mass index, hospital, and selected medications. Factors associated with lower risk of HAI included year of admission (declined over the course of the study), admitting service and medications. Risk factors for HAI were similar in sensitivity analyses restricted to patients with diagnostic codes for pneumonia/upper respiratory infection and urinary tract infection. CONCLUSIONS SARS-CoV-2 was associated with significantly increased risk of HAI.
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Affiliation(s)
- J H Kwon
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - K B Nickel
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - K A Reske
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - D Stwalley
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - E R Dubberke
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - P G Lyons
- Division of Pulmonary and Critical Care Medicine, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - A Michelson
- Division of Pulmonary and Critical Care Medicine, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - K McMullen
- Mercy, Infection Prevention, St Louis, MO, USA
| | - J M Sahrmann
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - S Gandra
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - M A Olsen
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - J P Burnham
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA.
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Trends in Pseudomonas aeruginosa ( P. aeruginosa) Bacteremia during the COVID-19 Pandemic: A Systematic Review. Antibiotics (Basel) 2023; 12:antibiotics12020409. [PMID: 36830319 PMCID: PMC9952731 DOI: 10.3390/antibiotics12020409] [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: 12/23/2022] [Revised: 01/25/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Pseudomonas aeruginosa (P. aeruginosa) is among the most common pathogens associated with healthcare-acquired infections, and is often antibiotic resistant, causing significant morbidity and mortality in cases of P. aeruginosa bacteremia. It remains unclear how the incidence of P. aeruginosa bacteremia changed during the Coronavirus Disease 2019 (COVID-19) pandemic, with studies showing almost contradictory conclusions despite enhanced infection control practices during the pandemic. This systematic review sought to examine published reports with incidence rates for P. aeruginosa bacteremia during (defined as from March 2020 onwards) and prior to the COVID-19 pandemic. A systematic literature search was conducted in accordance with PRISMA guidelines and performed in Cochrane, Embase, and Medline with combinations of the key words (pseudomonas aeruginosa OR PAE) AND (incidence OR surveillance), from database inception until 1 December 2022. Based on the pre-defined inclusion criteria, a total of eight studies were eligible for review. Prior to the pandemic, the prevalence of P. aeruginosa was on an uptrend. Several international reports found a slight increase in the incidence of P. aeruginosa bacteremia during the COVID-19 pandemic. These findings collectively highlight the continued importance of good infection prevention and control and antimicrobial stewardship during both pandemic and non-pandemic periods. It is important to implement effective infection prevention and control measures, including ensuring hand hygiene, stepping up environmental cleaning and disinfection efforts, and developing timely guidelines on the appropriate prescription of antibiotics.
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Implementation of a hospital antimicrobial stewardship program to improve vancomycin use in Cyprus: Challenges and opportunity. Infect Prev Pract 2022; 4:100254. [PMID: 36387606 PMCID: PMC9646909 DOI: 10.1016/j.infpip.2022.100254] [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: 04/09/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background The Republic of Cyprus is among the highest consumers of antibacterials for systemic use in Europe. The antimicrobial resistance of invasive isolates in Cyprus is also high compared to the European Union. Formal antimicrobial stewardship initiatives are scarce in Cyprus, raising an urgent need to address the challenges for implementing hospital antimicrobial stewardship. Aim To implement an antimicrobial stewardship program and improve vancomycin use in a tertiary care hospital in Cyprus, through implementation of a protocol for treatment and therapeutic drug monitoring (TDM) and to discuss the current challenges present in Cyprus. Methods Following a local audit of practices, we established a hospital antimicrobial stewardship program with limited resources, towards a model of stewardship which included a persuasive approach, education, selective reporting of antimicrobial susceptibility, providing comments on the microbiology results and regular microbiology clinical ward rounds. Findings By implementing our vancomycin protocol, we achieved a statistically significant improvement (P<0.01) in achieving vancomycin therapeutic levels over a 2-year period, while improving administration practices. Conclusion Meaningful steps toward implementing a local antimicrobial stewardship program are possible even in resource-limited and unfavourable settings.
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Risk stratification for selecting empiric antibiotherapy during and after COVID-19. Curr Opin Infect Dis 2022; 35:605-613. [PMID: 36165454 DOI: 10.1097/qco.0000000000000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW SARS-CoV-2 deeply modified the risk of bacterial infection, bacterial resistance, and antibiotic strategies. This review summarized what we have learned. RECENT FINDINGS During the COVID-19 pandemic, we observed an increase in healthcare-acquired infection and multidrug-resistant organism-related infection, triggered by several factors: structural factors, such as increased workload and ongoing outbreaks, underlying illnesses, invasive procedures, and treatment-induced immunosuppression. The two most frequently healthcare-acquired infections described in patients hospitalized with COVID-19 were bloodstream infection, related or not to catheters, health-acquired pneumonia (in ventilated or nonventilated patients). The most frequent species involved in bacteremia were Gram-positive cocci and Gram-negative bacilli in health-acquired pneumonia. The rate of Gram-negative bacilli is particularly high in late-onset ventilator-associated pneumonia, and the specific risk of Pseudomonas aeruginosa- related pneumonia increased when the duration of ventilation was longer than 7 days. A specificity that remains unexplained so far is the increase in enterococci bacteremia. SUMMARY The choice of empiric antibiotimicrobials depends on several factors such as the site of the infection, time of onset and previous length of stay, previous antibiotic therapy, and known multidrug-resistant organism colonization. Pharmacokinetics of antimicrobials could be markedly altered during SARS-CoV-2 acute respiratory failure, which should encourage to perform therapeutic drug monitoring.
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Bauer KA, Puzniak LA, Yu KC, Finelli L, Moise P, Ai C, Watts JA, Gupta V. Epidemiology and outcomes of culture-positive bloodstream pathogens prior to and during the SARS-CoV-2 pandemic: a multicenter evaluation. BMC Infect Dis 2022; 22:841. [PMID: 36368931 PMCID: PMC9651895 DOI: 10.1186/s12879-022-07810-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Bloodstream infections (BSIs) are an important cause of morbidity and mortality in hospitalized patients. We evaluate incidence of community- and hospital-onset BSI rates and outcomes before and during the SARS-CoV-2 pandemic. Methods We conducted a retrospective cohort study evaluating patients who were hospitalized for ≥ 1 day with discharge or death between June 1, 2019, and September 4, 2021, across 271 US health care facilities. Community- and hospital-onset BSI and related outcomes before and during the SARS-CoV-2 pandemic, including intensive care admission rates, and overall and ICU-specific length of stay (LOS) was evaluated. Bivariate correlations were calculated between the pre-pandemic and pandemic periods overall and by SARS-CoV-2 testing status. Results Of 5,239,692 patient admissions, there were 20,113 community-onset BSIs before the pandemic (11.2/1000 admissions) and 39,740 (11.5/1000 admissions) during the pandemic (P ≤ 0.0062). Corresponding rates of hospital-onset BSI were 2,771 (1.6/1000 admissions) and 6,864 (2.0/1000 admissions; P < 0.0062). Compared to the pre-pandemic period, rates of community-onset BSI were higher in patients who tested negative for SARS-CoV-2 (15.8/1000 admissions), compared with 9.6/1000 BSI admissions among SARS-CoV-2-positive patients. Compared with patients in the pre-pandemic period, SARS-CoV-2-positive patients with community-onset BSI experienced greater ICU admission rates (36.6% vs 32.8%; P < 0.01), greater ventilator use (10.7% vs 4.7%; P < 0.001), and longer LOS (12.2 d vs 9.1 d; P < 0.001). Rates of hospital-onset BSI were higher in the pandemic vs the pre-pandemic period (2.0 vs 1.5/1000; P < 0.001), with rates as high a 7.3/1000 admissions among SARS-CoV-2-positive patients. Compared to the pre-pandemic period, SARS-CoV-2-positive patients with hospital-onset BSI had higher rates of ICU admission (72.9% vs 55.4%; P < 0.001), LOS (34.8 d vs 25.5 d; P < 0.001), and ventilator use (52.9% vs 21.5%; P < 0.001). Enterococcus species, Staphylococcus aureus, Klebsiella pneumoniae, and Candida albicans were more frequently detected in the pandemic period. Conclusions and relevance This nationally representative study found an increased risk of both community-onset and hospital-onset BSI during the SARS-CoV-2 pandemic period, with the largest increased risk in hospital-onset BSI among SARS-CoV-2-positive patients. SARS-CoV-2 positivity was associated with worse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07810-8.
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Wychimicins, a new class of spirotetronate polyketides from Actinocrispum wychmicini MI503-A4. J Antibiot (Tokyo) 2022; 75:535-541. [PMID: 36071214 PMCID: PMC9449258 DOI: 10.1038/s41429-022-00560-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022]
Abstract
In the course of our screening program for new anti-methicillin-resistant Staphylococcus aureus antibiotics, four novel antibiotics, termed wychimicins A–D, were isolated from the culture broth of the rare actinomycete Actinocrispum wychmicini strain MI503-AF4. Wychimicins are spirotetronates possessing a macrocyclic 13-membered ring containing trans-decalin and β-d-xylo-hexopyranose moieties connected to C-17 by an O-glycosidic linkage according to MS, NMR and X-ray analyses. In X-ray crystal structure analysis, the Flack constant was 0.10 (11). The stereochemistry of the spirocarbon C-25 was R. Wychimicins had a minimum inhibitory concentration of 0.125–2 µg ml−1 against methicillin-resistant Staphylococcus aureus.
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Velásquez-Garcia L, Mejia-Sanjuanelo A, Viasus D, Carratalà J. Causative Agents of Ventilator-Associated Pneumonia and Resistance to Antibiotics in COVID-19 Patients: A Systematic Review. Biomedicines 2022; 10:biomedicines10061226. [PMID: 35740246 PMCID: PMC9220146 DOI: 10.3390/biomedicines10061226] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with coronavirus disease 2019 (COVID-19) have an increased risk of ventilator-associated pneumonia (VAP). This systematic review updates information on the causative agents of VAP and resistance to antibiotics in COVID-19 patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, and LILACS databases from December 2019 to December 2021. Studies that described the frequency of causative pathogens associated with VAP and their antibiotic resistance patterns in critically ill COVID-19 adult patients were included. The Newcastle-Ottawa Quality Assessment Scale was used for critical appraisal. The data are presented according to the number or proportions reported in the studies. A total of 25 articles were included, involving 2766 VAP cases in COVID-19 patients (range 5–550 VAP cases). Most of the studies included were carried out in France (32%), Italy (20%), Spain (12%) and the United States (8%). Gram-negative bacteria were the most frequent causative pathogens of VAP (range of incidences in studies: P. aeruginosa 7.5–72.5%, K. pneumoniae 6.9–43.7%, E. cloacae 1.6–20% and A. baumannii 1.2–20%). S. aureus was the most frequent Gram-positive pathogen, with a range of incidence of 3.3–57.9%. The median incidence of Aspergillus spp. was 6.4%. Few studies have recorded susceptibility patterns among Gram-negative causative pathogens and have mainly reported extended-spectrum beta-lactamase (ESBL), AmpC, and carbapenem resistance. The median frequency of methicillin resistance among S. aureus isolates was 44.4%. Our study provides the first comprehensive description of the causative agents and antibiotic resistance in COVID-19 patients with VAP. Gram-negative bacteria were the most common pathogens causing VAP. Data on antibiotic resistance patterns in the published medical literature are limited, as well as information about VAP from low- and middle-income countries.
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Affiliation(s)
- Larry Velásquez-Garcia
- Department of Medicine, Division of Health Sciences, Universidad del Norte and Hospital Universidad del Norte, Barranquilla 081001, Colombia; (L.V.-G.); (A.M.-S.); (D.V.)
| | - Ana Mejia-Sanjuanelo
- Department of Medicine, Division of Health Sciences, Universidad del Norte and Hospital Universidad del Norte, Barranquilla 081001, Colombia; (L.V.-G.); (A.M.-S.); (D.V.)
| | - Diego Viasus
- Department of Medicine, Division of Health Sciences, Universidad del Norte and Hospital Universidad del Norte, Barranquilla 081001, Colombia; (L.V.-G.); (A.M.-S.); (D.V.)
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital—Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
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