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Kumar NR, Balraj TA, Shivashankar KK, Jayaram TC, Prashant A. Inflammaging in Multidrug-Resistant Sepsis of Geriatric ICU Patients and Healthcare Challenges. Geriatrics (Basel) 2024; 9:45. [PMID: 38667512 PMCID: PMC11049875 DOI: 10.3390/geriatrics9020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Multidrug-resistant sepsis (MDR) is a pressing concern in intensive care unit (ICU) settings, specifically among geriatric patients who experience age-related immune system changes and comorbidities. The aim of this review is to explore the clinical impact of MDR sepsis in geriatric ICU patients and shed light on healthcare challenges associated with its management. We conducted a comprehensive literature search using the National Center for Biotechnology Information (NCBI) and Google Scholar search engines. Our search incorporated keywords such as "multidrug-resistant sepsis" OR "MDR sepsis", "geriatric ICU patients" OR "elderly ICU patients", and "complications", "healthcare burdens", "diagnostic challenges", and "healthcare challenges" associated with MDR sepsis in "ICU patients" and "geriatric/elderly ICU patients". This review explores the specific risk factors contributing to MDR sepsis, the complexities of diagnostic challenges, and the healthcare burden faced by elderly ICU patients. Notably, the elderly population bears a higher burden of MDR sepsis (57.5%), influenced by various factors, including comorbidities, immunosuppression, age-related immune changes, and resource-limited ICU settings. Furthermore, sepsis imposes a significant economic burden on healthcare systems, with annual costs exceeding $27 billion in the USA. These findings underscore the urgency of addressing MDR sepsis in geriatric ICU patients and the need for tailored interventions to improve outcomes and reduce healthcare costs.
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Affiliation(s)
- Nishitha R. Kumar
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India; (N.R.K.); (K.K.S.)
| | - Tejashree A. Balraj
- Department of Microbiology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India;
| | - Kusuma K. Shivashankar
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India; (N.R.K.); (K.K.S.)
| | - Tejaswini C. Jayaram
- Department of Geriatrics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India;
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India; (N.R.K.); (K.K.S.)
- Department of Medical Genetics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India
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Roseau-Vincenti A, Forestier E, Lanoix JP, Ricard C, Carret MC, Caraux-Paz P, Paccalin M, Gavazzi G, Roubaud-Baudron C. Empirical antibiotic therapy modalities for Enterobacteriaceae bloodstream infections in older patients and their impact on mortality: a multicentre retrospective study. Infection 2024; 52:155-163. [PMID: 37608043 DOI: 10.1007/s15010-023-02073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/01/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Enterobacteriaceae (EB) bloodstream infections (BSI) are frequent and serious in older patients. Physicians are faced with the dilemma of prescribing early appropriate empirical antibiotics to limit the risk of death, and sparing broad-spectrum antibiotic prescription. The aim of the study was to assess the rate of appropriate empirical antibiotics prescription to treat EB BSI in older patients and its impact on survival. METHODS This study conducted in 49 centres enrolled retrospectively up to the 10 last consecutive patients aged 75 years and over and treated for EB BSI. Factors related to in-hospital death were investigated using logistic regression. RESULTS Among the 487 enrolled patients (mean age 86 ± 5.9 years), 70% had at least one risk factor of being infected by third-generation cephalosporins (3GC)-resistant strain; however, only 13.8% of EB strains were resistant to 3GC. An empirical antimicrobial treatment was initiated for 418 patients (85.8%), and for 86% (n = 360/418) of them, it was considered appropriate. In-hospital mortality was 12.7% (n = 62) and was related to the severity of infection (OR 3.17, CI 95% 1.75-5.75), while a urinary portal of entry was protective (OR 0.34, CI 95% 0.19-0.60). Neither the absence of nor inappropriate empirical antibiotics prescription was associated with increased mortality. CONCLUSION While patients enrolled in this study were at risk of being infected by multidrug-resistant bacteria, yet mainly treated with 3GC, empirical antibiotics prescription was appropriate in most cases and did not influence mortality.
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Affiliation(s)
| | | | | | - Cécile Ricard
- Epidémiologiste/statisticienne indépendante, Annecy, France
| | | | - Pauline Caraux-Paz
- Maladies infectieuses CH Intercommunal Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | | | - Gaëtan Gavazzi
- Clinique universitaire de médecine gériatrique, CHU Grenoble-Alpes, Grenoble, France
| | - Claire Roubaud-Baudron
- CHU Bordeaux, Pôle de gérontologie clinique, 33000, Bordeaux, France.
- Univ. Bordeaux, BRIC Bordeaux Institute of Oncology INSERM UMR 1312, 33000, Bordeaux, France.
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Quang HV, Nhung LTK, Thuy PTT, Quyen PC, Huy LB, Dung HS. Blood-Stream Infections: Causative Agents, Antibiotic Resistance and Associated Factors in Older Patients. Mater Sociomed 2024; 36:82-89. [PMID: 38590604 PMCID: PMC10999148 DOI: 10.5455/msm.2024.36.82-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Background The rate of multi-drug antibiotic resistance in nosocomial bloodstream infections in elderly patients is increasing. This study examined the data for bloodstream infections to gain a better understanding of bacterial antibiotic resistance. Methods This was a retrospective study of 817 patients with the first positive blood culture between January 1, 2016 and December 31, 2019. Results Moyen's age was 77.4 ± 9.8 years, male (52.4%) and SOFA 5.0 ± 4. ESBL(+) rate was 78/817 (9.5%). ESBL(+) rate for Escherichia coli and Klebsiella pneumoniae was 69/141 (48.9%) and 9/52 (17.3%), respectively. The most common isolates were Escherichia coli (17.3%), Stenotrophomonas maltophilia (13.7%), and Staphylococcus species (23.1%). The rate of septic shock and mortality accounted for 22.3% and 28.9%, respectively. Escherichia coli is highly sensitive to carbapenem, and resistant (>50%) with quinolone and aminoside. Klebsiella pneumoniae and Pseudomonas aeruginosa were highly sensitive to carbapenem. Acinetobacter baumannii was resistant to meropenem (75%). Stenotrophomonas maltophilia was sensitive to quinolone (13.8 %), and highly resistant to remaining antibiotics. Methicillin-resistant Staphylococcus aureus had a low resistance rate for vancomycin, teicoplanin, and linezolid. Multivariate analysis showed that the significant factors associated with mortality were age >75; SOFA >7; respiratory infection; intensive care unit treatment and presentation with septic shock. Conclusion The mortality rate was still high, especially for antibiotic-resistant agents.
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Affiliation(s)
- Hoang-Van Quang
- Department of Internal Medicine, Medical Faculty, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Le-Thi Kim Nhung
- Department of Internal Medicine, Medical Faculty, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
| | | | - Phan Chau Quyen
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Le Bao Huy
- Department of Emergency Medicine, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Ho Si Dung
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
- Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
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Intrinsic values of procalcitonin in bacterial bloodstream infections in people aged 75 years and over: a retrospective study. Diagn Microbiol Infect Dis 2023; 105:115887. [PMID: 36640698 DOI: 10.1016/j.diagmicrobio.2022.115887] [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: 07/21/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate PCT measurement in the diagnosis of bloodstream infection (BSI) in hospitalized patients aged 75+. METHOD Descriptive, retrospective, monocentric study conducted in France, in patients with at least one blood culture and PCT and CRP measurements within the 24 hours before or after blood culture. RESULTS The mean PCT and CRP values for the 118 (15.2%) positive blood cultures were 18.90 ng/ml [95%CI: 0.007-334.7] and 153.93 mg/l [1-557], respectively. With a threshold of 0.3 ng/ml, PCT measurement had a sensitivity of 84%, a specificity of 53%, a PPV of 24%, and an NPV of 95%, making it possible to rule out BSI in 350 (45.1%) patients (α-risk=5%). CONCLUSION PCT measurement may eliminate BSI diagnosis more quickly than does blood culture reducing the inadequate and detrimental use of antibiotic therapy. A prospective study is required to validate its usefulness and confirm the cut-off value in geriatric populations.
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Hernández-Quiles R, Merino-Lucas E, Boix V, Fernández-Gil A, Rodríguez-Díaz JC, Gimeno A, Valero B, Sánchez-Martínez R, Ramos-Rincón JM. Bacteraemia and quick Sepsis Related Organ Failure Assessment (qSOFA) are independent risk factors for long-term mortality in very elderly patients with suspected infection: retrospective cohort study. BMC Infect Dis 2022; 22:248. [PMID: 35279079 PMCID: PMC8918285 DOI: 10.1186/s12879-022-07242-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background In older adult patients, bloodstream infections cause significant mortality. However, data on long-term prognosis in very elderly patients are scarce. This study aims to assess 1-year mortality from bacteraemia in very elderly patients.
Methods Retrospective cohort study in inpatients aged 80 years or older and suspected of having sepsis. Patients with (n = 336) and without (n = 336) confirmed bacteraemia were matched for age, sex, and date of culture, and their characteristics were compared. All-cause mortality and risk of death were assessed using the adjusted hazard ratio (aHR). Results Compared to controls, cases showed a higher 1-year mortality (34.8% vs. 45.2%) and mortality rate (0.46 vs. 0.69 deaths per person-year). Multivariable analysis showed significant risk of 1-year mortality in patients with bacteraemia (aHR: 1.31, 95% confidence interval [CI] 1.03–1.67), quick Sepsis Related Organ Failure Assessment (qSOFA) score of 2 or more (aHR: 2.71, 95% CI 2.05–3.57), and age of 90 years or older (aHR 1.53, 95% CI 1.17–1.99). Conclusions In elderly patients suspected of sepsis, bacteraemia is associated with a poor prognosis and higher long-term mortality. Other factors related to excess mortality were age over 90 years and a qSOFA score of 2 or more.
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Bloodstream infections in the elderly: what is the real goal? Aging Clin Exp Res 2021; 33:1101-1112. [PMID: 31486996 DOI: 10.1007/s40520-019-01337-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022]
Abstract
Bloodstream infections (BSI) represent a serious bacterial infection with substantial morbidity and mortality. Population-based studies demonstrate an increased incidence, especially among elderly patients. Controversy exists regarding whether presentation of BSI are different in older patients compared to younger patients; our narrative review of the literature suggests that BSI in elderly patients would probably include one or more of the traditional symptoms/signs of fever, severe sepsis or septic shock, acute kidney injury, and/or leukocytosis. Sources of BSI in older adults are most commonly the urinary tract (more so than in younger adults) and the respiratory tract. Gram-negative bacteria are the most common isolates in the old (~ 40-60% of BSI); isolates from the elderly patient population show higher antibiotic resistance rates, with long-term care facilities serving as reservoirs for multidrug-resistant bacteria. BSI entail significantly higher rates of mortality in older age, both short and long term. Some of the risk factors for mortality are modifiable, such as the appropriateness of empirical antibiotic therapy and nosocomial acquisition of infection. Health-related quality of life issues regarding the elderly patient with BSI are not well addressed in the literature. Utilization of comprehensive geriatric assessment and comprehensive geriatric discharge planning need to be investigated further in this setting and might serve as key for improved results in this population. In this review, we address all these aspects of BSI in old patients with emphasis on future goals for management and research.
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Giovannenze F, Murri R, Palazzolo C, Taccari F, Camici M, Spanu T, Posteraro B, Sanguinetti M, Cauda R, Onder G, Fantoni M. Predictors of mortality among adult, old and the oldest old patients with bloodstream infections: An age comparison. Eur J Intern Med 2021; 86:66-72. [PMID: 33414015 DOI: 10.1016/j.ejim.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bloodstream infections (BSIs) are a major cause of mortality in elderly. Objective of the study is to identify factors predictive of mortality in old and oldest old patients. METHODS This is a single centre retrospective observational study, including all patients admitted to Fondazione Policlinico A. Gemelli university hospital and diagnosed with BSI. Patients were stratified into three groups according to age: adult (A), younger than 65; old (O), aged between 65 and 80; oldest old (OO), older than 80. Primary outcome was 30-day in-hospital mortality. Secondary outcomes were duration of antimicrobial therapy (DOT) and length of hospital stay (LOS). RESULTS Of the 1034 patients included in the study, 346 were in group A, 447 in group O and 241 in group OO. The rate of 30-day mortality raised from 6.9% (24/346) in group A to 10.8% (84/447) in group O and 33.2% (80/241) in group OO (p<0.01), while DOT and LOS significantly decreased moving from adults to oldest old (p<0.01). Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus spp were both independently correlated to an increased 30-day mortality risk selectively in patients older than 80 (MRSA: HR 2.37, p=0.03; Enterococcus spp: HR 2.44, p=0.01). CONCLUSIONS BSIs have a high impact on survival in old and oldest old patients. BSIs by gram-positive pathogens, in particular MRSA and Enterococcus spp, should be a wake-up call for physicians, who should focus efforts on adequate and prompt antibiotic and support treatment.
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Affiliation(s)
- Francesca Giovannenze
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy.
| | - Rita Murri
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Claudia Palazzolo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; Istituto Nazionale Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Francesco Taccari
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Marta Camici
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; Istituto Nazionale Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Teresa Spanu
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica S. Cuore, Rome, Italy
| | - Brunella Posteraro
- Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica S. Cuore, Rome, Italy
| | - Roberto Cauda
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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Wilke M, Hübner C, Kämmerer W. Calculated parenteral initial treatment of bacterial infections: Economic aspects of antibiotic treatment. GMS INFECTIOUS DISEASES 2020; 8:Doc03. [PMID: 32373428 PMCID: PMC7186923 DOI: 10.3205/id000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the seventeenth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. This chapter analyses economic aspects of antiinfective therapy. Any treatment decision is also a cost decision. In this chapter the authors particularly analyse whether or not there is evidence that certain clinically effective strategies as Antimicrobial Stewardship programs (AMS), guideline adherent initial therapy, early diagnostics, De-escalation, sequence therapy or therapeutic drug monitoring also have benficial economic effects. These can be direct savings or shortening of length of stay to free resources.
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Affiliation(s)
| | - Claudia Hübner
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Universität Greifswald, Germany
| | - Wolfgang Kämmerer
- Klinische Pharmazie, Apotheke des Universitätsklinikums Augsburg, Germany
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Jiménez-Aguilar P, López-Cortés LE, Rodríguez-Baño J. Impact of infectious diseases consultation on the outcome of patients with bacteraemia. Ther Adv Infect Dis 2019; 6:2049936119893576. [PMID: 31839942 PMCID: PMC6900613 DOI: 10.1177/2049936119893576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/15/2019] [Indexed: 12/29/2022] Open
Abstract
Bacteraemia or bloodstream infections (BSI) are associated with much morbidity and mortality. Management of patients with bacteraemia is complex, and the increase in immunosuppressed patients and multidrug-resistant organisms poses additional challenges. The objective of this review is to assess the available published information about the impact of different aspects of management on the outcome of patients with BSI, and, specifically, the importance of infectious diseases specialists (IDS) consultation. The impact of management by IDS on different aspects, including interpretation of newer rapid techniques, early evaluation and treatment, and follow up, are reviewed. Overall, the available data suggest that IDS intervention improves the management and outcome of patients with BSI, either through consultation or structured unsolicited interventions in the context of multidisciplinary bacteraemia programmes.
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Affiliation(s)
- Patricia Jiménez-Aguilar
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
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Atypical Presentation of Bacteremia in Older Patients Is a Risk Factor for Death. Am J Med 2019; 132:1344-1352.e1. [PMID: 31163127 DOI: 10.1016/j.amjmed.2019.04.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The absence of fever in bacteremia in patients who are older is known to delay diagnosis. Our objective was to determine whether atypical presentation was associated to mortality as a result of bacteremia in this patient cohort as well as possible factors associated with this atypical presentation. METHODS We conducted an observational prospective study in 2 French university hospitals in 2016-2017 including patients ages ≥75 years with bacteremia. Atypical presentation was defined as the absence of a temperature ≥38.3°C or <36°C, chills, or hypotension. Mortality and dependence for activities of daily living (ADL) were recorded at 1 week (D7) and 3 months (D90). RESULTS Among the 151 patients (mean age 85.4±5.8 years) enrolled, atypical presentation prevalence was 21.2%. D7 and D90 mortality rates were 7.9% and 40.0%, respectively. Atypical presentation was independently associated with D7 (odds ratio (OR) 4.46, 95% confidence interval (CI) 1.04-19.24) and D90 mortality (OR 3.76, 95% CI 1.30-10.92) after controlling for other prognostic factors. Patients with diabetes and those infected with Staphylococcus aureus were more likely to have atypical signs of infection. ADL score decreased from 3.6±2.0 before bacteremia to 2.8±2.1 at D90 (P <0.001). CONCLUSION Patients who are older with bacteremia have poor vital and functional prognoses in the short and long terms. The absence of typical signs of infection is associated with mortality. Blood culture should be considered for patients who are older, especially with diabetes with acute unexplained clinical manifestations.
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Ramos-Rincón JM, Fernández-Gil A, Merino E, Boix V, Gimeno A, Rodríguez-Diaz JC, Valero B, Sánchez-Martínez R, Portilla J. The quick Sepsis-related Organ Failure Assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: A retrospective observational study. Sci Rep 2019; 9:15075. [PMID: 31636319 PMCID: PMC6803690 DOI: 10.1038/s41598-019-51439-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 10/01/2019] [Indexed: 01/09/2023] Open
Abstract
People over 80 years old are now the fastest-growing age group. Bloodstream infections (BSI) in these patients may present with specific characteristics. The objective of this study was to analyze independent factors affecting in-hospital mortality (IHM) due to BSI in very elderly patients (≥80 years of age) and to compare the clinical presentation of BSI in patients aged 80–89 years versus those aged 90 or more. Retrospective, cross-sectional and observational study of BSI in patients aged 80 years or older. The study used IHM as the primary outcome. Stepwise multiple logistic regression models were used to identify associations between potential predictors and IHM. Of the 336 included patients, 76.8% (n = 258) were in the 80–89-year age group and 23.2% (n = 78) in the 90+ age group; 17.3% (n = 58) of patients died during admission. This outcome was independently associated with quick Sepsis Related Organ Failure Assessment (qSOFA) of 2 or more (adjusted odds ratio [aOR] 4.7, 95% confidence interval [CI] 2.3–9.4; p < 0.001). Other predictors included an origin of BSI outside the urinary tract (aOR 5.5, 95% CI 2.4–12.6; p < 0.001), thrombocytopenia (aOR 4.9, 95% CI 1.8–13.4; p = 0.002), hospital-acquired infection (aOR 3.0, 95% CI 1.2–7.5; p = 0.015), and inappropriate empiric antibiotics (aOR 2.0, 95% CI 1.1–3.9; p = 0.04). IHM was 23.1% in the 90+ age group and 15.5% in patients aged 80 to 89 (p = 0.012). However, the 90+ age group was more likely to have a score of at least 2 on the qSOFA (29.9% vs. 19.1%, p = 0.043) and Pitt bacteremia scales (44.9% vs. 30.2%; p = 0.02), as well as chronic kidney disease (56.4% vs. 36.0%; p = 0.001) and altered mental state (40.3% vs. 25.7%; p = 0.013). In conclusion: A qSOFA score of 2 or more and a BSI originating outside the urinary tract were independent predictors of IHM. The 90+ age group was at higher risk than the 80–89-year age group of having a qSOFA score and Pitt bacteremia score of 2 or more as well as an altered mental state.
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Affiliation(s)
- José M Ramos-Rincón
- Department of Internal Medicine. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain. .,Miguel Hernández University of Elche. San Joan d'Alacant Campus, Alicante, Spain.
| | - Adela Fernández-Gil
- Miguel Hernández University of Elche. San Joan d'Alacant Campus, Alicante, Spain
| | - Esperanza Merino
- Infectious Diseases Unit. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Vicente Boix
- Miguel Hernández University of Elche. San Joan d'Alacant Campus, Alicante, Spain.,Infectious Diseases Unit. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Adelina Gimeno
- Microbiology Service. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Juan C Rodríguez-Diaz
- Microbiology Service. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Beatriz Valero
- Department of Internal Medicine. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Rosario Sánchez-Martínez
- Department of Internal Medicine. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
| | - Joaquín Portilla
- Department of Internal Medicine. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain.,Miguel Hernández University of Elche. San Joan d'Alacant Campus, Alicante, Spain.,Infectious Diseases Unit. General University Hospital of Alicante and Institute for Health and Biomedical Research of Alicante (ISABIAL- Foundation FISABIO), Alicante, Spain
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Papadimitriou-Olivgeris M, Psychogiou R, Garessus J, Camaret AD, Fourre N, Kanagaratnam S, Jecker V, Nusbaumer C, Monnerat LB, Kocher A, Portillo V, Duplain H. Predictors of mortality of bloodstream infections among internal medicine patients in a Swiss Hospital: Role of quick Sequential Organ Failure Assessment. Eur J Intern Med 2019; 65:86-92. [PMID: 31128976 DOI: 10.1016/j.ejim.2019.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sepsis has been associated with high morbidity and mortality. The aims were to determine predictors of mortality among patients with bloodstream infections (BSIs) and to ascertain the role of quick Sequential Organ Failure Assessment (qSOFA) in predicting poor outcomes. METHODS All internal medicine patients with BSIs at the Hospital of Jura, Switzerland during a three year period (July 2014 to June 2017) were included. RESULTS Among 404 BSIs, Escherichia coli represented the most common species isolated (156 episodes; 38.6%), followed by Staphylococcus aureus (68; 16.8%). The most common site of infection was urinary tract accounting for 39.6% of BSIs (160 episodes). Thirty-day mortality was 18.1%. Multivariate analysis revealed BSI due to staphylococci, malignancy (haematologic or solid organ), qSOFA≥2 points, Pitt bacteraemia score as independent predictors of mortality, while appropriate empiric antibiotic therapy and administration of antibiotic therapy within three hours from infection's recognition were identified as a predictor of good prognosis. qSOFA showed the highest sensitivity (87.7%), negative predictive value (96.6%) and accuracy (0.83) as compared to other scores. Mortality among 141 septic patients was 45.4%. Malignancy (haematologic or solid organ), primary BSI, Pitt bacteraemia score, were independently associated with mortality, while appropriate empiric antibiotic therapy and administration of antibiotic therapy within the first hour from infection's recognition were associated with better prognosis. CONCLUSION qSOFA as compared to other severity scores showed an excellent negative predictive value. Better prognosis was associated with administration of appropriate empiric antibiotic therapy and its timely initiation.
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Affiliation(s)
| | - Roxanni Psychogiou
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Jonathan Garessus
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Adeline De Camaret
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Nicolas Fourre
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | | | - Virginie Jecker
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | | | | | - Alain Kocher
- Intensive Care Unit, Hospital of Jura, Delémont, Switzerland
| | - Vera Portillo
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Hervé Duplain
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
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13
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Sousa A, Pérez-Rodríguez MT, Suárez M, Val N, Martínez-Lamas L, Nodar A, Longueira R, Crespo M. Short- versus long-course therapy in gram-negative bacilli bloodstream infections. Eur J Clin Microbiol Infect Dis 2019; 38:851-857. [PMID: 30680566 DOI: 10.1007/s10096-019-03467-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/02/2019] [Indexed: 11/25/2022]
Abstract
Bacteremia due to gram-negative bacilli (GNB) is one of the most frequent causes of admission and prolongation of hospital stay. Nevertheless, optimal duration of antibiotic treatment is not clearly established. We designed an observational, prospective study of a cohort of adult patients with uncomplicated GNB bacteremia. They were classified according to the duration of treatment in short (7-10 days) or long (> 10 days) course. Mortality and bacteremia recurrence rate were evaluated, and propensity score for receiving short-course treatment was calculated. A total of 395 patients met eligibility criteria including 232 and 163 who received long- and short-course therapy, respectively. Median age was 71 years, 215 (54.4% male) and 51% had a urinary source. Thirty-day mortality was 12%. In multivariate analysis by logistic regression stratified according to propensity score quartile for receiving short-course therapy showed no association of duration of treatment with 30-day mortality or 90-day recurrence rate. Based on the results observed in our cohort, short-course therapy could be as safe and effective as longer courses.
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Affiliation(s)
- Adrian Sousa
- Infectious Diseases Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, IIS Galicia Sur, Estrada Clara Campoamor 341, 36212, Vigo, Pontevedra, Spain.
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro Bloque Técnico, Estrada Clara Campoamor 341, 36312, Vigo, Spain.
| | - María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, IIS Galicia Sur, Estrada Clara Campoamor 341, 36212, Vigo, Pontevedra, Spain
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro Bloque Técnico, Estrada Clara Campoamor 341, 36312, Vigo, Spain
| | - Milagros Suárez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, IIS Galicia Sur, Estrada Clara Campoamor 341, 36212, Vigo, Pontevedra, Spain
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro Bloque Técnico, Estrada Clara Campoamor 341, 36312, Vigo, Spain
| | - Nuria Val
- Infectious Diseases Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, IIS Galicia Sur, Estrada Clara Campoamor 341, 36212, Vigo, Pontevedra, Spain
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro Bloque Técnico, Estrada Clara Campoamor 341, 36312, Vigo, Spain
| | - Lucía Martínez-Lamas
- Microbiology Department, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Andrés Nodar
- Infectious Diseases Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, IIS Galicia Sur, Estrada Clara Campoamor 341, 36212, Vigo, Pontevedra, Spain
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro Bloque Técnico, Estrada Clara Campoamor 341, 36312, Vigo, Spain
| | - Rebeca Longueira
- Infectious Diseases Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, IIS Galicia Sur, Estrada Clara Campoamor 341, 36212, Vigo, Pontevedra, Spain
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro Bloque Técnico, Estrada Clara Campoamor 341, 36312, Vigo, Spain
| | - Manuel Crespo
- Infectious Diseases Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, IIS Galicia Sur, Estrada Clara Campoamor 341, 36212, Vigo, Pontevedra, Spain
- Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro Bloque Técnico, Estrada Clara Campoamor 341, 36312, Vigo, Spain
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14
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Sousa A, Pérez-Rodríguez MT, Suarez M, Val N, Martínez-Lamas L, Nodar A, Crespo M. Validation of a clinical decision tree to predict if a patient has a bacteraemia due to a β-lactamase producing organism. Infect Dis (Lond) 2018; 51:32-37. [PMID: 30371118 DOI: 10.1080/23744235.2018.1508883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND In recent years, several scores and algorithms have been developed in order to guide empirical antibiotic treatment in patients with gram-negative bacilli (GNB) bacteraemia according to the risk of extended-spectrum β-lactamase (BL) producing. Some of these algorithms do not have easy applicability or present some limitations in their validation. The aim of our study was to validate a recently designed decision tree in our prospective cohort of bacteraemia due to gram-negative bacilli. METHODS We prospectively identified and analyzed all bacteraemia due to gram-negative bacilli in adult patients in our centre between January 2015 and December 2016. Previously developed clinical decision tree was used to classify patients in each of the terminal nodes. Patients were classified as BL group according to whether they were producers of any type of BL. The statistical power of the tree was analyzed by receiver operating characteristics (ROC) curve and by calculation of C-statistics. RESULTS A total of 448 episodes of bacteraemia were included; 132 (29.5%) were BL group; 68 (15.1%) ESBL producing, 43 (9.6%) due to AmpC and 21 (4.7%) isolates of Pseudomonas aeruginosa. The original clinical decision tree was modified according to the results of our multivariate analysis. The modified tree has a sensitivity of 71%, specificity of 92%, predictive positive value (PPV) of 79% and predictive negative value (NPV) of 88% generating an ROC curve with a C-statistic of 0.76. CONCLUSIONS An easy-to-apply clinical decision tree could be used at the exact moment of diagnosis and adjust the empirical antibiotic treatment in patients with gram-negative bacilli bacteraemia.
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Affiliation(s)
- Adrian Sousa
- a Infectious Diseases Unit-Internal Medicine Department , Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - María Teresa Pérez-Rodríguez
- a Infectious Diseases Unit-Internal Medicine Department , Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - Milagros Suarez
- a Infectious Diseases Unit-Internal Medicine Department , Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - Nuria Val
- a Infectious Diseases Unit-Internal Medicine Department , Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - Lucia Martínez-Lamas
- b Infectious Diseases Unit-Microbiology Department , Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - Andrés Nodar
- a Infectious Diseases Unit-Internal Medicine Department , Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - Manuel Crespo
- a Infectious Diseases Unit-Internal Medicine Department , Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo , Vigo , Spain
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15
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Almog M, Yanovskay A, Edelstein H, Schwartz N, Colodner R, Chazan B. Increasing Antimicrobial Resistance in Long-Term Care Facility Patients With Bacteremia: A 5 Year's Surveillance. J Am Med Dir Assoc 2018; 19:1024-1026.e1. [PMID: 30122324 DOI: 10.1016/j.jamda.2018.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Moty Almog
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel
| | - Anna Yanovskay
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel
| | - Hana Edelstein
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel
| | - Naama Schwartz
- Statistics and Epidemiology, Emek Medical Center, Afula, Israel
| | - Raul Colodner
- Laboratory Medicine Department, Emek Medical Center, Afula, Israel
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel
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16
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Chapelet G, Boureau AS, Dylis A, Herbreteau G, Corvec S, Batard E, Berrut G, de Decker L. Association between dementia and reduced walking ability and 30-day mortality in patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia. Eur J Clin Microbiol Infect Dis 2017; 36:2417-2422. [PMID: 28801698 DOI: 10.1007/s10096-017-3077-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022]
Abstract
Previous studies have shown controversial results of factors associated with short-term mortality in patients with extended-spectrum beta-lactamase (ESBL)-producing E. coli bacteremia and no research has investigated the impact of the geriatric assessment criteria on short-term mortality. Our objective was to determine whether dementia and walking ability are associated with 30-day mortality in patients with ESBL-producing E. coli bacteremia. All blood bottle cultures, analyzed from January 2008 to April 2015, in the Bacteriology Department of a 2,600-bed, university-affiliated center, Nantes, France, were retrospectively extracted. Factors associated with short-term mortality in patients with ESBL-producing E. coli bacteremia: 140 patients with an ESBL-producing E. coli bloodstream infection were included; 22 (15.7%) patients died within 30 days following the first positive blood bottle culture of ESBL-producing E.coli. In multivariate analysis, a reduced ability to walk (OR = 0.30; p = 0.021), presence of dementia (OR = 54.51; p = 0.040), a high Sepsis-related Organ Failure Assessment (SOFA) score (OR = 1.69; p < 0.001), presence of neutropenia (OR = 12.94; p = 0.049), and presence of a urinary tract infection (OR = 0.07; p = 0.036), were associated with 30-day mortality. Our findings provide new data showing an independent association between 30-day mortality with dementia and reduced walking ability, in patients with ESBL-producing E. coli bacteremia. These criteria should be considered in the therapeutic management of patients with ESBL-producing E. coli bacteremia.
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Affiliation(s)
- G Chapelet
- EE Microbiotas, Hosts, Antibiotics and bacterial Resistances (MiHAR) Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Bénoni-Goullin, 44200, Nantes, France. .,Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France. .,Faculté de médecine-Porte 438, 1 rue Gaston Veil, 44035, Nantes cedex 1, France.
| | - A S Boureau
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - A Dylis
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - G Herbreteau
- Bacteriology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - S Corvec
- Bacteriology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - E Batard
- EE Microbiotas, Hosts, Antibiotics and bacterial Resistances (MiHAR) Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Bénoni-Goullin, 44200, Nantes, France.,Emergency Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - G Berrut
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - L de Decker
- EE Microbiotas, Hosts, Antibiotics and bacterial Resistances (MiHAR) Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Bénoni-Goullin, 44200, Nantes, France.,Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France
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17
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Del Arco A, Olalla J, de la Torre J, Blázquez A, Montiel-Quezel N, Prada JL, Rivas F, García-Alegría J, Fernández-Sánchez F. Results of an early intervention programme for patients with bacteraemia: analysis of prognostic factors and mortality. BMC Infect Dis 2017; 17:360. [PMID: 28532458 PMCID: PMC5440927 DOI: 10.1186/s12879-017-2458-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 05/10/2017] [Indexed: 11/28/2022] Open
Abstract
Background Bacteraemia is a common cause of morbidity and mortality in patients admitted to hospital. The aim of this study is to analyse the results of a two-year programme for the early optimisation of antibiotic treatment in patients admitted to the Costa del Sol Hospital (Marbella. Spain). Methods A prospective two-year cohort study was conducted, evaluating all episodes of bacteraemia at the Costa del Sol Hospital. Epidemiological and microbiological characteristics, any modification of the initial antibiotic treatment, prognostic risk stratification, early mortality related to the episode of bacteraemia, and mortality after the seventh day, were included in the analysis. Results Seven hundred seventy-three episodes of bacteraemia were treated, 61.6% males and 38.4% females. The mean age was 65.2 years. The condition was most commonly acquired in the community (41.4%). The bacteraemia was most frequently urological in nature (30.5%), and E coli was the microorganism most frequently isolated (31.6%). In 51.1% of the episodes, a modification was made to optimise the treatment. In the first week, 8.2% died from bacteraemia, and 4.5% had died when they were located. The highest rates of death were associated with older patients, nosocomial acquisition, no source, McCabe score rapidly fatal, Charlson index ≥3, Pitt index ≥3 and treatment remained unmodified. Conclusion The existence of bacteraemia control programmes and teams composed of clinicians who are experienced in the treatment of infectious diseases, can improve the disease outcome by enabling more severe episodes of bacteraemia to be recognised and their empirical treatment optimised.
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Affiliation(s)
- A Del Arco
- Infectious Diseses Group. Internal Medicine Unit. Costa del Sol Hospital, 29603, Marbella, Málaga, Spain.
| | - J Olalla
- Infectious Diseses Group. Internal Medicine Unit. Costa del Sol Hospital, 29603, Marbella, Málaga, Spain
| | - J de la Torre
- Infectious Diseses Group. Internal Medicine Unit. Costa del Sol Hospital, 29603, Marbella, Málaga, Spain
| | - A Blázquez
- Infectious Diseses Group. Internal Medicine Unit. Costa del Sol Hospital, 29603, Marbella, Málaga, Spain
| | | | - J L Prada
- Infectious Diseses Group. Internal Medicine Unit. Costa del Sol Hospital, 29603, Marbella, Málaga, Spain
| | - F Rivas
- Research Support Unit, Hospital Costa del Sol, Marbella, Spain.,Health Services and Chronic Disease Research Network (REDISSEC), Marbella, Spain
| | - J García-Alegría
- Infectious Diseses Group. Internal Medicine Unit. Costa del Sol Hospital, 29603, Marbella, Málaga, Spain
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Bloodstream infections caused by Enterococcus spp: A 10-year retrospective analysis at a tertiary hospital in China. ACTA ACUST UNITED AC 2017; 37:257-263. [PMID: 28397040 DOI: 10.1007/s11596-017-1725-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/07/2016] [Indexed: 12/28/2022]
Abstract
In order to discover the risk factors for 30-day mortality in bloodstream infections (BSI) caused by Enterococcus spp. strains, we explored the clinical and therapeutic profile of patients with Enterococcus spp. BSI and the characteristics of this condition. A total of 64 patients with BSI caused by Enterococcus spp. who were treated in our hospital between 2006 and 2015 were included in the study. The clinical features of patients, microbiology, and 30-day mortality were collected from the electronic medical records database and analyzed. The results showed that there were 38 patients infected by Enterococcus faecalis (E. faecalis), 24 by Enterococcus faecium (E. faecium), 1 by Enterococcus casseliflavus (E. casseliflavus), and 1 by Enterococcus gallinarum (E. gallinarum). A Charlson comorbidity score ≥5, corticosteroid treatment, placement of catheters or other prosthetic devices and history of antibiotic use were found more frequently in E. faecium BSI patients than in E. faecalis patients (P=0.017, P=0.027, P=0.008 and P=0.027, respectively). Furthermore, the univariate and multivariate analysis showed that corticosteroid treatment (OR=17.385, P=0.008), hospital acquisition (OR=16.328, P=0.038), and vascular catheter infection (OR=14.788, P=0.025) were all independently associated with 30-day mortality. Our results indicate that E. faecalis and E. faecium are two different pathogens with unique microbiologic characteristics, which cause different clinical features in BSI, and the empiric antimicrobial treatments are paramount for patients with enterococcal BSI.
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Kadia BM, Dimala CA, Aroke D, Ekabe CJ, Kadia RSM, Mefire AC. A prospective analysis of pinch grafting of chronic leg ulcers in a series of elderly patients in rural Cameroon. BMC DERMATOLOGY 2017; 17:4. [PMID: 28320360 PMCID: PMC5360079 DOI: 10.1186/s12895-017-0056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/16/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chronic leg ulcers (CLUs) pose serious public health concerns worldwide. They mainly affect the elderly population. Pinch grafting (PG) could be used to treat a variety of CLUs. However, in Cameroon, there is scarce data on the outcome of PG of CLUs in elderly patients in rural hospitals where most of these patients seek for medical attention and where clinicians rely on unconventional wound dressing methods to treat CLUs. Our objective was to describe the outcome of PG of CLUs in elderly patients in rural Cameroon. METHODS This was a prospective study conducted in a rural hospital of North West Cameroon. From February 2015 to January 2016, comprehensive historical and clinical data were collected per elderly patient who presented with a chronic leg ulcer necessitating PG. PG was done using a simple procedure and each patient followed up for 8 months. Outcome was described in terms of ulcer healing and pain and donor site complications. RESULTS Our series included 13 patients: 8 males (61.54%; 95% CI: 31.58-86.14) and 5 females (38.46%; 95% CI: 13.86-68.42) aged from 69 to 88 years (mean: 77.54 ± 5.70 years). Three patients (23.08%; 95% CI: 5.04-53.81) had associated co-morbidities. All the ulcers were unilateral with durations ranging from 7 to 41 months (mean: 19.46 ± 11.03 months). The ulcers ranged in size from 9.0 to 38.1 cm2 (mean: 17.66 ± 8.35 cm 2). We registered one (7.69%; 95% CI: 0.19-36.03) graft rejection. Concerning the other ulcers, ten (83.33%; 95% CI: 51.59-97.91) had healed after 12 postoperative weeks while 2 (16.67%; 95% CI: 2.09%-48.41) had healed after 14 postoperative weeks and the mean healing time was 12.33 ± 0.78 weeks. Patients with healed ulcers had reduced ulcer site pain from the immediate postoperative period but there was no significant difference in the mean pain scores before and after graft (6.77 against 4.23, p = 0.13). These ulcers remained healed after 8 postoperative months. Each donor site had healed 2 weeks after PG. Donor site problems were minimal and included hypopigmentation. CONCLUSION The outcome of PG of CLUs in our series of older patients was satisfactory. This finding does not discount the role of conservative therapy, but we encourage clinicians in rural Cameroon to consider PG over long-term unconventional conservative therapy in the elderly.
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Affiliation(s)
- Benjamin Momo Kadia
- Presbyterian General Hospital Acha-Tugi, Acha-Tugi, Cameroon
- Grace Community Health and Development Association, Kumba, Cameroon
| | - Christian Akem Dimala
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical medicine, London, UK
- Health and Human Development (2HD) Research Group, Douala, Cameroon
- Department of Orthopaedics, Southend University Hospital, Essex, UK
| | - Desmond Aroke
- Health and Human Development (2HD) Research Group, Douala, Cameroon
| | | | | | - Alain Chichom Mefire
- Department of Surgery and Obstetrics/Gynaecology, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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20
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Martín S, Pérez A, Aldecoa C. Sepsis and Immunosenescence in the Elderly Patient: A Review. Front Med (Lausanne) 2017; 4:20. [PMID: 28293557 PMCID: PMC5329014 DOI: 10.3389/fmed.2017.00020] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/15/2017] [Indexed: 12/27/2022] Open
Abstract
Sepsis is a prevalent, serious medical condition with substantial mortality and a significant consumption of health-care resources. Its incidence has increased around 9% annually in general population over the last years and specially in aged patients group. Several risk factors such as comorbidities, preadmission status, malnutrition, frailty, and an impared function in the immune system called immunosenescence are involved in the higher predisposition to sepsis in the elderly patients. Immunosenescence status consists in a functional impairment in both cell-mediated immunity and humoral immune responses and increases not only the risk for develop sepsis but also lead to more severe presentation of infection and may be is also related with a higher mortality. There is a also a concern about to admit patients in the intensive care units taking into account that the outcome of elderly patients is poorer compared to younger people. Nevertheless, the management of septic elderly patients does not differ substantially from younger people. In addition, the quality of life in septic elderly survivors is also lower than in younger people. But age, as alone factor, should not be used to determine treatment options because the poorer outcomes is thought to be due to the increased comorbidities and frailty in this group of patients.
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Affiliation(s)
- Silvia Martín
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega , Valladolid , Spain
| | - Alba Pérez
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega , Valladolid , Spain
| | - Cesar Aldecoa
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega, Valladolid, Spain; University of Valladolid Medical School, Valladolid, Spain
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Alfandari S, Cabaret P, Nguyen S, Descamps D, Vachée A, Cattoen C, Van Grunderbeeck N. Evaluating the management of 493 patients presenting with bacteremia in 23 northern French hospitals. Med Mal Infect 2016; 46:194-9. [PMID: 27132208 DOI: 10.1016/j.medmal.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/12/2016] [Accepted: 03/17/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We aimed to update the epidemiology of bacteremia and evaluate their management and short-term outcome. METHODS We conducted a prospective multicenter survey from October to November 2011. Consecutive patients with at least one positive blood culture (BC) were included in the study. We evaluated the type and adequacy of empirical and documented antibiotic therapy, time to active antibiotic therapy, compliance with guidelines, and 10-day outcome. RESULTS A total of 23 public and private hospitals and 633 patients (493 true pathogens and 140 contaminants) were included in the study. Patients' wards were medicine (57%), surgery (19%), intensive care (14%), onco/hematology (3.7%), pediatrics (3.4%), infectious diseases (1.8%), and obstetrics (1.2%). Main pathogens were Escherichia coli (36%), Staphylococcus aureus (16%), coagulase-negative staphylococci, and Klebsiella sp. (8% each). A total of 43 (8.7%) multidrug-resistant strains were observed, including 26 extended-spectrum beta-lactamase strains and 15 methicillin-resistant S. aureus strains. An antibiotic active against the isolated pathogen was used in 74% of empirical and 96% of documented therapies. Median time between BC and administration of an active drug was 0.61 day. Empirical antibiotic therapies were protocol-compliant in 77% of cases. Few (4%) patients with contaminated BC received an antibiotic therapy (all inappropriate). Day-10 mortality was 12.1%, higher in patients presenting with severe sepsis or septic shock (22.5%) than in patients presenting with non-severe bacteremia (7.1%; P<0.0001). CONCLUSION The management of bacteremia seems satisfactory in these volunteer hospitals but bacteremia remains a severe infection.
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Affiliation(s)
- S Alfandari
- Service de réanimation et maladies infectieuses, centre hospitalier Dron, 155, rue du Président-Coty, 59200 Tourcoing, France.
| | - P Cabaret
- Réanimation polyvalente, centre hospitalier Saint-Philibert, rue du Grand-But, 59160 Lomme, France
| | - S Nguyen
- Infectiologie, centre hospitalier, 62408 Béthune cedex, France
| | - D Descamps
- Laboratoire de microbiologie, centre hospitalier, 62408 Béthune cedex, France
| | - A Vachée
- Laboratoire de microbiologie, centre hospitalier, 59100 Roubaix, France
| | - C Cattoen
- Laboratoire de microbiologie, centre hospitalier, 59300 Valenciennes, France
| | - N Van Grunderbeeck
- Maladies infectieuses, centre hospitalier, 99, route de la Bassée, 862307 Lens cedex, France
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Abstract
Bloodstream infections (BSIs) are both common and fatal in older patients. We describe data from studies evaluating older patients hospitalized with BSIs. Most older patients with BSIs present "typically" with either fever or leukocytosis. The most common source of BSI in older patients is the urinary tract, and accordingly, Gram-negative organisms predominate. A significant part of these BSIs may thus be preventable by removal of unnecessary urinary catheters. Increased long term mortality is reported following BSIs in older patients, however, data on other long-term outcomes, including functional capacity, cognitive decline and others are lacking. Management of BSIs may include less invasive procedures due to the fragility of older patients. This approach may delay the diagnosis and treatment in some cases. Older patients are probably under-represented in clinical trials assessing treatment of bacteremia. Physicians treating older patients should consider the relevance of these studies' outcomes.
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Affiliation(s)
- Dafna Yahav
- a Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital , Petah-Tikva , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Ramat-Aviv , Israel
| | - Noa Eliakim-Raz
- a Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital , Petah-Tikva , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Ramat-Aviv , Israel
| | - Leonard Leibovici
- b Sackler Faculty of Medicine, Tel Aviv University , Ramat-Aviv , Israel.,c Department of Medicine E , Rabin Medical Center, Beilinson Hospital , Petah-Tikva , Israel
| | - Mical Paul
- b Sackler Faculty of Medicine, Tel Aviv University , Ramat-Aviv , Israel.,d Unit of Infectious Diseases, Rambam Hospital , Haifa , Israel
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