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Kuzawka M, Cassanelli M, Capecce F, Pereda R. [Detection of microorganisms and resistance genes from positive blood cultures using the FilmArray® BCID2 panel: Experience in a pediatric hospital]. Rev Argent Microbiol 2024; 56:249-257. [PMID: 39079884 DOI: 10.1016/j.ram.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/01/2023] [Accepted: 07/27/2023] [Indexed: 09/20/2024] Open
Abstract
The rapid identification of microorganisms that cause bacteremia and their possible resistance markers are extremely important for the timely initiation of effective antibiotic therapy. The FilmArray® panel BCID2 (an automated rapid multiplex PCR assay) detects microorganisms and resistance genes from positive blood cultures within one hour. The aim of this study was to compare the results obtained from the FilmArray® Panel BCID2 and conventional culture in pediatric patients, as well as the reporting times of both methods. Sixty (60) FilmArray® results were included in the analysis. BCID2 showed high agreement with culture in the identification of microorganisms in monomicrobial bacteremias. However, in polymicrobial blood cultures, BCID2 detected a greater number of microorganisms compared to conventional culture, specifically,1 Staphylococcus aureus, 3 Staphylococcus epidermidis, 1 Enterococcus faecium, 2 Klebsiella oxytoca, 1 Acinetobacter calcoaceticus-baumannii complex, 1 Bacteroides fragilis and 1 Haemophilus influenzae. Furthermore, 88.3% (95%CI: 78.7-94.8) of the FilmArray® results coincided with conventional culture, while in polymicrobial bacteremias, BCID2 detected a greater number of microorganisms with respect to conventional culture [70% (95%CI: 39.3-91.5)]. The agreement of resistance genes was good with a few exceptions (one ESBL was not detected by FilmArray® and one S. aureus strain was characterized as methicillin-resistant by BCID2 and methicillin-sensitive by culture). When comparing the time elapsing since the blood culture was reported as positive up to the results were obtained, BCID2 had a median of 2h 50min (IQR of 1 h 58min to 9h 27min) while the conventional culture had a median of 45h 20min (IQR of 24h 57min to 63h 50min).
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Affiliation(s)
- Marilina Kuzawka
- Hospital General de Niños «Pedro de Elizalde», Buenos Aires, Argentina.
| | - Martín Cassanelli
- Hospital General de Niños «Pedro de Elizalde», Buenos Aires, Argentina
| | - Fabrina Capecce
- Hospital General de Niños «Pedro de Elizalde», Buenos Aires, Argentina
| | - Rosana Pereda
- Hospital General de Niños «Pedro de Elizalde», Buenos Aires, Argentina
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2
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Saparamadu AADNS, Ratnayake L. Epidemiology of Escherichia coli and Klebsiella pneumoniae bloodstream infections in a general hospital in Singapore: a retrospective cohort study. Singapore Med J 2023; 64:700-706. [PMID: 35848338 PMCID: PMC10754363 DOI: 10.11622/smedj.2022094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
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Rebrosova K, Bernatová S, Šiler M, Mašek J, Samek O, Ježek J, Kizovsky M, Holá V, Zemanek P, Růžička F. Rapid Identification of Pathogens Causing Bloodstream Infections by Raman Spectroscopy and Raman Tweezers. Microbiol Spectr 2023; 11:e0002823. [PMID: 37078868 PMCID: PMC10269886 DOI: 10.1128/spectrum.00028-23] [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: 01/20/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023] Open
Abstract
The search for the "Holy Grail" in clinical diagnostic microbiology-a reliable, accurate, low-cost, real-time, easy-to-use method-has brought up several methods with the potential to meet these criteria. One is Raman spectroscopy, an optical, nondestructive method based on the inelastic scattering of monochromatic light. The current study focuses on the possible use of Raman spectroscopy for identifying microbes causing severe, often life-threatening bloodstream infections. We included 305 microbial strains of 28 species acting as causative agents of bloodstream infections. Raman spectroscopy identified the strains from grown colonies, with 2.8% and 7% incorrectly identified strains using the support vector machine algorithm based on centered and uncentred principal-component analyses, respectively. We combined Raman spectroscopy with optical tweezers to speed up the process and captured and analyzed microbes directly from spiked human serum. The pilot study suggests that it is possible to capture individual microbial cells from human serum and characterize them by Raman spectroscopy with notable differences among different species. IMPORTANCE Bloodstream infections are among the most common causes of hospitalizations and are often life-threatening. To establish an effective therapy for a patient, the timely identification of the causative agent and characterization of its antimicrobial susceptibility and resistance profiles are essential. Therefore, our multidisciplinary team of microbiologists and physicists presents a method that reliably, rapidly, and inexpensively identifies pathogens causing bloodstream infections-Raman spectroscopy. We believe that it might become a valuable diagnostic tool in the future. Combined with optical trapping, it offers a new approach where the microorganisms are individually trapped in a noncontact way by optical tweezers and investigated by Raman spectroscopy directly in a liquid sample. Together with the automatic processing of measured Raman spectra and comparison with a database of microorganisms, it makes the whole identification process almost real time.
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Affiliation(s)
- Katarina Rebrosova
- Department of Microbiology, Faculty of Medicine of Masaryk University, St. Anne’s University Hospital, Brno, Czech Republic
| | - Silvie Bernatová
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Martin Šiler
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Jan Mašek
- National Centre for Biomolecular Research, Faculty of Science, Masaryk University, Brno, Czech Republic
- Department of Plant Developmental Genetics, Institute of Biophysics, Academy of Sciences of the Czech Republic, Brno, Czech Republic
| | - Ota Samek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Jan Ježek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Martin Kizovsky
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Veronika Holá
- Department of Microbiology, Faculty of Medicine of Masaryk University, St. Anne’s University Hospital, Brno, Czech Republic
| | - Pavel Zemanek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Filip Růžička
- Department of Microbiology, Faculty of Medicine of Masaryk University, St. Anne’s University Hospital, Brno, Czech Republic
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Prevalence and Antimicrobial Resistance of Bloodstream Infections Caused by ESKAPEEc Pathogens: A Five-year Analysis. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm-122990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Antimicrobial resistance in ESKAPEEc (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, and Escherichia coli) pathogens causing bloodstream infections (BSIs) is a growing threat to clinicians and public health. Objectives: Our purpose was to determine the prevalence and susceptibility of ESKAPEEcs causing BSI over five years (2016 to 2020) at a large tertiary hospital in Istanbul, Turkey. Methods: Of 2591 unique isolates obtained from blood culture specimens, 1.281 (49.4%) were positive for ESKAPEEc pathogens. The ESKAPEEc rates increased from 2016 to 2019 and decreased during the COVID-19 pandemic. Results: The most common pathogen was K. pneumoniae (34.3%). Carbapenem resistant (CR) K. pneumoniae was 61.8% and A. baumannii was 90.4%. The percentages of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant E. faecium (VRE) were 38.6% and 29.4%, respectively. Conclusions: Our findings showed a high incidence of ESKAPEEc and AMR in BSIs. Antibiotic policies and restrictions in health care settings and the community will play an essential role in the solution in the future.
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Tuon FF, Telles JP, Cieslinski J, Borghi MB, Bertoldo RZ, Ribeiro VST. Development and validation of a risk score for predicting positivity of blood cultures and mortality in patients with bacteremia and fungemia. Braz J Microbiol 2021; 52:1865-1871. [PMID: 34287809 PMCID: PMC8578208 DOI: 10.1007/s42770-021-00581-5] [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: 01/13/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Bacteremia is a major cause of morbidity and mortality in hospitalized patients. Predictors of mortality are critical for the management and survival of hospitalized patients. The objective of this study was to determine the factors related to blood culture positivity and the risk factors for mortality in patients whose blood cultures were collected. METHODS A prospective 2-cohort study (derivation with 784 patients and validation with 380 patients) based on the Pitt bacteremia score for all patients undergoing blood culture collection. The score was obtained from multivariate analysis. The Kaplan-Meier survival curve of the cohort derivation and the cohort validation groups was calculated, and the difference was assessed using a log-rank test. Mortality-related factors were older age, extended hospitalization, > 10% of immature cells in the leukogram, lower mean blood pressure, elevated heart rate, elevated WBC count, and elevated respiratory rate. These continuous variables were dichotomized according to their significance level, and a cut-off limit was created. RESULTS The area under the ROC curve (AUC) was 0.789. The score was validated in a group of 380 patients who were prospectively evaluated. CONCLUSION Prolonged hospitalization, body temperature, and elevated heart rate were related to positive blood cultures. The Pitt score can be used to assess the risk of death; however it can be individualized according to the epidemiology of each hospital.
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Affiliation(s)
- Felipe Francisco Tuon
- Laboratorio de Doenças Infecciosas Emergentes, Pontifícia Universidade Católica Do Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná, 80215-901, Brazil.
| | - João Paulo Telles
- Laboratorio de Doenças Infecciosas Emergentes, Pontifícia Universidade Católica Do Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Juliette Cieslinski
- Laboratorio de Doenças Infecciosas Emergentes, Pontifícia Universidade Católica Do Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná, 80215-901, Brazil
| | | | | | - Victoria Stadler Tasca Ribeiro
- Laboratorio de Doenças Infecciosas Emergentes, Pontifícia Universidade Católica Do Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná, 80215-901, Brazil
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Elseady NSM, Khamis NAGA, AbdelGhani S, Rabea HM, Elanany MG, Nashat Alsheshtawi K, Abdelrahim MEA. Antibiotic sensitivity/resistance pattern of hospital acquired blood stream infection in children cancer patients: A retrospective study. Int J Clin Pract 2021; 75:e14617. [PMID: 34235824 DOI: 10.1111/ijcp.14617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The literature shows a growing emphasis on understanding the local patterns of antimicrobial resistance (AMR). We aimed to evaluate the spectrum of local microorganisms that cause bloodstream infections (BSI) and their AMR patterns in an Egyptian institution treating children with cancer. METHODS We conducted a single-centre, retrospective, study on children with confirmed primary, hospital-acquired, BSIs over one year. The microbiological examination of blood samples was done according to the Clinical and Laboratory Standards Institute. The antibiotic sensitivity test was done using VITEK® 2 system. RESULTS We retrieved the data of 607 children with a median age of 5 (0.25-18) years old. The most encountered diagnosis was acute lymphoblastic leukaemia (40%). Most identified microorganisms were gram-negative bacilli, mainly Escherichia coli (27.8%), followed by Klebsiella pneumoniae (12.2%). Gram-negative bacilli showed high resistance to piperacillin/tazobactam, levofloxacin, and meropenem. The lowest resistance rates for Gram-negative bacilli isolates were noted for colistin and tigecycline. Similarly, the gram-positive cocci showed high resistance to ampicillin/sulbactam, cefoxitin, and clindamycin; and low resistance regarding vancomycin and linezolid. CONCLUSION Resistance proportions (pattern) were similar to those reported in other countries with a higher distribution of E coli and a growing resistance to levofloxacin. Further investigation of the predisposing factors and the development of more effective strategies for the prevention of BSI should be a significant public health priority.
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Affiliation(s)
| | | | - Sameh AbdelGhani
- Department of Microbiology and Immunology, Beni-Suef University, Beni-Suef, Egypt
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | | | - Mervat Gaber Elanany
- Clinical Pathology Department Faculty of Medicine, Cairo University, Microbiology Unit 57357 - Children Cancer Hospital, Cairo, Egypt
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Holma T, Torvikoski J, Friberg N, Nevalainen A, Tarkka E, Antikainen J, Martelin JJ. Rapid molecular detection of pathogenic microorganisms and antimicrobial resistance markers in blood cultures: evaluation and utility of the next-generation FilmArray Blood Culture Identification 2 panel. Eur J Clin Microbiol Infect Dis 2021; 41:363-371. [PMID: 34350523 PMCID: PMC8831274 DOI: 10.1007/s10096-021-04314-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
Rapid detection of pathogens causing bloodstream infections (BSI) directly from positive blood cultures is of highest importance in order to enable an adequate and timely antimicrobial therapy. In this study, the utility and performance of a recently launched next-generation fully automated test system, the Biofire FilmArray® Blood Culture Identification 2 (BCID2) panel, was evaluated using a set of 103 well-characterized microbial isolates including 29 antimicrobial resistance genes and 80 signal-positive and 23 signal-negative clinical blood culture samples. The results were compared to culture-based reference methods, MALDI-TOF, and/or 16S rDNA sequencing. Of the clinical blood culture samples, 68 were monomicrobial (85.0%) and 12 polymicrobial (15.0%). Six samples contained ESBL (blaCTX-M), two MRSA (mecA), and three MRSE (mecA) isolates. In overall, the FilmArray BCID2 panel detected well on-panel targets and resistance markers from mono- and polymicrobial samples. However, one Klebsiella aerogenes and one Bacteroides ovatus were undetected, and the assay falsely reported one Shigella flexneri as Escherichia coli. Hence, the sensitivity and specificity for detecting microbial species were 98.8% (95%CI, 95.8–99.9%) and 99.9% (95%CI, 99.8–99.9%), respectively. The sensitivity and specificity for detecting of resistance gene markers were 100%. The results were available within 70 min from signal-positive blood cultures with minimal hands-on time. In conclusion, the BCID2 test allows reliable and simplified detection of a vast variety of clinically relevant microbes causing BSI and the most common antimicrobial resistance markers present among these isolates.
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Affiliation(s)
- Tanja Holma
- HUS Diagnostic Center, HUSLAB, Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Jukka Torvikoski
- HUS Diagnostic Center, HUSLAB, Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nathalie Friberg
- HUS Diagnostic Center, HUSLAB, Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annika Nevalainen
- HUS Diagnostic Center, HUSLAB, Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eveliina Tarkka
- HUS Diagnostic Center, HUSLAB, Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jenni Antikainen
- HUS Diagnostic Center, HUSLAB, Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari J Martelin
- HUS Diagnostic Center, HUSLAB, Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Buetti N, Marschall J, Timsit JF, Atkinson A, Kronenberg A, Sommerstein R. Distribution of pathogens and antimicrobial resistance in bacteraemia according to hospitalization duration: a nationwide surveillance study in Switzerland. Clin Microbiol Infect 2021; 27:1820-1825. [PMID: 33933567 DOI: 10.1016/j.cmi.2021.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Changing microorganism distributions and decreasing antibiotic susceptibility with increasing length of hospital stay have been demonstrated for the colonization or infection of selected organ systems. We wanted to describe microorganism distribution or antibiotic resistance in bacteraemia according to duration of the hospitalization using a large national epidemiological/microbiological database (ANRESIS) in Switzerland. METHODS We conducted a nationwide, observational study on bacteraemia using ANRESIS data from 1 January 2008 to 31 December 2017. We analysed data on bacteraemia from those Swiss hospitals that sent information on a regular basis during the entire study period. We described the pathogen distribution and specific trends of resistance during hospitalization for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens and Staphylococcus aureus. RESULTS We included 28 318 bacteraemia isolates from 90 Swiss hospitals. The most common aetiology was E. coli (33.4%, 9459), followed by S. aureus (16.7%, 4721), K. pneumoniae (7.1%, 2005), Enterococcus faecalis (5.2%, 1473), P. aeruginosa (4.3%, 1228), Streptococcus pneumoniae (4.3%, 1208) and Enterococcus faecium (3.9%, 1101). We observed 489 (1.73%) S. marcescens isolates. We observed an increasing trend for E. faecium (from 1.5% at day 0 to 13.7% at day 30; p < 0.001), K. pneumoniae (from 6.1% to 7.8%, p < 0.001) and P. aeruginosa (from 2.9% to 13.7%, p < 0.001) with increasing duration of hospitalization; and decreasing trends for E. coli (from 41.6% to 21.6%; p < 0.001) and S. aureus (p < 0.001). Ceftriaxone resistance among E. coli remained stable for the first 15 days of hospitalization and then increased. Ceftriaxone resistance among K. pneumoniae and S. marcescens and oxacillin resistance among S. aureus increased linearly during the hospitalization. Cefepime resistance among P. aeruginosa remained stable during the hospitalization. DISCUSSION We showed that hospitalization duration is associated with a species- and antibiotic class-dependent pattern of antimicrobial resistance.
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Affiliation(s)
- Niccolò Buetti
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland; UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland
| | - Jean-François Timsit
- UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland; Infectious Diseases and Hospital Epidemiology, Hirslanden Central Switzerland, Lucerne, Switzerland
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Piezzi V, Gasser M, Atkinson A, Kronenberg A, Vuichard-Gysin D, Harbarth S, Marschall J, Buetti N. Increasing proportion of vancomycin-resistance among enterococcal bacteraemias in Switzerland: a 6-year nation-wide surveillance, 2013 to 2018. ACTA ACUST UNITED AC 2020; 25. [PMID: 32885778 PMCID: PMC7472687 DOI: 10.2807/1560-7917.es.2020.25.35.1900575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Vancomycin-resistant enterococci (VRE), mostly Enterococcus faecium, are multidrug-resistant microorganisms that can cause nosocomial infections. VRE has increased throughout many European countries, but data from Switzerland are scarce. Aim The aim of this work was to characterise the epidemiology of enterococcal bacteraemias in Switzerland with a focus on VRE. Methods In this observational study, we retrospectively investigated bacteraemias from 81 healthcare institutions from January 2013 to December 2018 using data from the Swiss Centre for Antibiotic Resistance. Only the first blood isolate with E. faecalis or E. faecium from an individual patient was considered. We analysed the annual incidences of enterococcal bacteraemias and determined the proportion of VRE over time. We also assessed epidemiological factors potentially associated with VRE bacteraemia. Results We identified 5,369 enterococcal bacteraemias, of which 3,196 (59.5%) were due to E. faecalis and 2,173 (40.5%) to E. faecium. The incidence of enterococcal bacteraemias increased by 3.2% per year (95% confidential interval (CI): 1.6–4.8%), predominantly due to a substantial increase in E. faecalis bacteraemic episodes. Vancomycin resistance affected 30 (1.4%) E. faecium and one E. faecalis bacteraemic episodes. Among all E. faecium bacteraemias, the proportion of vancomycin-resistant isolates increased steadily from 2013 to 2018 (2% per year; 95% CI: 1.5–2.9%). No independent epidemiological factor for higher prevalence of vancomycin-resistant E. faecium bacteraemias was identified. Conclusions Vancomycin-resistant E. faecium bacteraemias remain infrequent in Switzerland. However, an important increase was observed between 2013 and 2018, highlighting the need for implementing active surveillance and targeted prevention strategies in the country.
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Affiliation(s)
- Vanja Piezzi
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Gasser
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Danielle Vuichard-Gysin
- Department of Internal Medicine, Cantonal Hospital Muensterlingen, Thurgau Hospital Group, Kreuzlingen, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Niccolò Buetti
- IAME, DeSCID team, INSERM, Université Paris Diderot and Sorbonne Paris Cité, Paris, France.,Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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- The members of the advisory board of ANRESIS are acknowledged at the end of the article
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- The members of Swissnoso are acknowledged at the end of the article
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Messina JA, Moehring RW, Schmader KE, Anderson DJ. Impact of Location of Acquisition of Gram-Positive Bloodstream Infections on Clinical Outcomes Among Patients Admitted to Community Hospitals. Infect Drug Resist 2020; 13:3023-3031. [PMID: 32922048 PMCID: PMC7457735 DOI: 10.2147/idr.s259185] [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: 04/23/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose We investigated the association between location of acquisition (LOA) of gram-positive (GP) bloodstream infections (BSI) in community hospitals and clinical outcomes. Methods We performed a multicenter cohort study of adult inpatients with GP BSI in nine community hospitals from 2003 to 2006. LOA was defined by CDC criteria: 1) community-acquired (CA), 2) healthcare-associated (HCA) such as BSI <48 hours after admission plus hospitalization, surgery, dialysis, invasive device, or residence in a long-term care facility in the prior 12 months, and 3) hospital-acquired (HA) as BSI ≥48 hours after hospital admission. Results A total of 750 patients were included. Patients with HCA or HA GP BSI were significantly more likely to require assistance with ≥1 activity of daily living, have higher Charlson scores, and die during the hospitalization. Patients with HCA or HA GP BSI were more likely to have BSI due to a multidrug-resistant GP organism, but less likely to receive appropriate antibiotics within 24 hours of BSI presentation. Those with CA BSI were more likely to have a streptococcal BSI and to be discharged home following hospitalization. HA BSI was a risk factor for requiring a procedure for BSI and receiving inappropriate antibiotics within 24 hours of BSI. Both HA and HCA GP BSI were risk factors for in-hospital mortality. Conclusion LOA for patients with GP BSI in community hospitals was significantly associated with differences in clinical outcomes including receiving inappropriate antibiotics and in-hospital mortality. Distinguishing LOA in a patient presenting with suspected GP BSI is a critical assessment that should influence empiric treatment patterns.
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Affiliation(s)
- Julia A Messina
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, NC, USA
| | - Rebekah W Moehring
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, NC, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Division of Infectious Diseases, Durham, NC, USA
| | - Kenneth E Schmader
- Duke University Medical Center, Department of Medicine, Division of Geriatrics and GRECC, Durham VA Health Care System, Durham, NC, USA
| | - Deverick J Anderson
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, NC, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Division of Infectious Diseases, Durham, NC, USA
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Tao X, Wang H, Min C, Yu T, Luo Y, Li J, Hu Y, Yan Q, Liu WE, Zou M. A retrospective study on Escherichia coli bacteremia in immunocompromised patients: Microbiological features, clinical characteristics, and risk factors for shock and death. J Clin Lab Anal 2020; 34:e23319. [PMID: 32267010 PMCID: PMC7439330 DOI: 10.1002/jcla.23319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate clinical features, bacterial characteristics, and risk factors for shock and mortality of immunocompromised patients with Escherichia coli bacteremia. Methods A nearly 6‐year retrospective study of E coli bacteremia in 188 immunocompromised patients at Xiangya Hospital was conducted. Demographic, clinical, and laboratory data were documented. Phylogenetic background and virulence factors of E coli isolates were detected by polymerase chain reaction. Risk factors for shock and mortality were also investigated. Results Of all 188 E coli isolates, most prevalent virulence factors were fimH (91.0%), followed by traT (68.6%) and iutA (67.0%), while papG allele I, gafD, and cdtB were not detected. Phylogenetic group D was dominant (42.0%) among all isolates, and group B2 accounted for 17.6%, while group A and B1 accounted for 28.2% and 12.2%, respectively. In univariate analysis, ibeA and cnf1 were associated with mortality, which were not found in multivariate regression analysis. 22.3% of patients suffered shock, and 30‐day mortality rate was 21.3%. MDR (HR 2.956; 95% CI, 1.091‐8.012) was the only risk factor for shock, while adult (HR 0.239; 95% CI, 0.108‐0.527) was a protective factor. Multivariate analysis revealed that shock (HR 4.268; 95% CI, 2.208‐8.248; P < .001) and Charlson index > 2 (HR 2.073; 95% CI, 1.087‐3.952; P = .027) were associated with fatal outcome. Conclusions Escherichia coli bacteremia was highly lethal in immunocompromised patients, and host‐related factors played major roles in poor prognosis, while bacterial determinants had little effect on outcome. This study also provided additional information about the virulence and phylogenetic group characteristics of E coli bacteremia.
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Affiliation(s)
- Xiaoyan Tao
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Haichen Wang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Changhang Min
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Yu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Luo
- Faculty of Laboratory Medicine, Xiangya School of Medicine, Central South University, Changsha, China
| | - Jun Li
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Yongmei Hu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Qun Yan
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Wen' En Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxiang Zou
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
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The Epidemiology of Bloodstream Infections and Antimicrobial Susceptibility Patterns: A Nine-Year Retrospective Study at St. Dominic Hospital, Akwatia, Ghana. J Trop Med 2019; 2019:6750864. [PMID: 31641359 PMCID: PMC6770298 DOI: 10.1155/2019/6750864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/23/2019] [Accepted: 08/21/2019] [Indexed: 12/29/2022] Open
Abstract
Background Bloodstream infections are among the top causes of morbidity and mortality in people of all ages, especially in immunocompromised patients in sub-Saharan Africa. This study aimed at describing the epidemiology of bloodstream infections and antimicrobial susceptibility pattern over a nine-year period at St. Dominic Hospital, Akwatia, in the Eastern Region of Ghana. Method This study retrospectively analysed data from 4,489 patients who were referred to the Laboratory Department for blood culture and sensitivity testing from January 2009 to December 2017. Sociodemographic data included age, gender, and patients' department. Blood culture results were retrieved from archival records in the laboratory. The authorities of St. Dominic Hospital granted approval for the study. Results The incidence of bloodstream infection over the 9 years was 51.4 positive cultures per 100,000 hospital attendance. Staphylococcus aureus was the leading causative agent of bacteraemia for the first two scalar years (2009–2011 (38.9%) and 2012–2014 (42.2%)) while coagulase-negative staphylococcus (CoNS) (50.5%) was predominant for the last scalar year (2015–2017), followed by Staphylococcus aureus (169/587 (28.8%)). The highest incidence of bloodstream infections was recorded in the wet seasons (months of May (8.9 per 10,000 persons) and October (10.1 per 10,000 persons)). The bacterial isolates demonstrated high resistance to tetracyclines (390/531 (73.4%)), penicillins (1282/1669 (76.8%)), and sulphonamides (450/499 (90.2%)). Conclusion Bloodstream infection and antimicrobial resistance are high in patients seeking healthcare in Akwatia. This therefore calls for concerted efforts aimed at reducing the incidence in the study area.
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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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14
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Increasing burden of Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecium in hospital-acquired bloodstream infections (2000-2014): A national dynamic cohort study. Infect Control Hosp Epidemiol 2019; 40:705-709. [PMID: 31012402 DOI: 10.1017/ice.2019.59] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The epidemiology of hospital-acquired bloodstream infections (HABSIs) based on the Belgian national surveillance program was analyzed (2000-2014). Our mixed-effects regression analysis identified increased rates of Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecium. HABSI incidence and resistance patterns should be further monitored because of their impact on proper empiric antibiotic therapy.
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Yang S, Xu H, Sun J, Sun S. Shifting trends and age distribution of ESKAPEEc resistance in bloodstream infection, Southwest China, 2012-2017. Antimicrob Resist Infect Control 2019; 8:61. [PMID: 30976388 PMCID: PMC6441235 DOI: 10.1186/s13756-019-0499-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 02/20/2019] [Indexed: 01/07/2023] Open
Abstract
Background ESKAPEEc contribute to a majority of bloodstream infections (BSIs) and their antibiogram have changed overtime, while data concerning about these alterations are lacking in China. Added that a paucity of studies referred to ESKAPEEc in pediatric BSIs, our study aimed to demonstrate the longitudinal alterations of ESKAPEEc distribution and antibiogram in adult and pediatric BSIs in Southwest China. Methods A multicenter retrospective surveillance study was launched from 2012 to 2017. Data of China Antimicrobial Resistance Surveillance System (CARSS) was analyzed by Whonet 5.6 and Graphpad Prism 6 Software. Chi-square test or Fisher’s exact test was used to examine and compare temporal changes. Results A total of 32,259 strains was isolated, with 17.4% from pediatric BSIs. ESKAPEEc contributed to 58.67% (18,924/32,259) of BSIs, with 65.3% of adult BSIs and 27.2% of pediatric BSIs. Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) were the two predominant species. Carbapenem resistance was prevalent in 0.76, 4.60, 9.47,13.66, 59.47% of E. coli, K. pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii), respectively. The proportions of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VREFM) were 28.91% and 2.20%, respectively. Between 2012-2014 and 2015–2017, E. coli and K. pneumonia showed significantly increased resistance rates to imipenem but decreased to ceftriaxone and ceftazidime, while A. baumannii exhibited reduced resistances to almost all the beta-lactams tested. The prevalence of antimicrobial resistance to most of agents against Gram-positive ESKAPEEc did not significantly varied during the same timeframe. In comparison with those from adult BSIs, K. pneumoniae from pediatric BSIs exhibited high resistance rates to all the beta-lactams tested, especially to carbapenems (12.79% vs 3.87%), while A. baumannii showed low resistance rates to all the agents. Conclusions Ongoing burden of ESKAPEEc in BSIs and increasing trend of imipenem resistance in E. coli and K. pneumoniae call for continued surveillance. Carbapenems are still active against Gram-negative ESKAPEEc, except for A. baumannii and vancomycin or linezolid is still effective against Gram-positive ESKAPEEc. Carbapenem-resistant K. pneumoniae in children and carbapenem-resistant A. baumannii in adults necessitate effective antimicrobial strategies in consideration of age stratification.
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Affiliation(s)
- Shuangshuang Yang
- 1Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing, 400016 People's Republic of China
| | - Haofeng Xu
- 2Laboratory Medicine, Chongqing Medical University, No.1, Yixueyuan Road, Yuzhong District, Chongqing, 400016 People's Republic of China
| | - Jide Sun
- 1Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing, 400016 People's Republic of China
| | - Shan Sun
- 1Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing, 400016 People's Republic of China
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Zlatian O, Balasoiu AT, Balasoiu M, Cristea O, Docea AO, Mitrut R, Spandidos DA, Tsatsakis AM, Bancescu G, Calina D. Antimicrobial resistance in bacterial pathogens among hospitalised patients with severe invasive infections. Exp Ther Med 2018; 16:4499-4510. [PMID: 30542398 PMCID: PMC6257814 DOI: 10.3892/etm.2018.6737] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/04/2018] [Indexed: 12/29/2022] Open
Abstract
The most severe infections are invasive infections, due to the fact that the germs can accumulate in multiple sites and produce a body-wide infection known as sepsis. Septic shock has the highest mortality rate among non-traumatic medical conditions. In this study, we aimed to evaluate the incidence and prevalence of invasive infections in a hospital environment. Another second objective was to establish the aetiology of invasive infections in our hospital and the antibiotic resistance profile of the germs involved, which are both important for determining the therapeutic approach for the treatment of these infections. The study included 505 hospitalized patients from which we collected a total of 974 blood cultures. For the analysis of the blood cultures, we used an automated incubator. The bottles flagged as positive were subcultured on blood agar, and the grown colonies were identified using an identification system. Invasive infections had a prevalence rate of 27.72% in our hospital. From the 974 blood cultures, we isolated 170 bacterial strains: Staphylococcus aureus (SA; 63 strains, 37.06%), Klebsiella spp. (27 strains, 15.88%), coagulase-negative staphylococci (CoNS; 18 strains, 10.59%), Enterococcus spp. (17 strains, 10.00%), Escherichia coli (12 strains, 7.06%), Streptococcus spp. (11 strains, 6.47%) and other bacterial species. The prevalence of methicillin-resistant SA (MRSA) in our study was 36.51% from the SA strains. The MRSA prevalence differed significantly according to age (37.50% in adults vs. 28.57% in children, P=0.047) and ICU admission (42.42% in ICU patients vs. 30.00% in non-ICU patients, P=0.018). We performed a multivariate analysis of the invasive infection risk which detected as significant predictors the admission into the cardiology ward and plastic surgery ward. On the whole, the findings of this study indicate that the high prevalence of Gram-positive cocci in blood cultures, mostly SA, with multidrug resistance has important consequences for the management of invasive infections.
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Affiliation(s)
- Ovidiu Zlatian
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andrei Theodor Balasoiu
- Department of Ophtalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Maria Balasoiu
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Oana Cristea
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Radu Mitrut
- Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Aristides M Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Gabriela Bancescu
- Department of Microbiology, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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A ten-year review of healthcare-associated bloodstream infections from forty hospitals in Québec, Canada. Infect Control Hosp Epidemiol 2018; 39:1202-1209. [PMID: 30156168 DOI: 10.1017/ice.2018.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Healthcare-associated bloodstream infections (HABSI) are a significant cause of morbidity and mortality worldwide. In Québec, Canada, HABSI arising from acute-care hospitals have been monitored since April 2007 through the Surveillance des bactériémies nosocomiales panhospitalières (BACTOT) program, but this is the first detailed description of HABSI epidemiology. METHODS This retrospective, descriptive study was conducted using BACTOT surveillance data from hospitals that participated continuously between April 1, 2007, and March 31, 2017. HABSI cases and rates were stratified by hospital type and/or infection source. Temporal trends of rates were analyzed by fitting generalized estimating equation Poisson models, and they were stratified by infection source. RESULTS For 40 hospitals, 13,024 HABSI cases and 23,313,959 patient days were recorded, for an overall rate of 5.59 per 10,000 patient days (95% CI, 5.54-5.63). The most common infection sources were catheter-associated BSIs (23.0%), BSIs secondary to a urinary focus (21.5%), and non-catheter-associated primary BSIs (18.1%). Teaching hospitals and nonteaching hospitals with ICUs often had rates higher than nonteaching hospitals without ICUs. Annual HABSI rates did not exhibit statistically significant changes from year to year. Non-catheter-associated primary BSIs were the only HABSI type that exhibited a sustained change across the 10 years, increasing from 0.69 per 10,000 patient days (95% CI, 0.59-0.80) in 2007-2008 to 1.42 per 10,000 patient days (95% CI, 1.27-1.58) in 2016-2017. CONCLUSIONS Despite ongoing surveillance, overall HABSI rates have not decreased. The effect of BACTOT participation should be more closely investigated, and targeted interventions along alternative surveillance modalities should be considered, prioritizing high-burden and potentially preventable BSI types.
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Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Use with Positive Blood Cultures: Methodology, Performance, and Optimization. J Clin Microbiol 2017; 55:3328-3338. [PMID: 28855303 DOI: 10.1128/jcm.00868-17] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Early initiation of effective antibiotics for septic patients is essential for patient survival. Matrix-assisted desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has revolutionized clinical microbiology for isolate identification and has the possibility to impact how blood culture testing is performed. This review discusses the various uses of MALDI-TOF MS for the identification and susceptibility testing of positive blood cultures, the performance of these methods, and the outcomes involved with its implementation.
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Liu CF, Shi XP, Chen Y, Jin Y, Zhang B. Rapid diagnosis of sepsis with TaqMan-Based multiplex real-time PCR. J Clin Lab Anal 2017; 32. [PMID: 28512861 DOI: 10.1002/jcla.22256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 04/17/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The survival rate of septic patients mainly depends on a rapid and reliable diagnosis. A rapid, broad range, specific and sensitive quantitative diagnostic test is the urgent need. Thus, we developed a TaqMan-Based Multiplex real-time PCR assays to identify bloodstream pathogens within a few hours. METHODS Primers and TaqMan probes were designed to be complementary to conserved regions in the 16S rDNA gene of different kinds of bacteria. To evaluate accurately, sensitively, and specifically, the known bacteria samples (Standard strains, whole blood samples) are determined by TaqMan-Based Multiplex real-time PCR. In addition, 30 blood samples taken from patients with clinical symptoms of sepsis were tested by TaqMan-Based Multiplex real-time PCR and blood culture. RESULTS The mean frequency of positive for Multiplex real-time PCR was 96% at a concentration of 100 CFU/mL, and it was 100% at a concentration greater than 1000 CFU/mL. All the known blood samples and Standard strains were detected positively by TaqMan-Based Multiplex PCR, no PCR products were detected when DNAs from other bacterium were used in the multiplex assay. Among the 30 patients with clinical symptoms of sepsis, 18 patients were confirmed positive by Multiplex real-time PCR and seven patients were confirmed positive by blood culture. CONCLUSION TaqMan-Based Multiplex real-time PCR assay with highly sensitivity, specificity and broad detection range, is a rapid and accurate method in the detection of bacterial pathogens of sepsis and should have a promising usage in the diagnosis of sepsis.
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Affiliation(s)
- Chang-Feng Liu
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Xin-Ping Shi
- Department of Clinical Laboratory, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Yun Chen
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Ye Jin
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Bing Zhang
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
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Buetti N, Atkinson A, Kronenberg A, Marschall J. Different Epidemiology of Hospital-Acquired Bloodstream Infections Between Small Community Hospitals and Large Community Hospitals. Clin Infect Dis 2017; 64:984-985. [PMID: 28362940 DOI: 10.1093/cid/cix040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Niccolò Buetti
- Department of Infectious Diseases, University Hospital Bern
| | - Andrew Atkinson
- Department of Infectious Diseases, University Hospital Bern.,Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital; and
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Stenehjem E, Hersh AL, Pavia AT. Reply to Buetti et al. Clin Infect Dis 2017; 64:985-986. [PMID: 28362941 DOI: 10.1093/cid/cix041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Edward Stenehjem
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah; and
| | - Adam L Hersh
- Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City
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Bernasconi OJ, Donà V, Tinguely R, Endimiani A. In vitro activity of three commercial bacteriophage cocktails against multidrug-resistant Escherichia coli and Proteus spp. strains of human and non-human origin. J Glob Antimicrob Resist 2017; 8:179-185. [PMID: 28232228 DOI: 10.1016/j.jgar.2016.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Bacteriophages may represent a therapeutic alternative to treat infections caused by multidrug-resistant (MDR) pathogens. However, studies analysing their activity against MDR Enterobacteriaceae are limited. METHODS The in vitro lytic activity of three commercial bacteriophage cocktails (PYO, INTESTI and Septaphage) was evaluated against 70 Escherichia coli and 31 Proteus spp. of human and non-human origin. Isolates were characterised by phenotypic and genotypic methods and included 82 MDR strains [44 extended-spectrum-β-lactamase (ESBL)-producers (18 CTX-M-15-like, including ST131/ST648 E. coli); 27 plasmid-mediated AmpC β-lactamase (pAmpC)-producers (23 CMY-2-like, including ST131 E. coli); 3 ESBL+pAmpC-producers; and 8 carbapenemase-producers]. Phage susceptibility was determined by the spot test. RESULTS E. coli susceptibility to PYO, INTESTI and Septaphage was 61%, 67% and 9%, whereas that of Proteus spp. was 29%, 39% and 19%, respectively. For the subgroup of ESBL-producing E. coli/Proteus spp., the following susceptibility rates were recorded: PYO, 57%; INTESTI, 59%; and Septaphage, 11%. With regard to pAmpC-producers, 59%, 70% and 11% were susceptible to PYO, INTESTI and Septaphage, respectively. Five of eight carbapenemase-producers and three of four colistin-resistant E. coli were susceptible to PYO and INTESTI. CONCLUSIONS This is the first study analysing the activity of the above three cocktails against well-characterised MDR E. coli and Proteus spp. The overall narrow spectrum of activity observed could be related to the absence of specific bacteriophages targeting these contemporary MDR strains that are spreading in different settings. Therefore, bacteriophages targeting emerging MDR pathogens need to be isolated and integrated in such biopreparations.
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Affiliation(s)
- Odette J Bernasconi
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001 Bern, Switzerland; Graduate School of Cellular and Biomedical Sciences, University of Bern, Freiestrasse 1, CH-3012 Bern, Switzerland
| | - Valentina Donà
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001 Bern, Switzerland
| | - Regula Tinguely
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001 Bern, Switzerland
| | - Andrea Endimiani
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001 Bern, Switzerland.
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