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Gurney H, White J, Sweeney J, Valyko A, Washer L. Evaluation of hospital-onset bloodstream infections compared to central line...associated bloodstream infections at an acute, tertiary care hospital. Am J Infect Control 2023; 51:1120-1123. [PMID: 37054893 DOI: 10.1016/j.ajic.2023.04.001] [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: 02/23/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Central line...associated bloodstream infection (CLABSI) is the current benchmark used in HAI (Hospital-associated infection) surveillance and effective interventions have greatly reduced the incidence in recent years. However, bloodstream infection (BSI) continues to be a major source of morbidity and mortality in hospitals. Hospital-onset bloodstream infection (HOBSI), which includes central and peripheral line surveillance, may be a more sensitive indicator of preventable BSI. Our objective is to assess the impact of a change to HOBSI surveillance by comparing the incidence of BSIs using the National Health care and Safety Network LabID and BSI definitions compared to CLABSI. METHODS Utilizing electronic medical charts, we determined if each blood culture met the HOBSI criteria according to the National Health care and Safety Network LabID and BSI definitions. We calculated the incidence rates (IRs) per 10,000 patient days for both definitions and compared them to the CLABSI rate per 10,000 patient days for the same period. RESULTS The IR of HOBSI using the LabID definition was 10.25. Using the BSI definition, we found an IR of 3.77. The IR of CLABSI for the same period was 1.84. CONCLUSIONS After excluding secondary BSIs, the HOBSI rate is still double that of the CLABSI rate. HOBSI surveillance is a more sensitive indicator of BSI than CLABSI, and thus a better target for monitoring effectiveness of interventions.
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Affiliation(s)
- Haley Gurney
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI.
| | - Jacqueline White
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI
| | - Jennifer Sweeney
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI
| | - Amanda Valyko
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI
| | - Laraine Washer
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI
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Singh N, Puri S, Kumar S, Pahuja H, Kalia R, Arora R. Risk Factors and Outcome Analysis of Gram-Positive Bacteremia in Critically Ill Patients. Cureus 2023; 15:e36585. [PMID: 37097814 PMCID: PMC10122440 DOI: 10.7759/cureus.36585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Introduction Bloodstream infection (BSI) is a common problem for patients in the intensive care unit (ICU). Nearly 60% of primary bloodstream infections are caused by Gram-positive cocci. Gram-positive bacteria gain access to the bloodstream through invasive procedures and various patient care equipment like catheters, intravenous lines, and mechanical ventilators. S. aureus is considered to be the major cause of septicemia. Knowledge of healthcare-associated infections and the antimicrobial susceptibility patterns of the isolates are crucial in guiding empirical treatment. Methods This prospective observational study was conducted in Medical ICU, Dayanand Medical College & Hospital, Ludhiana over a period of one year (December 2015 to November 2016). Patients whose blood cultures tested positive for Gram-positive bacteria were included in the study. This study was carried out to assess the implications and risk factors for nosocomial BSI and several factors, including the age of the patient, the severity of illness, the presence of catheters, and the microorganisms causing the BSI to independently predict mortality. Chief complaints and risk factors were evaluated. APACHE-II scores were calculated for all patients and outcomes were analyzed. Results In our study, the mean age of patients was 50.93±14.09 years. Central line insertion was found as the most common risk factor (58.7%). A statistically significant correlation was obtained between APACHE-II scores and the presence of risk factors i.e. central line insertion (p-value=0.010) and diabetes mellitus (p-value=0.003). The most common Gram-positive pathogen isolated by blood culture was methicillin-sensitive S. aureus (44.2%). For management, the majority of the patients were prescribed teicoplanin (58.7%). The 28-day overall mortality rate in our study was 52.9%. Conclusion We conclude that independent risk factors like diabetes mellitus, central line insertion, and acute pancreatitis in adult patients with Gram-positive bacteremia were associated with higher mortality. We have also concluded that the administration of early appropriate antibiotics improves patient outcomes.
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Affiliation(s)
- Navpreet Singh
- Internal Medicine, Gian Sagar Medical College and Hospital, Rajpura, IND
| | - Sandeep Puri
- Internal Medicine, Dayanand Medical College & Hospital, Ludhiana, IND
| | - Sachin Kumar
- Anaesthesiology, All India Institute of Medical Sciences, New Delhi, Delhi, IND
| | - Hardik Pahuja
- Psychiatry, Gian Sagar Medical College and Hospital, Rajpura, IND
| | - Rajni Kalia
- Anaesthesiology, Government Medical College & Hospital, Chandigarh, IND
| | - Rashmi Arora
- Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Increase in the incidence of Candida parapsilosis and Candida tropicalis bloodstream infections during the coronavirus disease 2019 (COVID-19) pandemic. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e2. [PMID: 36714279 PMCID: PMC9879889 DOI: 10.1017/ash.2022.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023]
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Galatage ST, Manjappa AS, Kumbhar PS, Salawi A, Sabei FY, Siddiqui AM, Patil RV, Akole VS, Powar RD, Kagale MN. Synthesis of silver nanoparticles using Emilia sonchifolia plant for treatment of bloodstream diseases caused by Escherichia coli. ANNALES PHARMACEUTIQUES FRANÇAISES 2022:S0003-4509(22)00179-1. [PMID: 36529284 DOI: 10.1016/j.pharma.2022.12.007] [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: 02/13/2022] [Revised: 08/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Among infectious diseases, bloodstream infection (BSI) caused by gram-negative bacteria (E. coli) is the leading cause of death worldwide. However, the bacteria have produced resistance to many of these antibiotics. Thus, the present study aimed to develop silver nanoparticles (AgNPs) loaded with Emilia sonchifolia (ES) extract (ES-AgNPs) to treat BSI efficiently. METHODS AgNPs were synthesized by reduction of silver nitrate (AgNO3) solution by ES extract. Furthermore, these ES-AgNPs were characterized for particle size and zeta potential, crystallinity by powder X-ray diffraction (P-XRD) technique, in vitro antibacterial activity, time-kill assay, film bio adhesion, and fluorescence assay. RESULTS Surface plasmon resonance (SPR) has been used to confirm the formation of AgNPs by seeing a shift in colour to dark-brown. The ES-AgNPs displayed a mean particle size of 137±3nm (PDI of 0.168±0.02) and zeta potential of 18.2±0.8mV. Furthermore, according to P-XRD results, the developed AgNPs are highly crystalline. The ES-AgNPs showed effective antibacterial action against E. coli with minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) of 0.4±0.02μg/mL and 0.8±0.03μg/mL, respectively. In addition, ES-AgNPs inhibited biofilm formation and bacterial adhesion in a dose-dependent manner with 100% inhibition obtained in 48h at MBC. CONCLUSIONS Present research work revealed that the ES-AgNPs obtained by green synthesis holds a prominent antibacterial activity in the treatment of BSIs caused by E. coli and they may be used as a competent substitute for current treatments. However, further, in vivo antibacterial studies are required to establish its efficacy in the treatment of BSIs.
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Affiliation(s)
- S T Galatage
- Sant Gajanan Maharaj College of Pharmacy, Mahagoan Site: Chinchewadi-416502, Kolhapur, Maharashtra, India.
| | - A S Manjappa
- Department of Pharmaceutics, Tatyasaheb Kore College of Pharmacy, Warananagar-416113, Kolhapur, Maharashtra, India.
| | - P S Kumbhar
- Department of Pharmaceutics, Tatyasaheb Kore College of Pharmacy, Warananagar-416113, Kolhapur, Maharashtra, India
| | - A Salawi
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - F Y Sabei
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - A M Siddiqui
- Sant Gajanan Maharaj College of Pharmacy, Mahagoan Site: Chinchewadi-416502, Kolhapur, Maharashtra, India
| | - R V Patil
- Sant Gajanan Maharaj College of Pharmacy, Mahagoan Site: Chinchewadi-416502, Kolhapur, Maharashtra, India
| | - V S Akole
- Sant Gajanan Maharaj College of Pharmacy, Mahagoan Site: Chinchewadi-416502, Kolhapur, Maharashtra, India
| | - R D Powar
- Sant Gajanan Maharaj College of Pharmacy, Mahagoan Site: Chinchewadi-416502, Kolhapur, Maharashtra, India
| | - M N Kagale
- Sant Gajanan Maharaj College of Pharmacy, Mahagoan Site: Chinchewadi-416502, Kolhapur, Maharashtra, India
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Hernandez-Cuellar E, Guerrero-Barrera AL, Avelar-Gonzalez FJ, Díaz JM, Santiago ASD, Chávez-Reyes J, Poblano-Sánchez E. Characterization of Candida albicans and Staphylococcus aureus polymicrobial biofilm on different surfaces. Rev Iberoam Micol 2022; 39:36-43. [PMID: 35738989 DOI: 10.1016/j.riam.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 03/24/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Staphylococcus aureus and Candida albicans have been co-isolated from biofilm-associated diseases such as denture stomatitis, periodontitis, and burn wound infections, as well as from medical devices. However, the polymicrobial biofilm of both microorganisms has not been fully characterized. AIMS To characterize the polymicrobial biofilm of C. albicans and S. aureus in terms of microbial density, synergy, composition, structure, and stability against antimicrobials and chemical agents. METHODS Crystal violet assay was used to measure the biofilm formation. Scanning electron microscopy and confocal microscopy were used to analyze the structure and chemical composition of the biofilms, respectively. RESULTS Supplemented media with fetal bovine serum (FBS) decreased the biofilm formation of S. aureus and the polymicrobial biofilm. For C. albicans, depending on the culture media, the addition of glucose or FBS had a positive effect in biofilm formation. FBS decreased the adhesion to polystyrene wells for both microorganisms. Supplementing the media with glucose and FBS enhanced the growth of C. albicans and S. aureus, respectively. It seems that C. albicans contributes the most to the adhesion process and to the general structure of the biofilms on all the surfaces tested, including a catheter model. Interestingly, S. aureus showed a great adhesion capacity to the surface of C. albicans in the biofilms. Proteins and β-1,6-linked polysaccharides seem to be the most important molecules in the polymicrobial biofilm. CONCLUSIONS The polymicrobial biofilm had a complex structure, with C. albicans serving as a scaffold where S. aureus adheres, preferentially to the hyphal form of the fungus. Detection of polymicrobial infections and characterization of biofilms will be necessary in the future to provide a better treatment.
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Affiliation(s)
- Eduardo Hernandez-Cuellar
- Laboratorio de Biología Celular y Tisular, Departamento de Morfología, Universidad Autónoma de Aguascalientes (UAA), Aguascalientes, Mexico.
| | - Alma Lilián Guerrero-Barrera
- Laboratorio de Biología Celular y Tisular, Departamento de Morfología, Universidad Autónoma de Aguascalientes (UAA), Aguascalientes, Mexico
| | - Francisco Javier Avelar-Gonzalez
- Laboratorio de Ciencias Ambientales, Departamento de Fisiología y Farmacología, Universidad Autónoma de Aguascalientes (UAA), Aguascalientes, Mexico
| | - Juan Manuel Díaz
- Laboratorio de Biología Celular y Tisular, Departamento de Morfología, Universidad Autónoma de Aguascalientes (UAA), Aguascalientes, Mexico
| | - Alfredo Salazar de Santiago
- Unidad Académica de Odontología, Área de Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas, Mexico
| | - Jesús Chávez-Reyes
- Laboratorio de Farmacología y Terapéutica Experimental, Departamento de Fisiología y Farmacología, Universidad Autónoma de Aguascalientes (UAA), Aguascalientes, Mexico
| | - Emanuel Poblano-Sánchez
- Institute for Social Security and Services for State Workers (ISSSTE), Aguascalientes, Mexico
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Wei J, He L, Weng F, Huang F, Teng P. Effectiveness of chlorhexidine in preventing infections among patients undergoing cardiac surgeries: a meta-analysis and systematic review. Antimicrob Resist Infect Control 2021; 10:140. [PMID: 34620240 PMCID: PMC8499511 DOI: 10.1186/s13756-021-01009-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/30/2021] [Indexed: 01/15/2023] Open
Abstract
Background Although several meta-analyses reported the impact of chlorhexidine (CHX) use in patients undergoing various types of surgery, no meta-analysis summarized the overall effectiveness of CHX specifically for cardiac surgery. This meta-analysis aimed to examine the impact of CHX on infections after cardiac surgery compared with other cleansers or antiseptics. Methods PubMed, Embase, and the Cochrane Library were searched from inception up to October 2020 for potentially eligible studies: (1) population: patients who underwent cardiac surgery; (2) intervention or exposure: any type of CHX use in the treatment or exposed group; (3) outcome: number of patients with infections; (4) comparison: placebo or other antiseptic agents; (5) English. The primary outcome was surgical site infection (SSI). Results Fourteen studies were included, with 8235 and 6901 patients in the CHX and control groups. CHX was not protective against SSI (OR = 0.77, 95% CI: 0.57–1.04, P = 0.090). CHX was protective for superficial wound infection (OR = 0.42, 95% CI: 0.26–0.70, P = 0.001), but not with deep wound infection (P = 0.509). CHX was not protective against urinary tract of infection (P = 0.415) but was protective for bloodstream infection (OR = 0.36, 95% CI: 0.16–0.80, P = 0.012), nosocomial infections (OR = 0.55, 95% CI: 0.44–0.69, P < 0.001), and pneumonia (OR = 0.26, 95% CI: 0.11–0.61, P = 0.002). Conclusions In patients undergoing cardiac surgery, CHX does not protect against SSI, deep wound infection, and urinary tract infections but might protect against superficial SSI, bloodstream infection, nosocomial infections, and pneumonia. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01009-3.
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Affiliation(s)
- Jianhua Wei
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
| | - Lingying He
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Fengxia Weng
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Fangfang Huang
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Peng Teng
- Surgical Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
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Yuan S, Sun Y, Xiao X, Long Y, He H. Using Machine Learning Algorithms to Predict Candidaemia in ICU Patients With New-Onset Systemic Inflammatory Response Syndrome. Front Med (Lausanne) 2021; 8:720926. [PMID: 34490306 PMCID: PMC8416760 DOI: 10.3389/fmed.2021.720926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Distinguishing ICU patients with candidaemia can help with the precise prescription of antifungal drugs to create personalized guidelines. Previous prediction models of candidaemia have primarily used traditional logistic models and had some limitations. In this study, we developed a machine learning algorithm trained to predict candidaemia in patients with new-onset systemic inflammatory response syndrome (SIRS). Methods: This retrospective, observational study used clinical information collected between January 2013 and December 2017 from three hospitals. The ICU patient data were used to train 4 machine learning algorithms–XGBoost, Support Vector Machine (SVM), Random Forest (RF), ExtraTrees (ET)–and a logistic regression (LR) model to predict patients with candidaemia. Results: Of the 8,002 cases of new-onset SIRS (in 7,932 patients) included in the analysis, 137 new-onset SIRS cases (in 137 patients) were blood culture positive for candidaemia. Risk factors, such as fungal colonization, diabetes, acute kidney injury, the total number of parenteral nutrition days and renal replacement therapy, were important predictors of candidaemia. The XGBoost machine learning model outperformed the other models in distinguishing patients with candidaemia [XGBoost vs. SVM vs. RF vs. ET vs. LR; area under the curve (AUC): 0.92 vs. 0.86 vs. 0.91 vs. 0.90 vs. 0.52, respectively]. The XGBoost model had a sensitivity of 84%, specificity of 89% and negative predictive value of 99.6% at the best cut-off value. Conclusions: Machine learning algorithms can potentially predict candidaemia in the ICU and have better efficiency than previous models. These prediction models can be used to guide antifungal treatment for ICU patients when SIRS occurs.
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Affiliation(s)
- Siyi Yuan
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yunbo Sun
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiongjian Xiao
- Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yun Long
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huaiwu He
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Scardina T, Oikonomopoulou Z, Sun S, Muller WJ, Patel SJ. Opportunities for Antimicrobial Stewardship Among Pediatric Patients Prescribed Combination Antifungal Therapy. J Pediatr Pharmacol Ther 2021; 26:624-631. [PMID: 34421413 DOI: 10.5863/1551-6776-26.6.624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/13/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Combination antifungal therapy (CAF) may be prescribed to treat invasive fungal infections (IFIs). Data on the incidence of CAF among the pediatric population are limited. Antimicrobial stewardship for CAF includes therapeutic drug monitoring (TDM) and monitoring for adverse events. Primary outcome was to determine the incidence of CAF prescribed for documented proven, probable, and possible IFI. Secondary outcomes were to determine initial dose of antifungal therapy, determine incidence of adverse events, and evaluate our practice of TDM. METHODS Medical charts of patients who received CAF for proven, probable, or possible IFI within 6 years were reviewed. Patients age ≤18 years, prescribed CAF (defined as a second antifungal therapy started ≤72 hours of initial antifungal therapy) for at least 72 hours, and with normal liver function test results were included. RESULTS 57 patients received CAF for 72 separate episodes: 35 episodes were proven IFI, 11 were probable IFI, and 26 were possible IFI. Initial dose of antifungal therapy varied, and 29.1% received a loading dose. A total of 10 patients experienced 14 adverse events that were related to antifungal therapy. In 63.8% of CAF episodes, TDM was conducted. Target antifungal concentrations were documented for 10 CAF episodes. Reason for discontinued of CAF was documented for 35 episodes. Of these episodes, 74% were discontinued after therapeutic antifungal concentrations were achieved. CONCLUSIONS There are opportunities for antimicrobial stewardship interventions in the method of TDM and monitoring for adverse events that could aid in management of CAF.
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Meyer A, Schreiber J, Brinkmann J, Klatt AR, Stosch C, Streichert T. Deterioration in hygiene behavior among fifth-year medical students during the placement of intravenous catheters: a prospective cohort comparison of practical skills. BMC MEDICAL EDUCATION 2021; 21:434. [PMID: 34404414 PMCID: PMC8369648 DOI: 10.1186/s12909-021-02868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The American Association of Medical Colleges has defined peripheral intravenous cannulation as one of the eight practical skills that a medical student should possess upon graduation. Since following a standard hygiene protocol can reduce the rate of complications such as bloodstream infections, the medical student's compliance to hygienic standards is highly relevant. METHODS This unicentric longitudinal cohort study included 177 medical students undergoing OSCE 1 in the winter semesters 2016/2017 and 2017/2018 as well as OSCE 2 during the winter semesters 2018/2019 and 2019/2020 at the University of Cologne. Their performance in peripheral intravenous cannulation was rated by trained student supervisors using a scaled 13-item questionnaire and compared between OSCE 1 and OSCE 2. RESULTS Overall, a decline in the correct placement of peripheral intravenous catheters was observed among advanced medical students during OSCE 2 (mean total score: 6.27 ± 1.84) in comparison to their results in OSCE 1 (mean total score: 7.67 ± 1.7). During OSCE 2, the students were more negligent in regard to hygienic behavior, such as disinfection of the puncture site as well as hand disinfection before and after venipuncture. Their patients were also less likely to be informed about the procedure as compared to OSCE 1. CONCLUSIONS An unsatisfying performance in regard to peripheral intravenous cannulation was observed in medical students with hygiene compliance deteriorating between the third and fifth year of their study. Thus, we promote an extension of practical hygiene and stress management training in medical school to reduce complications associated with intravenous catheters, such as bloodstream infections.
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Affiliation(s)
- Annika Meyer
- Department of clinical chemistry, University of Cologne, Faculty of medicine and university hospital, Kerpener Str. 62, 50937, Cologne, Germany.
- Interprofessional Skills Lab and Simulation center (KISS), University of Cologne, faculty of medicine and university hospital, Joseph-Stelzmann-Straße 9a, 50931, Cologne, Germany.
| | - Jakob Schreiber
- Interprofessional Skills Lab and Simulation center (KISS), University of Cologne, faculty of medicine and university hospital, Joseph-Stelzmann-Straße 9a, 50931, Cologne, Germany
| | - Julian Brinkmann
- Interprofessional Skills Lab and Simulation center (KISS), University of Cologne, faculty of medicine and university hospital, Joseph-Stelzmann-Straße 9a, 50931, Cologne, Germany
| | - Andreas R Klatt
- Department of clinical chemistry, University of Cologne, Faculty of medicine and university hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - Christoph Stosch
- Interprofessional Skills Lab and Simulation center (KISS), University of Cologne, faculty of medicine and university hospital, Joseph-Stelzmann-Straße 9a, 50931, Cologne, Germany
| | - Thomas Streichert
- Department of clinical chemistry, University of Cologne, Faculty of medicine and university hospital, Kerpener Str. 62, 50937, Cologne, Germany
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Soulountsi V, Schizodimos T, Kotoulas SC. Deciphering the epidemiology of invasive candidiasis in the intensive care unit: is it possible? Infection 2021; 49:1107-1131. [PMID: 34132989 DOI: 10.1007/s15010-021-01640-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
Invasive candidiasis (IC) has emerged in the last decades as an important cause of morbidity, mortality, and economic load in the intensive care unit (ICU). The epidemiology of IC is still a difficult and unsolved enigma for the literature. Accurate estimation of the true burden of IC is difficult due to variation in definitions and limitations inherent to available case-finding methodologies. Candidemia and intra-abdominal candidiasis (IAC) are the two predominant types of IC in ICU. During the last two decades, an increase in the incidence of candidemia has been constantly reported particularly in the expanding populations of elderly or immunosuppressed patents, with a parallel change in Candida species (spp.) distribution worldwide. Epidemiological shift in non-albicans spp. has reached worrisome trends. Recently, a novel, multidrug-resistant Candida spp., Candida auris, has globally emerged as a nosocomial pathogen causing a broad range of healthcare-associated invasive infections. Epidemiological profile of IAC remains imprecise. Though antifungal drugs are available for Candida infections, mortality rates continue to be high, estimated to be up to 50%. Increased use of fluconazole and echinocandins has been associated with the emergence of resistance to these drugs, which affects particularly C. albicans and C. glabrata. Crucial priorities for clinicians are to recognize the epidemiological trends of IC as well as the emergence of resistance to antifungal agents to improve diagnostic techniques and strategies, develop international surveillance networks and antifungal stewardship programmes for a better epidemiological control of IC.
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Affiliation(s)
- Vasiliki Soulountsi
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece.
| | - Theodoros Schizodimos
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
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Tsuzuki S, Matsunaga N, Yahara K, Shibayama K, Sugai M, Ohmagari N. Disease burden of bloodstream infections caused by antimicrobial-resistant bacteria: A population-level study, Japan, 2015-2018. Int J Infect Dis 2021; 108:119-124. [PMID: 33992765 DOI: 10.1016/j.ijid.2021.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health problem. However, quantitative evaluation of its disease burden is challenging. This study aimed to estimate the disease burden of bloodstream infections (BSIs) caused by major antimicrobial-resistant bacteria in Japan between 2015 and 2018 in terms of disability-adjusted life-years (DALYs). METHODS DALYs of BSIs caused by nine major antimicrobial-resistant bacteria in Japan were estimated using comprehensive national surveillance data of all routine bacteriological test results from more than 1400 hospitals between 2015 and 2018. The methodology of Cassini et al. was modified to enable comparison of the present results with those in other countries. RESULTS It was estimated that 137.9 [95% uncertainty interval (UI) 130.7-145.2] DALYs per 100,000 population were attributable to BSIs caused by nine antimicrobial-resistant bacteria in 2018. Methicillin-resistant Staphylococcus aureus (MRSA), fluoroquinolone-resistant Escherichia coli (FQREC) and third-generation cephalosporin-resistant E. coli (3GREC) accounted for 87.2% overall. The burden did not decrease during the study period and was highest in people aged ≥65 years. CONCLUSION The results revealed, for the first time, the disease burden of BSIs caused by nine major antimicrobial-resistant bacteria in Japan. The estimated disease burden associated with AMR in Japan is substantial and has not begun to decrease. Notably, the burden from FQREC and 3GREC has increased steadily, and that from MRSA is larger in Japan than in the European Union/European Economic Area, whereas the burden from other bacteria is comparatively small. These results are expected to provide useful information for healthcare policy makers for prioritizing interventions for AMR.
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Affiliation(s)
- Shinya Tsuzuki
- AMR Clinical Reference Centre, National Centre for Global Health and Medicine, Tokyo, Japan; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan.
| | - Nobuaki Matsunaga
- AMR Clinical Reference Centre, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Koji Yahara
- Antimicrobial Resistance Research Centre, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keigo Shibayama
- Antimicrobial Resistance Research Centre, National Institute of Infectious Diseases, Tokyo, Japan; Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Motoyuki Sugai
- Antimicrobial Resistance Research Centre, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Centre, National Centre for Global Health and Medicine, Tokyo, Japan; Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan
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Interleukin-10 (IL-10) 1082 promoter polymorphisms and plasma IL-10 levels in patients with bacterial sepsis. ACTA ACUST UNITED AC 2021; 59:50-57. [PMID: 33155998 DOI: 10.2478/rjim-2020-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Indexed: 11/20/2022]
Abstract
Background. Interleukin-10 (IL-10) is a multifunctional cytokine which has been seen to play a relevant role in the pathogenesis of sepsis. We examined the association between a single nucleotide polymorphism (SNP) in IL-10-1082G/A in patients with sepsis in Cali city.Methods. A total of 100 patients with sepsis and 50 control subjects were enrolled in this study. Blood samples were collected from all patients in EDTA containing tubes. IL-10-1082G/A gene promoter polymorphism was analyzed by Sequence Specific Polymerase Chain Reaction (SS-PCR), while levels of serum IL-10 were measured by Enzyme Linked Immunoassay Assay (ELISA) in patients with sepsis and healthy controls.Results. AA homozygous genotype was found more frequently in patients (32%), compared with controls (18%). AA homozygous patients showed an increased risk of developing infection by Gram-negative bacteria (OR = 2,875; 95% CI = 1.162-7.113; p = 0.020), and significantly high plasma levels of IL-10 (OR = 4.800, 95% CI 1.652-13.944; p = 0.002). AA homozygous patients high plasma IL-10 levels have greater risk of developing sepsis (63.6%; OR = 4,894; 95% CI: 1,337-17,909; p = 0.002). In this group, Afro-Colombian individuals were overrepresented among the sepsis patients with high plasma IL-10 levels (OR = 1.661; 95% CI: 1.408-1.959; p = 0.036).Conclusion. Our study concluded that AA genotype of IL-10-1082G/A polymorphism is a risk factor for high IL-10 production and development of sepsis by Gram negative bacteria, especially in Afro-Colombian patients.
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Antimicrobial Resistance in Pathogens Isolated from Blood Cultures: A Two-Year Multicenter Hospital Surveillance Study in Italy. Antibiotics (Basel) 2020; 10:antibiotics10010010. [PMID: 33374232 PMCID: PMC7824585 DOI: 10.3390/antibiotics10010010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Antimicrobial resistance (AMR) is one of the most concerning issues in medicine today. The objectives of this study were to investigate the AMR distribution of the blood-borne pathogens isolated over a two-year period in an Italian region. Methods: A retrospective electronic record review of laboratory-confirmed bloodstream infections (BSIs) was done, and data from three major diagnostic laboratories were used. Twelve invasive clinically important bacteria species were included in the sample. Results: During the study period, 1228 positive BSIs were collected. The most common pathogens were Coagulase-negative Staphylococcus (CoNS) (29.7%), Staphylococcus aureus (19.1%) and Escherichia coli (15.9%). With regard to the AMR pattern, 31.7% of CoNS and 28.1% of Staphylococcus aureus were oxacillin-resistant, and almost half of the Enterococci showed resistance to high-level gentamicin. Among Gram-negative species, 11.7% of Escherichia coli and 39.5% of Klebsiella pneumoniae were carbapenem-resistant. Among the non-fermentative Gram-negative bacteria, the most frequently combined AMR pattern was aminoglycosides and fluoroquinolones (48.4% in A. baumannii and 14.6% in P. aeruginosa). Conclusion: The results display an alarming prevalence of AMR among hospital isolated pathogens, consistently higher than the European average. Information from surveillance systems to better characterize the trend in the incidence of AMR at local and national levels is needed.
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Clinical characteristics, management and outcome of patients with invasive candidiasis hospitalized in Internal Medicine Units: findings from a registry by the Italian Scientific Society FADOI. Infection 2020; 49:277-285. [PMID: 33095391 DOI: 10.1007/s15010-020-01535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Invasive candidiasis (IC) is a challenging clinical condition, burdened by relevant mortality and morbidity. There is limited knowledge on the occurrence and management of IC in Internal Medicine Units (IMUs). Aim of this study was to provide real-world data on this topic. METHODS Consecutive objectively diagnosed cases of IC were collected in this prospective registry, which involved 18 IMUs in Italy. Patients were followed-up to 90 days from the diagnosis of candidemia. RESULTS A total of 111 patients were observed (median age 78, IQR 67-83) for an overall incidence of infection of 1.89 cases/1000 hospital admissions. Candida albicans was the most frequent isolated species (62%), followed by Candida parapsilosis (17%) and Candida glabrata (13%). Echinocandins and fluconazole were used as initial therapy in 56.8 and 43.2% of patients, respectively. Antifungal therapy was started within 24 h in 18.9% of patients, in 40.6% in the period 1-3 days, and in 40.5% of patients more than 3 days after blood cultures. Death rate was 19.8% at 30 days and 40.5% at 90 days. At multivariable analysis concomitant bacteremia (i.e. polymicrobial sepsis), and fluconazole as the initial therapy were associated with an increased risk of death at 90 days. CONCLUSIONS The incidence of IC is not negligible, and our registry confirmed that these patients have a relevant mortality rate at 90 days. Concomitant bacteremia, featuring polymicrobial sepsis, and starting antifungal treatment with fluconazole instead of echinocandins independently increase the risk of death. Efforts are needed to improve the awareness and management of IC in IMUs.
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Tsuzuki S, Matsunaga N, Yahara K, Gu Y, Hayakawa K, Hirabayashi A, Kajihara T, Sugai M, Shibayama K, Ohmagari N. National trend of blood-stream infection attributable deaths caused by Staphylococcus aureus and Escherichia coli in Japan. J Infect Chemother 2020; 26:367-371. [DOI: 10.1016/j.jiac.2019.10.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/21/2019] [Accepted: 10/29/2019] [Indexed: 01/31/2023]
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Wadhwa R, Pandey P, Gupta G, Aggarwal T, Kumar N, Mehta M, Satija S, Gulati M, Madan JR, Dureja H, Balusamy SR, Perumalsamy H, Maurya PK, Collet T, Tambuwala MM, Hansbro PM, Chellappan DK, Dua K. Emerging Complexity and the Need for Advanced Drug Delivery in Targeting Candida Species. Curr Top Med Chem 2019; 19:2593-2609. [DOI: 10.2174/1568026619666191026105308] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/15/2019] [Accepted: 09/07/2019] [Indexed: 02/07/2023]
Abstract
Background:Candida species are the important etiologic agents for candidiasis, the most prevalent cause of opportunistic fungal infections. Candida invasion results in mucosal to systemic infections through immune dysfunction and helps in further invasion and proliferation at several sites in the host. The host defence system utilizes a wide array of the cells, proteins and chemical signals that are distributed in blood and tissues which further constitute the innate and adaptive immune system. The lack of antifungal agents and their limited therapeutic effects have led to high mortality and morbidity related to such infections.Methods:The necessary information collated on this review has been gathered from various literature published from 1995 to 2019.Results:This article sheds light on novel drug delivery approaches to target the immunological axis for several Candida species (C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, C. krusei, C. rugose, C. hemulonii, etc.).Conclusion:It is clear that the novel drug delivery approaches include vaccines, adoptive transfer of primed immune cells, recombinant cytokines, therapeutic antibodies, and nanoparticles, which have immunomodulatory effects. Such advancements in targeting various underpinning mechanisms using the concept of novel drug delivery will provide a new dimension to the fungal infection clinic particularly due to Candida species with improved patient compliance and lesser side effects. This advancement in knowledge can also be extended to target various other similar microbial species and infections.
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Affiliation(s)
- Ridhima Wadhwa
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia
| | - Parijat Pandey
- Shri Baba Mastnath Institute of Pharmaceutical Sciences and Research, Baba Mastnath University, Rohtak 124001, India
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura 302 017, Jaipur, India
| | - Taru Aggarwal
- Amity Institute of Biotechnology, Amity University, Noida 201303, India
| | - Nitesh Kumar
- Amity Institute for Advanced Research & Studies (M&D), Amity University, Noida 201303, India
| | - Meenu Mehta
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar, Delhi G.T. Road (NH-1), Phagwara-144411, Punjab, India
| | - Saurabh Satija
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar, Delhi G.T. Road (NH-1), Phagwara-144411, Punjab, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar, Delhi G.T. Road (NH-1), Phagwara-144411, Punjab, India
| | - Jyotsna R. Madan
- Department of Pharmaceutics, Smt. Kashibai Navale College of Pharmacy, Kondhwa, Pune, 411048, Maharashtra, India
| | - Harish Dureja
- Department of Pharmaceutical Sciences, Maharishi Dayanand University, Rohtak, Haryana 124001, India
| | - Sri R. Balusamy
- Department of Food Science and Biotechnology, Sejong University, Gwangjin-gu, Seoul, 05006, Korea
| | - Haribalan Perumalsamy
- Graduate School of Biotechnology, College of Life Science, Kyung Hee University, Yongin, 446-701, Korea
| | - Pawan K. Maurya
- Department of Biochemistry, Central University of Haryana, Jant-Pali, Mahendergarh District 123031, Haryana, India
| | - Trudi Collet
- Innovative Medicines Group, Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia
| | - Murtaza M. Tambuwala
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, County Londonderry, BT52 1SA, Northern Ireland, United Kingdom
| | - Philip M. Hansbro
- School of Life Sciences, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Kamal Dua
- School of Pharmaceutical Sciences, Shoolini University, Bajhol, Sultanpur, Solan, Himachal Pradesh 173 229, Australia
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Huang CT, Ruan SY, Tsai YJ, Ku SC, Yu CJ. Clinical Trajectories and Causes of Death in Septic Patients with a Low APACHE II Score. J Clin Med 2019; 8:jcm8071064. [PMID: 31330785 PMCID: PMC6678558 DOI: 10.3390/jcm8071064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023] Open
Abstract
Clinical course and mortality in septic patients with low disease severity remain poorly understood and is worth further investigation. We enrolled septic patients admitted to intensive care units (ICUs) between 2010 and 2014 with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≤15. We sought to determine their clinical trajectories and causes of death, and to analyze risk factors associated with in-hospital mortality. A total of 352 patients were included, of whom 89 (25%) did not survive to hospital discharge, at a rate higher than predicted (<21%) by the APACHE II score. Approximately one third (31/89) of non-survivors succumbed to index sepsis; however, more patients (34/89) died of subsequent sepsis. New-onset ICU sepsis developed in 99 (28%) patients and was an independent risk factor for mortality. In addition, septic patients with comorbid malignancy or index infection acquired in the hospital settings were more likely to have in-hospital mortality than those without. In conclusion, septic patients with low APACHE II scores were at a higher mortality risk than expected, and subsequent sepsis rather than index sepsis was the primary cause of death. This study provides insight into unexpected clinical trajectories and outcomes of septic patients with low disease severity at ICU admission and highlights the need for more research and clinical attention in this patient population.
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Affiliation(s)
- Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Yi-Ju Tsai
- Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
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Karlović K, Nikolić J, Arapović J. Ceftriaxone treatment of complicated urinary tract infections as a risk factor for enterococcal re-infection and prolonged hospitalization: A 6-year retrospective study. Bosn J Basic Med Sci 2018; 18:361-366. [PMID: 29750894 DOI: 10.17305/bjbms.2018.3544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 11/16/2022] Open
Abstract
A frequent complication during hospital stay of patients with urinary tract infections (UTIs) is a re-infection of the urinary tract after the initial improvement. In this study, we investigated the impact of two empirical antibiotic therapies on the outcomes of complicated bacterial UTIs. We retrospectively evaluated 325 adult patients hospitalized during 6 years period with a diagnosis of complicated bacterial UTIs. The patients were classified into two groups according to the antibiotic therapy: ceftriaxone- and co-amoxiclav+gentamicin-treated group. Clinical data were collected from the patient records into a designed form. Output data included information on the treatment outcome, length of stay (LOS), development of complications, and cause of re-infections. The patients treated with ceftriaxone had significantly longer LOS (p = 0.012), as well as higher occurrence of complications (p = 0.023) and urinary tract re-infections (p < 0.001), compared to co-amoxiclav+gentamicin-treated group. No significant difference was observed in the treatment outcome between the two groups (p = 0.137). The most common complication in both investigated groups were re-infections of the urinary tract, and Enterococcus spp. was detected as the cause of re-infections only in patients from ceftriaxone-treated group (40/69 patients). Out of the 40 ceftriaxone-treated patients with enterococcal urinary tract re-infections, 35 patients had one or more chronic diseases and 29 patients had urinary catheter inserted. Ceftriaxone therapy should be considered carefully in patients with complicated UTIs due to the possibility of enterococcal re-infection and consequent prolonged hospital stay.
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Affiliation(s)
- Kristian Karlović
- Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina.
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Bassetti M, Vena A, Russo A. Management of patients with septic shock due to Candida infection. Hosp Pract (1995) 2018; 46:258-265. [PMID: 30170000 DOI: 10.1080/21548331.2018.1518104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Septic shock represents a serious complication occurring between 6% and 30% of all hospitalized patients; Candida septic shock represents a challenge for clinicians due to the absence of specific risk factors, diagnostic tests, and management. Identification of specific risk factors and use of biomarkers are useful tools considering that differentiation of Candida from bacterial septic shock is demanding. Early effective antifungal treatment, preferably with echinocandins with an adequate source control, represents the best approach for improving survival of patients with septic shock due to Candida. Given the importance of adequate therapy and source control in septic shock attributable to Candida clinical strategies and pathways are needed. This review will focus on epidemiology of septic shock in patients with invasive candidiasis with special attention to diagnostic pathways and treatment strategies.
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Affiliation(s)
- Matteo Bassetti
- a Dipartimento di Area Medica , Università degli studi di Udine , Udine , Italy
| | - Antonio Vena
- a Dipartimento di Area Medica , Università degli studi di Udine , Udine , Italy
| | - Alessandro Russo
- a Dipartimento di Area Medica , Università degli studi di Udine , Udine , Italy
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20
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Deng S, Feng S, Wang W, Zhu H, Gong Y. Bacterial Distribution and Risk Factors of Nosocomial Blood Stream Infection in Neurologic Patients in the Intensive Care Unit. Surg Infect (Larchmt) 2018; 20:25-30. [PMID: 30234461 DOI: 10.1089/sur.2018.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate the risk factors and analyze the distribution of pathogens to provide a basis for the prevention of nosocomial blood stream infections (BSI) and reduce the incidence and mortality of nosocomial BSI in neurologic patients. PATIENTS AND METHODS A retrospective chart review of neurologic patients admitted to an adult intensive care unit from January 2012 to December 2017 was conducted. Every positive blood culture, clinical demographic, microbiologic and laboratory result, as well as 28-day outcome data, were compiled on a data collection sheet. The clinical significance of each isolate was determined; in addition, the antimicrobial susceptibilities of causative pathogens and the most likely source were recorded. RESULTS During the five-year study period, there were 121 nosocomial BSI yielding 151 isolates in 404 neurologic patients. Eighty-one percent of nosocomial BSI were monomicrobial. Gram-positive organisms caused 67.9% of these BSI, gram-negative organisms caused 32.1%, and fungi caused 0.8%. The crude incidence rate was approximately 29.9%, and the mortality of nosocomial BSI was as high as 29.8%. Intravascular lines were the most common source of nosocomial BSI (79.3%). The most common organisms causing BSI were coagulase-negative staphylococci (CoNS; 44.6% of isolates), Staphylococcus aureus (17.4%), Klebsiella species (11.5%), and Acinetobacter spp. (11.5%). Multivariable regression analysis revealed that the use of antibiotic agents in the 90 days prior (odds ratio [OR], 5.81; 95% confidence interval [CI], 3.18-10.62; p = 0.001), brain trauma (OR, 0.28; 95% CI, 0.15-0.51; p = 0.001), and transfusion (OR, 3.02; 95% CI, 1.45-6.29; p = 0.001) were significant predictors of nosocomial BSI. CONCLUSIONS The incidence and mortality of nosocomial BSI were high in our neurologic patients. Strictly aseptic operations, hand hygiene, and reasonable use of transfusions and antibiotic agents are effective measures to prevent nosocomial BSI.
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Affiliation(s)
- Shuixiang Deng
- Department of Intensive Care Unit, HuaShan Hospital, Fudan University , Shanghai, China
| | - Shengjie Feng
- Department of Intensive Care Unit, HuaShan Hospital, Fudan University , Shanghai, China
| | - Wei Wang
- Department of Intensive Care Unit, HuaShan Hospital, Fudan University , Shanghai, China
| | - Hechen Zhu
- Department of Intensive Care Unit, HuaShan Hospital, Fudan University , Shanghai, China
| | - Ye Gong
- Department of Intensive Care Unit, HuaShan Hospital, Fudan University , Shanghai, China
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21
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Candidemia in Children Caused by Uncommon Species of Candida. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.11895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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22
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Kılınçel Ö, Çalışkan E, Şahin İ, Öztürk CE, Kılıç N, Öksüz Ş. The effect of melatonin on antifungal susceptibility in planktonic and biofilm forms ofCandidastrains isolated from clinical samples. Med Mycol 2018; 57:45-51. [DOI: 10.1093/mmy/myx157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/30/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Özge Kılınçel
- Düzce Atatürk State Hospital, Medical Microbiology, Düzce, Turkey
| | - Emel Çalışkan
- Düzce University Faculty of Medicine, Medical Microbiology, Düzce, Turkey
| | - İdris Şahin
- Düzce University Faculty of Medicine, Medical Microbiology, Düzce, Turkey
| | | | - Nida Kılıç
- Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Medical Microbiology, Ankara, TURKEY
| | - Şükrü Öksüz
- Düzce University Faculty of Medicine, Medical Microbiology, Düzce, Turkey
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Haber JM, Gascoyne PR, Sokolov K. Rapid real-time recirculating PCR using localized surface plasmon resonance (LSPR) and piezo-electric pumping. LAB ON A CHIP 2017; 17:2821-2830. [PMID: 28703830 PMCID: PMC5612715 DOI: 10.1039/c7lc00211d] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Rapid detection and characterization of pathogens in patients with bloodstream infections (BSIs) is a persistent problem for modern medicine, as current techniques are slow or provide incomplete diagnostic information. Real-time polymerase chain reaction (qPCR) allows specific detection of a wide range of targets and quantification of pathogenic burdens to aid in treatment planning. However, new technological advances are required for a rapid and multiplex implementation of qPCR in clinical applications. In this paper, the feasibility of a novel microfluidic platform for qPCR is presented, integrating highly sensitive, label-free localized surface plasmon resonance (LSPR) imaging of DNA hybridization into a recirculating chip design for real-time analysis. Single target and multiplex detection of DNA target amplification are demonstrated, with a limit of detection of 5 fg μL-1 of E. coli DNA for single target PCR, correlating with approximately 300 bacteria per mL. The results of this study demonstrate the potential of this platform for simultaneous real-time detection of multiple target genes within 15 minutes that could provide live saving benefits in patients with BSIs.
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Affiliation(s)
- J. M. Haber
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712
- Department of Imaging Physics, UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - P. R. Gascoyne
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712
| | - K. Sokolov
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712
- Department of Imaging Physics, UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
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Polat G, Ugan RA, Cadirci E, Halici Z. Sepsis and Septic Shock: Current Treatment Strategies and New Approaches. Eurasian J Med 2017; 49:53-58. [PMID: 28416934 DOI: 10.5152/eurasianjmed.2017.17062] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Sepsis is a complex condition characterized by the simultaneous activation of inflammation and coagulation in response to microbial insult. These events manifest as systemic inflammatory response syndrome or sepsis symptoms through the release of proinflammatory cytokines, procoagulants, and adhesion molecules from immune cells and/or damaged endothelium. Today, sepsis is a severe multisystem disease with difficult treatments for its manifestations and high mortality rates. In the last two decades in particular, many studies have been conducted on sepsis that cause shock, multiorgan dysfunction, and organ failure by especially leading to hemodynamic changes. In sepsis, increasing antibiotic resistance and medicine-resistant hemodynamic changes have resulted in further research on new treatment modalities in addition to classical treatments. In the last decade, the sepsis physiopathology has been elucidated. Various therapeutic agents have been used in addition to antibiotherapy, but no satisfactory results have been obtained. This review summarizes the sepsis pathophysiology, current treatment protocols, and new approaches.
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Affiliation(s)
- Gizem Polat
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara, Turkey
| | - Rustem Anil Ugan
- Department of Pharmacology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Elif Cadirci
- Department of Pharmacology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Zekai Halici
- Department of Pharmacology, Atatürk University School of Medicine, Erzurum, Turkey
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Silvestri L, Weir WI, Gregori D, Taylor N, Zandstra DF, van Saene JJM, van Saene HKF. Impact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth 2016; 31:2236-2244. [PMID: 28089599 DOI: 10.1053/j.jvca.2016.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Oropharyngeal overgrowth of microorganisms in the critically ill is a risk factor for lower respiratory tract infection and subsequent invasion of the bloodstream. Oral chlorhexidine has been used to prevent pneumonia, but its effect on bloodstream infection never has been assessed in meta-analyses. The authors explored the effect of oral chlorhexidine on the incidence of bloodstream infection, the causative microorganism, and on all-cause mortality in critically ill patients. DESIGN Systematic review and meta-analysis of published studies. SETTING Intensive care unit. PARTICIPANTS The study comprised critically ill patients receiving oral chlorhexidine (test group) and placebo or standard oral care (control group). INTERVENTIONS PubMed and the Cochrane Register of Controlled Trials were searched. Odds ratios (ORs) were pooled using the random-effects model. MEASUREMENTS AND MAIN RESULTS Five studies including 1,655 patients (832 chlorhexidine and 823 control patients) were identified. The majority of information was from studies at low or unclear risk bias; 1 study was at high risk of bias. Bloodstream infection and mortality were not reduced significantly by chlorhexidine (OR 0.74; 95% confidence interval [CI] 0.37-1.50 and OR 0.69; 95% CI 0.31-1.53, respectively). In the subgroup of surgical, mainly cardiac, patients, chlorhexidine reduced bloodstream infection (OR 0.47; 95% CI 0.22-0.97). Chlorhexidine did not affect any microorganism significantly. CONCLUSION In critically ill patients, oropharyngeal chlorhexidine did not reduce bloodstream infection and mortality significantly and did not affect any microorganism involved. The presence of a high risk of bias in 1 study and unclear risk of bias in others may have affected the robustness of these findings.
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Affiliation(s)
- Luciano Silvestri
- Department of Anaesthesia and Intensive Care, S. Giovanni di Dio Hospital, Gorizia, Italy; Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - William I Weir
- Department of Cardiothoracic Surgery, London Chest Hospital, London, UK
| | - Dario Gregori
- Department of Cardiological, Thoracic and Vascular Sciences, Unit of Biostatistics Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Nia Taylor
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | | | - Joris J M van Saene
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Morgan J, Meltzer MI, Plikaytis BD, Sofair AN, Huie-White S, Wilcox S, Harrison LH, Seaberg EC, Hajjeh RA, Teutsch SM. Excess Mortality, Hospital Stay, and Cost Due to Candidemia: A Case-Control Study Using Data From Population-Based Candidemia Surveillance. Infect Control Hosp Epidemiol 2016; 26:540-7. [PMID: 16018429 DOI: 10.1086/502581] [Citation(s) in RCA: 300] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To determine the mortality, hospital stay, and total hospital charges and cost of hospitalization attributable to candidemia by comparing patients with candidemia with control-patients who have otherwise similar illnesses. Prior studies lack broad patient and hospital representation or cost-related information that accurately reflects current medical practices.Design:Our case-control study included case-patients with candidemia and their cost-related data, ascertained from laboratory-based candidemia surveillance conducted among all residents of Connecticut and Baltimore and Baltimore County, Maryland, during 1998 to 2000. Control-patients were matched on age, hospital type, admission year, discharge diagnoses, and duration of hospitalization prior to candidemia onset.Results:We identified 214 and 529 sets of matched case-patients and control-patients from the two locations, respectively. Mortality attributable to candidemia ranged between 19% and 24%. On multivariable analysis, candidemia was associated with mortality (OR, 5.3 for Connecticut and 8.5 for Baltimore and Baltimore County;P< .05), whereas receiving adequate treatment was protective (OR, 0.5 and 0.4 for the two locations, respectively;P< .05). Candidemia itself did not increase the total hospital charges and cost of hospitalization; when treatment status was accounted for, having received adequate treatment for candidemia significantly increased the total hospital charges and cost of hospitalization ($6,000 to $29,000 and $3,000 to $22,000, respectively) and the length of stay (3 to 13 days).Conclusion:Our findings underscore the burden of candidemia, particularly regarding the risk of death, length of hospitalization, and cost associated with treatment (Infect Control Hosp Epidemiol2005;26:540-547).
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Affiliation(s)
- Juliette Morgan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Scerbo MH, Kaplan HB, Dua A, Litwin DB, Ambrose CG, Moore LJ, Murray COLCK, Wade CE, Holcomb JB. Beyond Blood Culture and Gram Stain Analysis: A Review of Molecular Techniques for the Early Detection of Bacteremia in Surgical Patients. Surg Infect (Larchmt) 2016; 17:294-302. [PMID: 26918696 PMCID: PMC5118953 DOI: 10.1089/sur.2015.099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sepsis from bacteremia occurs in 250,000 cases annually in the United States, has a mortality rate as high as 60%, and is associated with a poorer prognosis than localized infection. Because of these high figures, empiric antibiotic administration for patients with systemic inflammatory response syndrome (SIRS) and suspected infection is the second most common indication for antibiotic administration in intensive care units (ICU)s. However, overuse of empiric antibiotics contributes to the development of opportunistic infections, antibiotic resistance, and the increase in multi-drug-resistant bacterial strains. The current method of diagnosing and ruling out bacteremia is via blood culture (BC) and Gram stain (GS) analysis. METHODS Conventional and molecular methods for diagnosing bacteremia were reviewed and compared. The clinical implications, use, and current clinical trials of polymerase chain reaction (PCR)-based methods to detect bacterial pathogens in the blood stream were detailed. RESULTS BC/GS has several disadvantages. These include: some bacteria do not grow in culture media; others do not GS appropriately; and cultures can require up to 5 d to guide or discontinue antibiotic treatment. PCR-based methods can be potentially applied to detect rapidly, accurately, and directly microbes in human blood samples. CONCLUSIONS Compared with the conventional BC/GS, particular advantages to molecular methods (specifically, PCR-based methods) include faster results, leading to possible improved antibiotic stewardship when bacteremia is not present.
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Affiliation(s)
- Michelle H. Scerbo
- The Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Heidi B. Kaplan
- Department of Microbiology and Molecular Genetics, University of Texas Health Science Center, Houston, Texas
| | - Anahita Dua
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Douglas B. Litwin
- Department of Microbiology and Molecular Genetics, University of Texas Health Science Center, Houston, Texas
| | - Catherine G. Ambrose
- Department of Orthopedic Surgery, University of Texas Health Science Center, Houston, Texas
| | - Laura J. Moore
- The Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - COL Clinton K. Murray
- Department of Medicine, Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Charles E. Wade
- The Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - John B. Holcomb
- The Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas Health Science Center, Houston, Texas
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Pfaller MA, Castanheira M. Nosocomial Candidiasis: Antifungal Stewardship and the Importance of Rapid Diagnosis. Med Mycol 2015; 54:1-22. [PMID: 26385381 DOI: 10.1093/mmy/myv076] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/20/2015] [Indexed: 01/12/2023] Open
Abstract
Candidemia and other forms of candidiasis are associated with considerable excess mortality and costs. Despite the addition of several new antifungal agents with improved spectrum and potency, the frequency of Candida infection and associated mortality have not decreased in the past two decades. The lack of rapid and sensitive diagnostic tests has led to considerable overuse of antifungal agents resulting in increased costs, selection pressure for resistance, unnecessary drug toxicity, and adverse drug interactions. Both the lack of timely diagnostic tests and emergence of antifungal resistance pose considerable problems for antifungal stewardship. Whereas antifungal stewardship with a focus on nosocomial candidiasis should be able to improve the administration of antifungal therapy in terms of drug selection, proper dose and duration, source control and de-escalation therapy, an important parameter, timeliness of antifungal therapy, remains a victim of slow and insensitive diagnostic tests. Fortunately, new proteomic and molecular diagnostic tools are improving the time to species identification and detection. In this review we will describe the potential impact that rapid diagnostic testing and antifungal stewardship can have on the management of nosocomial candidiasis.
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Affiliation(s)
- Michael A Pfaller
- T2Biosystems, Lexington, Massachusetts JMI Laboratories, North Liberty, Iowa University of Iowa College of Medicine College of Public Health, Iowa City, Iowa
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Bailly S, Leroy O, Montravers P, Constantin JM, Dupont H, Guillemot D, Lortholary O, Mira JP, Perrigault PF, Gangneux JP, Azoulay E, Timsit JF. Antifungal de-escalation was not associated with adverse outcome in critically ill patients treated for invasive candidiasis: post hoc analyses of the AmarCAND2 study data. Intensive Care Med 2015; 41:1931-40. [PMID: 26370688 DOI: 10.1007/s00134-015-4053-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Systemic antifungal therapy (SAT) of invasive candidiasis needs to be initiated immediately upon clinical suspicion. Controversies exist about adequate time and potential harm of antifungal de-escalation (DE) in documented and suspected candidiasis in ICU patients. Our objective was to investigate whether de-escalation within 5 days of antifungal initiation is associated with an increase of the 28-day mortality in SAT-treated non-neutropenic adult ICU patients. METHODS From the 835 non-neutropenic adults recruited in the multicenter prospective observational AmarCAND2 study, we selected the patients receiving systemic antifungal therapy for a documented or suspected invasive candidiasis in the ICU and who were still alive 5 days after SAT initiation. They were included into two groups according to the occurrence of observed SAT de-escalation before day 6. The average causal SAT de-escalation effect on 28-day mortality was evaluated by using a double robust estimation. RESULTS Among the 647 included patients, early de-escalation at day 5 after antifungal initiation occurred in 142 patients (22%), including 48 (34%) patients whose SAT was stopped before day 6. After adjustment for the baseline confounders, early SAT de-escalation was the solely factor not associated with increased 28-day mortality (RR 1.12, 95% CI 0.76-1.66). CONCLUSION In non-neutropenic critically ill adult patients with documented or suspected invasive candidiasis, SAT de-escalation within 5 days was not related to increased day-28 mortality but it was associated with decreased SAT consumption. These results suggest for the first time that SAT de-escalation may be safe in these patients.
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Affiliation(s)
- Sébastien Bailly
- Inserm UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France. .,Grenoble 1 University, U823, Rond-point de la Chantourne, 38700, La Tronche, France.
| | | | - Philippe Montravers
- Paris Diderot Sorbonne Cite University, and Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, APHP, Paris, France
| | - Jean-Michel Constantin
- Perioperative Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Hervé Dupont
- Surgical ICU, Amiens University Hospital, Amiens, France
| | - Didier Guillemot
- Inserm UMR 1181 "Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases" (B2PHI), 75015, Paris, France
| | - Olivier Lortholary
- University Paris Descartes, Necker Pasteur Center for Infectious Diseases, Necker Enfants-Malades Hospital, IHU Imagine, Paris, France.,Pasteur Institute, National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, Paris, France
| | - Jean-Paul Mira
- Medical ICU, Cochin University Hospital, APHP, Paris, France.,Paris Descartes, Sorbonne Paris Cité University, Paris, France
| | | | | | - Elie Azoulay
- Medical ICU, Saint-Louis University Hospital, Paris, France
| | - Jean-François Timsit
- Inserm UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France. .,Medical and Infectious Diseases ICU, Paris Diderot University/Bichat University Hospital, APHP, 46 rue Henri Huchard, Paris, 75018, France.
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Sligl WI, Dragan T, Smith SW. Nosocomial Gram-negative bacteremia in intensive care: epidemiology, antimicrobial susceptibilities, and outcomes. Int J Infect Dis 2015; 37:129-34. [DOI: 10.1016/j.ijid.2015.06.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/03/2015] [Accepted: 06/28/2015] [Indexed: 10/23/2022] Open
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Abstract
ABSTRACT
Iatrogenic bacterial meningitis (IBM) is a rare but serious complication of neuraxial procedures, such as spinal and epidural anesthesia or lumbar puncture. We report a case of a 46-year-old female who presented to the emergency department with bacterial meningitis after spinal anesthesia. We reviewthe existing literature outlining the pathogenesis, vector hypothesis, diagnosis, treatment, and prevention as they relate to IBM. We highlight the role of the emergency physician in the rapid diagnosis of this disease, and underscore the need for sterile technique when performing lumbar punctures.
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Physiopathologie des candidoses invasives. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wu K, Luo T, Li L, Zhang Q, Zhu J, Gao Q, Chen M, Zhu M. Multilocus Sequence Typing of Pathogenic Candida albicans Isolates Collected from a Teaching Hospital in Shanghai, China: A Molecular Epidemiology Study. PLoS One 2015; 10:e0125245. [PMID: 25919124 PMCID: PMC4412568 DOI: 10.1371/journal.pone.0125245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/23/2015] [Indexed: 11/18/2022] Open
Abstract
Molecular typing of Candida albicans is important for studying the population structure and epidemiology of this opportunistic yeast, such as population dynamics, nosocomial infections, multiple infections and microevolution. The genetic diversity of C. albicans has been rarely studied in China. In the present study, multilocus sequence typing (MLST) was used to characterize the genetic diversity and population structure of 62 C. albicans isolates collected from 40 patients from Huashan Hospital in Shanghai, China. A total of 50 diploid sequence types (DSTs) were identified in the 62 C. albicans isolates, with 41 newly identified DSTs. Based on cluster analysis, the 62 isolates were classified into nine existing clades and two new clades (namely clades New 1 and New 2). The majority of the isolates were clustered into three clades, clade 6 (37.5%), clade 1 (15.0%) and clade 17 (15.0%). Isolates of clade New 2 were specifically identified in East Asia. We identified three cases of potential nosocomial transmission based on association analysis between patients' clinical data and the genotypes of corresponding isolates. Finally, by analyzing the genotypes of serial isolates we further demonstrated that the microevolution of C. albicans was due to loss of heterozygosity. Our study represents the first molecular typing of C. albicans in eastern China, and we confirmed that MLST is a useful tool for studying the epidemiology and evolution of C. albicans.
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Affiliation(s)
- Kefei Wu
- The Center for Medical Mycology, Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China
- Key Laboratory of Medical Molecular Virology, Institutes of Biomedical Sciences and Institute of Medical Microbiology, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Tao Luo
- Key Laboratory of Medical Molecular Virology, Institutes of Biomedical Sciences and Institute of Medical Microbiology, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Li Li
- The Center for Medical Mycology, Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China
| | - Qiangqiang Zhang
- The Center for Medical Mycology, Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China
| | - Junhao Zhu
- The Center for Medical Mycology, Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China
| | - Qian Gao
- Key Laboratory of Medical Molecular Virology, Institutes of Biomedical Sciences and Institute of Medical Microbiology, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Min Chen
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People’s Republic of China
| | - Min Zhu
- The Center for Medical Mycology, Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China
- * E-mail:
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Özkök S, Togan T, Yesilkaya A, Timurkaynak F, Azap ÖK, Arslan H. In vitro susceptibility of tigecycline against multidrug-resistant gram-negative strains: Etest versus agar dilution. Chemotherapy 2015; 60:151-6. [PMID: 25791941 DOI: 10.1159/000375440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/19/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Tigecycline is a semi-synthetic tetracycline with activity against most multidrug-resistant (MDR) bacteria. METHODS We studied in vitro activity of tigecycline by agar dilution (AD) and Etest methods to evaluate their correlation. The study included 206 isolates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, Klebsiella pneumoniae and MDR Acinetobacter baumannii recovered from blood cultures of patients of Baskent University between 2008 and 2010. RESULTS ESBL-producing E. coli had MIC50/MIC90 values of 0.5/0.5 µg/ml by AD and 0.25/0.5 µg/ml by Etest. ESBL-producing K. pneumoniae had MIC50/MIC90 values of 1/2 µg/ml by AD and 0.75/2 µg/ml by Etest, whereas MDR A. baumannii had MIC50/MIC90 values of 4/4 µg/ml by AD and 2/4 µg/ml by Etest. The correlation between AD and Etest was weak for ESBL-producing E. coli and strong for ESBL-producing K. pneumoniae and MDR A. baumannii. Tigecycline MIC values for ESBL-producing E. coli were lower than the tigecycline concentration, while they were higher than the concentrations attainable by treatment doses for A. baumannii. CONCLUSION Tigecycline is an appropriate agent in the treatment of E. coli bacteremia, but it is not for treating A. baumannii bacteremia. Tigecycline could be used for K. pneumoniae bacteremia treatment after determining its MIC value. Determining the MIC value by gold-standard methods is more appropriate due to the correlation between Etest and AD at high MIC values.
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Affiliation(s)
- Sezen Özkök
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Timsit JF, Chemam S, Bailly S. Empiric/pre-emptive anti-Candida therapy in non-neutropenic ICU patients. F1000PRIME REPORTS 2015; 7:21. [PMID: 25750739 PMCID: PMC4335794 DOI: 10.12703/p7-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The potential of the systemic antifungal treatment of non-immunocompromised patients with sepsis, extra-digestive Candida colonization and multiple organ failure is unknown, although it represents three out of four antifungal treatments prescribed in intensive care units. It may allow an early treatment of invasive fungal infection at incubation phase, but exposes patients to unnecessary antifungal treatments with subsequent costs and antifungal selection pressure. As early diagnostic tests for invasive candidiasis are still considered insufficient, the potential of this strategy needs to be demonstrated by a randomized controlled trial. Such a trial is currently ongoing.
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Affiliation(s)
- Jean-François Timsit
- INSERMIAME, UMR 1137, F-75018 ParisFrance
- Paris Diderot UniversityIAME, UMR 1137, Sorbonne Paris Cité, F-75018 ParisFrance
- AP-HP, Bichat Hospital, medical and infectious diseases ICUF-75018 ParisFrance
| | - Sarah Chemam
- AP-HP, Bichat Hospital, medical and infectious diseases ICUF-75018 ParisFrance
| | - Sébastien Bailly
- INSERMIAME, UMR 1137, F-75018 ParisFrance
- Paris Diderot UniversityIAME, UMR 1137, Sorbonne Paris Cité, F-75018 ParisFrance
- Joseph Fourier (Grenoble 1) University, Albert Bonniot instituteU 823, Grenoble, F-38000France
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Hanna H, Afif C, Alakech B, Boktour M, Tarrand J, Hachem R, Raad I. Central Venous Catheter–Related Bacteremia Due to Gram-Negative Bacilli: Significance of Catheter Removal in Preventing Relapse. Infect Control Hosp Epidemiol 2015; 25:646-9. [PMID: 15357155 DOI: 10.1086/502455] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To study the characteristics of catheter-related, gram-negative bacteremia (GNB) and the role of central venous catheter (CVC) removal.Design:This retrospective study involved a search of the microbiological department records of CVC and blood cultures and patients' medical records.Setting:University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.Patients:Patients with cancer who had catheter-related GNB, defined as (1) a positive catheter tip culture with at least 15 colony-forming units semiquantitatively, (2) isolation of the same organism from the tip and peripheral blood cultures, (3) no other source for bacteremia except the CVC, and (4) clinical manifestations of infection (fever or chills).Results:Between January 1990 and December 1996, 72 cases of catheter-related GNB were available for review. Most of the patients (67; 93%) had their CVCs removed in response to the bacteremia. Few patients (5; 7%) retained their CVCs and were treated with appropriate antibiotics. When CVCs were removed, only 1 patient (1%) relapsed with the same organism, whereas all 5 patients with retained CVCs relapsed after having responded (P < .001). The most commonly isolated organisms were Enterobacter, Klebsiella, Stenotrophomonas, Pseudomonas, and Acinetobacter species. Catheter removal within 72 hours of the onset of the catheter-related GNB was the only independent protective factor against relapse of the infection (odds ratio, 0.13; 95% confidence interval, 0.02–0.75; P = .02).Conclusion:In patients with documented catheter-related GNB, CVCs should be removed within 48 to 72 hours to prevent relapse.
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Affiliation(s)
- Hend Hanna
- The University of Texas M. D. Anderson Cancer Center, Department of Infectious Diseases, Infection Control and Employee Health (Unit 402), 1515 Holcombe Blvd., Houston, TX 77030, USA
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Wisplinghoff H, Cornely OA, Moser S, Bethe U, Stützer H, Salzberger B, Fätkenheuer G, Seifert H. Outcomes of Nosocomial Bloodstream Infections in Adult Neutropenic Patients: A Prospective Cohort and Matched Case-Control Study. Infect Control Hosp Epidemiol 2015; 24:905-11. [PMID: 14700405 DOI: 10.1086/502158] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To examine the clinical and epidemiologic features, excess length of stay, extra costs, and mortality attributable to bloodstream infection (BSI) in neutropenic patients with hematologic malignancies.Design:Prospective cohort and matched case-control study.Patients:All adult neutropenic patients with hematologic malignancies admitted to Cologne University Hospital between May 1, 1997, and April 30, 1998, were prospectively observed. Case-patients were defined as patients with nosocomial BSI; control-patients were selected among patients without BSI.Results:During the study period, the BSI rate in neutropenic patients was 14.3 per 100 neutropenic episodes. Eighty-four case-patients were included. Matching was successful for 96% of the cohort; 81 matched pairs were studied. The mean total length of stay was significantly longer for patients with BSI than for control-patients (37 vs 29 days;P= .002). Extra costs attributable to the infection averaged $3,200 (U.S.) per patient. The crude mortality rates of case-patients and control-patients were 16% and 4%, respectively (P= .013), with an attributable mortality of 12% (odds ratio, 11). Eighty-seven percent of patients met the criteria for sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine. Severe sepsis or septic shock occurred in 13% of patients and was correlated with mortality (55% vs 10% in patients without severe sepsis or septic shock;P=.01).Conclusions:Nosocomial BSI in neutropenic patients is significantly associated with an excess length of hospital stay, extra costs, and excess mortality. Severe sepsis and septic shock are closely correlated with an adverse outcome.
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Affiliation(s)
- Hilmar Wisplinghoff
- Institute for Medical Microbiology, Immunology and Hygiene, and Department of Internal Medicine, University of Cologne, Cologne, Germany
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Diekema DJ, Pfaller MA. Nosocomial Candidemia: An Ounce of Prevention Is Better Than a Pound of Cure. Infect Control Hosp Epidemiol 2015; 25:624-6. [PMID: 15357151 DOI: 10.1086/502451] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hurley JC. Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis. BMC Infect Dis 2014; 14:714. [PMID: 25551776 PMCID: PMC4300056 DOI: 10.1186/s12879-014-0714-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/11/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Among methods for preventing pneumonia and possibly also bacteremia in intensive care unit (ICU) patients, Selective Digestive Decontamination (SDD) appears most effective within randomized concurrent controlled trials (RCCT's) although more recent trials have been cluster randomized. However, of the SDD components, whether protocolized parenteral antibiotic prophylaxis (PPAP) is required, and whether the topical antibiotic actually presents a contextual hazard, remain unresolved. The objective here is to compare the bacteremia rates and patterns of isolates in SDD-RCCT's versus the broader evidence base. METHODS Bacteremia incidence proportion data were extracted from component (control and intervention) groups decanted from studies investigating antibiotic (SDD) or non-antibiotic methods of VAP prevention and summarized using random effects meta-analysis of study and group level data. A reference category of groups derived from purely observational studies without any prevention method under study provided a benchmark incidence. RESULTS Within SDD RCCTs, the mean bacteremia incidence among concurrent component groups not exposed to PPAP (27 control; 17.1%; 13.1-22.1% and 12 intervention groups; 16.2%; 9.1-27.3%) is double that of the benchmark bacteremia incidence derived from 39 benchmark groups (8.3; 6.8-10.2%) and also 20 control groups from studies of non-antibiotic methods (7.1%; 4.8 - 10.5). There is a selective increase in coagulase negative staphylococci (CNS) but not in Pseudomonas aeruginosa among bacteremia isolates within control groups of SDD-RCCT's versus benchmark groups with data available. CONCLUSIONS The topical antibiotic component of SDD presents a major contextual hazard toward bacteremia against which the PPAP component partially mitigates.
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Abstract
BACKGROUND The aim of this paper was to describe and analyze the effect of antibiotic policy changes on antibiotic consumption in Swedish hospitals and to review antibiotic stewardship in Swedish hospitals. RESULTS The main findings were: 1) Antibiotic consumption has significantly increased in Swedish hospitals over the last decade. The consumption of cephalosporins has decreased, whereas that of most other drugs including piperacillin-tazobactam, carbapenems, and penicillinase-sensitive and -resistant penicillins has increased and replaced cephalosporins. 2) Invasive infections caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae have increased, but the proportion of pathogens resistant to third-generation cephalosporins causing invasive infections is still very low in a European and international perspective. Furthermore, the following gaps in knowledge were identified: 1) lack of national, regional, and local data on the incidence of antibiotic resistance among bacteria causing hospital-acquired infections e.g. bloodstream infections and hospital-acquired pneumonia-data on which standard treatment guidelines should be based; 2) lack of data on the incidence of Clostridium difficile infections and the effect of change of antibiotic policies on the incidence of C. difficile infections and infections caused by antibiotic-resistant pathogens; and 3) lack of prospective surveillance programs regarding appropriate antibiotic treatment, including selection of optimal antimicrobial drug regimens, dosage, duration of therapy, and adverse ecological effects such as increases in C. difficile infections and emergence of antibiotic-resistant pathogens. CONCLUSIONS Evidence-based actions to improve antibiotic use and to slow down the problem of antibiotic resistance need to be strengthened. The effect of such actions should be analyzed, and standard treatment guidelines should be continuously updated at national, regional, and local levels.
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Affiliation(s)
- Håkan Hanberger
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- County Council of Östergötland, Linköping, Sweden
| | | | - Anders Ternhag
- The Public Health Agency of Sweden, Solna, Sweden
- Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Christian G. Giske
- The Department of Clinical Microbiology, Karolinska Institute MTC, Karolinska University Hospital, Stockholm, Sweden
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Harrison D, Muskett H, Harvey S, Grieve R, Shahin J, Patel K, Sadique Z, Allen E, Dybowski R, Jit M, Edgeworth J, Kibbler C, Barnes R, Soni N, Rowan K. Development and validation of a risk model for identification of non-neutropenic, critically ill adult patients at high risk of invasive Candida infection: the Fungal Infection Risk Evaluation (FIRE) Study. Health Technol Assess 2014; 17:1-156. [PMID: 23369845 DOI: 10.3310/hta17030] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is increasing evidence that invasive fungal disease (IFD) is more likely to occur in non-neutropenic patients in critical care units. A number of randomised controlled trials (RCTs) have evaluated antifungal prophylaxis in non-neutropenic, critically ill patients, demonstrating a reduction in the risk of proven IFD and suggesting a reduction in mortality. It is necessary to establish a method to identify and target antifungal prophylaxis at those patients at highest risk of IFD, who stand to benefit most from any antifungal prophylaxis strategy. OBJECTIVES To develop and validate risk models to identify non-neutropenic, critically ill adult patients at high risk of invasive Candida infection, who would benefit from antifungal prophylaxis, and to assess the cost-effectiveness of targeting antifungal prophylaxis to high-risk patients based on these models. DESIGN Systematic review, prospective data collection, statistical modelling, economic decision modelling and value of information analysis. SETTING Ninety-six UK adult general critical care units. PARTICIPANTS Consecutive admissions to participating critical care units. INTERVENTIONS None. MAIN OUTCOME MEASURES Invasive fungal disease, defined as a blood culture or sample from a normally sterile site showing yeast/mould cells in a microbiological or histopathological report. For statistical and economic modelling, the primary outcome was invasive Candida infection, defined as IFD-positive for Candida species. RESULTS Systematic review: Thirteen articles exploring risk factors, risk models or clinical decision rules for IFD in critically ill adult patients were identified. Risk factors reported to be significantly associated with IFD were included in the final data set for the prospective data collection. DATA COLLECTION Data were collected on 60,778 admissions between July 2009 and March 2011. Overall, 383 patients (0.6%) were admitted with or developed IFD. The majority of IFD patients (94%) were positive for Candida species. The most common site of infection was blood (55%). The incidence of IFD identified in unit was 4.7 cases per 1000 admissions, and for unit-acquired IFD was 3.2 cases per 1000 admissions. Statistical modelling: Risk models were developed at admission to the critical care unit, 24 hours and the end of calendar day 3. The risk model at admission had fair discrimination (c-index 0.705). Discrimination improved at 24 hours (c-index 0.823) and this was maintained at the end of calendar day 3 (c-index 0.835). There was a drop in model performance in the validation sample. Economic decision model: Irrespective of risk threshold, incremental quality-adjusted life-years of prophylaxis strategies compared with current practice were positive but small compared with the incremental costs. Incremental net benefits of each prophylaxis strategy compared with current practice were all negative. Cost-effectiveness acceptability curves showed that current practice was the strategy most likely to be cost-effective. Across all parameters in the decision model, results indicated that the value of further research for the whole population of interest might be high relative to the research costs. CONCLUSIONS The results of the Fungal Infection Risk Evaluation (FIRE) Study, derived from a highly representative sample of adult general critical care units across the UK, indicated a low incidence of IFD among non-neutropenic, critically ill adult patients. IFD was associated with substantially higher mortality, more intensive organ support and longer length of stay. Risk modelling produced simple risk models that provided acceptable discrimination for identifying patients at 'high risk' of invasive Candida infection. Results of the economic model suggested that the current most cost-effective treatment strategy for prophylactic use of systemic antifungal agents among non-neutropenic, critically ill adult patients admitted to NHS adult general critical care units is a strategy of no risk assessment and no antifungal prophylaxis. FUNDING Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.
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Affiliation(s)
- D Harrison
- Intensive Care National Audit and Research Centre, London, UK
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Anderson DJ, Moehring RW, Sloane R, Schmader KE, Weber DJ, Fowler VG, Smathers E, Sexton DJ. Bloodstream infections in community hospitals in the 21st century: a multicenter cohort study. PLoS One 2014; 9:e91713. [PMID: 24643200 PMCID: PMC3958391 DOI: 10.1371/journal.pone.0091713] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/13/2014] [Indexed: 01/24/2023] Open
Abstract
Background While the majority of healthcare in the US is provided in community hospitals, the epidemiology and treatment of bloodstream infections in this setting is unknown. Methods and Findings We undertook this multicenter, retrospective cohort study to 1) describe the epidemiology of bloodstream infections (BSI) in a network of community hospitals and 2) determine risk factors for inappropriate therapy for bloodstream infections in community hospitals. 1,470 patients were identified as having a BSI in 9 community hospitals in the southeastern US from 2003 through 2006. The majority of BSIs were community-onset, healthcare associated (n = 823, 56%); 432 (29%) patients had community-acquired BSI, and 215 (15%) had hospital-onset, healthcare-associated BSI. BSIs due to multidrug-resistant pathogens occurred in 340 patients (23%). Overall, the three most common pathogens were S. aureus (n = 428, 28%), E. coli (n = 359, 24%), coagulase-negative Staphylococci (n = 148, 10%), though type of infecting organism varied by location of acquisition (e.g., community-acquired). Inappropriate empiric antimicrobial therapy was given to 542 (38%) patients. Proportions of inappropriate therapy varied by hospital (median = 33%, range 21–71%). Multivariate logistic regression identified the following factors independently associated with failure to receive appropriate empiric antimicrobial therapy: hospital where the patient received care (p<0.001), assistance with ≥3 ADLs (p = 0.005), Charlson score (p = 0.05), community-onset, healthcare-associated infection (p = 0.01), and hospital-onset, healthcare-associated infection (p = 0.02). Important interaction was observed between Charlson score and location of acquisition. Conclusions Our large, multicenter study provides the most complete picture of BSIs in community hospitals in the US to date. The epidemiology of BSIs in community hospitals has changed: community-onset, healthcare-associated BSI is most common, S. aureus is the most common cause, and 1 of 3 patients with a BSI receives inappropriate empiric antimicrobial therapy. Our data suggest that appropriateness of empiric antimicrobial therapy is an important and needed performance metric for physicians and hospital stewardship programs in community hospitals.
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Affiliation(s)
- Deverick J. Anderson
- Duke University Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Infection Control Outreach Network, Durham, North Carolina, United States of America
- * E-mail:
| | - Rebekah W. Moehring
- Duke University Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Infection Control Outreach Network, Durham, North Carolina, United States of America
| | - Richard Sloane
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kenneth E. Schmader
- Department of Medicine-Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center (GRECC), Durham VA Medical Center, Durham, North Carolina, United States of America
| | - David J. Weber
- Department of Hospital Epidemiology, University of North Carolina Health System, Chapel Hill, North Carolina, United States of America
| | - Vance G. Fowler
- Duke University Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Emily Smathers
- Duke Infection Control Outreach Network, Durham, North Carolina, United States of America
| | - Daniel J. Sexton
- Duke University Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Infection Control Outreach Network, Durham, North Carolina, United States of America
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McCann CD, Jordan JA. Evaluation of MolYsis™ Complete5 DNA extraction method for detecting Staphylococcus aureus DNA from whole blood in a sepsis model using PCR/pyrosequencing. J Microbiol Methods 2014; 99:1-7. [PMID: 24503182 DOI: 10.1016/j.mimet.2014.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 11/18/2022]
Abstract
Bacterial bloodstream infections (BSI) and ensuing sepsis are important causes of morbidity and mortality. Early diagnosis and rapid treatment with appropriate antibiotics are vital for improving outcome. Nucleic acid amplification of bacteria directly from whole blood has the potential of providing a faster means of diagnosing BSI than automated blood culture. However, effective DNA extraction of commonly low levels of bacterial target from whole blood is critical for this approach to be successful. This study compared the Molzyme MolYsis™ Complete5 DNA extraction method to a previously described organic bead-based method for use with whole blood. A well-characterized Staphylococcus aureus-induced pneumonia model of sepsis in canines was used to provide clinically relevant whole blood samples. DNA extracts were assessed for purity and concentration and analyzed for bacterial rRNA gene targets using PCR and sequence-based identification. Both extraction methods yielded relatively pure DNA with median A260/280 absorbance ratios of 1.71 (MolYsis™) and 1.97 (bead-based). The organic bead-based extraction method yielded significantly higher average DNA concentrations (P<0.05) at each time point throughout the experiment, closely correlating with changes observed in white blood cell (WBC) concentrations during this same time period, while DNA concentrations of the MolYsis™ extracts closely mirrored quantitative blood culture results. Overall, S. aureus DNA was detected from whole blood samples in 70.7% (58/82) of MolYsis™ DNA extracts, and in 59.8% (49/82) of organic bead-based extracts, with peak detection rates seen at 48h for both MolYsis™ (87.0%) and organic bead-based (82.6%) methods. In summary, the MolYsis™ Complete5 DNA extraction kit proved to be the more effective method for isolating bacterial DNA directly from extracts made from whole blood.
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Affiliation(s)
- Chase D McCann
- George Washington University, School of Public Health and Health Services, Department of Epidemiology and Biostatistics, 2300 I Street NW, Washington, DC 20037, USA.
| | - Jeanne A Jordan
- George Washington University, School of Public Health and Health Services, Department of Epidemiology and Biostatistics, 2300 I Street NW, Washington, DC 20037, USA.
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Reitzel R, Rosenblatt J, Jiang Y, Hachem R, Raad I. Disposable gendine antimicrobial gloves for preventing transmission of pathogens in health care settings. Am J Infect Control 2014; 42:55-9. [PMID: 24388469 DOI: 10.1016/j.ajic.2013.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Transmission of organisms by contact of gloves with surfaces following contact with a pathogen source has been recognized as an important vector for pathogenesis of health care-associated infections. In these cases, the gloves protect the wearer from contact with the pathogenic organisms; however, this personal protection can facilitate the wearer unwittingly becoming a carrier of the pathogens from one location to another. A novel gendine (combination of chlorhexidine and gentian violet) antiseptic coating for the external surface of the glove was developed as a potential intervention to prevent this mode of transmission. METHODS We characterized the ability of the coating to rapidly kill bacterial and fungal pathogens within 1 minute of contact with the glove surface. The International Organization of Standardization 22196 concentrated inoculum contact testing methodology was followed. RESULTS The gendine-coated gloves were able to fully eradicate multidrug-resistant organisms included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterocci, multidrug-resistant Pseudomonas aeruginosa, and Klebsiella pneumoniae carbapenemase producing. In addition, Candida albicans, Candida glabarata, and 2 pathogenic Escherichia coli strains commonly associated with invasive gastroenteritis were also fully eradicated within 1 minute of contact. The gendine coating did not adversely impact the finish or integrity of the disposable gloves. CONCLUSION The highly efficacious gendine-coated antimicrobial gloves potentially provide an additional means of protection against horizontal transmission of common pathogens in a hospital setting.
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Sadique Z, Grieve R, Harrison DA, Jit M, Allen E, Rowan KM. An integrated approach to evaluating alternative risk prediction strategies: a case study comparing alternative approaches for preventing invasive fungal disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:1111-1122. [PMID: 24326164 DOI: 10.1016/j.jval.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 07/15/2013] [Accepted: 09/22/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This article proposes an integrated approach to the development, validation, and evaluation of new risk prediction models illustrated with the Fungal Infection Risk Evaluation study, which developed risk models to identify non-neutropenic, critically ill adult patients at high risk of invasive fungal disease (IFD). METHODS Our decision-analytical model compared alternative strategies for preventing IFD at up to three clinical decision time points (critical care admission, after 24 hours, and end of day 3), followed with antifungal prophylaxis for those judged "high" risk versus "no formal risk assessment." We developed prognostic models to predict the risk of IFD before critical care unit discharge, with data from 35,455 admissions to 70 UK adult, critical care units, and validated the models externally. The decision model was populated with positive predictive values and negative predictive values from the best-fitting risk models. We projected lifetime cost-effectiveness and expected value of partial perfect information for groups of parameters. RESULTS The risk prediction models performed well in internal and external validation. Risk assessment and prophylaxis at the end of day 3 was the most cost-effective strategy at the 2% and 1% risk threshold. Risk assessment at each time point was the most cost-effective strategy at a 0.5% risk threshold. Expected values of partial perfect information were high for positive predictive values or negative predictive values (£11 million-£13 million) and quality-adjusted life-years (£11 million). CONCLUSIONS It is cost-effective to formally assess the risk of IFD for non-neutropenic, critically ill adult patients. This integrated approach to developing and evaluating risk models is useful for informing clinical practice and future research investment.
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Affiliation(s)
- Z Sadique
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Timsit JF, Azoulay E, Cornet M, Gangneux JP, Jullien V, Vésin A, Schir E, Wolff M. EMPIRICUS micafungin versus placebo during nosocomial sepsis in Candida multi-colonized ICU patients with multiple organ failures: study protocol for a randomized controlled trial. Trials 2013; 14:399. [PMID: 24261608 PMCID: PMC4222830 DOI: 10.1186/1745-6215-14-399] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 11/08/2013] [Indexed: 12/16/2022] Open
Abstract
Background The potential interest of antifungal treatment of non-immunocompromized patients with sepsis, extra-digestive Candida colonization and multiple organ failure is unknown. It represents three-quarters of antifungals prescribed in Intensive Care Units. It may allow early treatment of invasive fungal infection in the incubation phase but expose patients to unnecessary antifungal treatments with subsequent cost and fungal selection pressure. As early diagnostic tests for invasive candidiasis are still considered to be insufficient, the potential interest in this strategy needs to be demonstrated. Methods This prospective multicenter, double blind, randomized-controlled trial is conducted in 23 French Intensive Care Units. All adult patients, mechanically ventilated for more than four days with sepsis of unknown origin and with at least one extradigestive fungal colonization site and multiple organ failure are eligible for randomization. Patients with proven invasive candidiasis are not included. After a complete mycological screening, patients are allocated to receive micafungin 100 mg intravenously once a day or placebo for 14 days. We plan to enroll 260 patients. The main objective is to demonstrate that micafungin increases survival of patients without invasive candidiasis at day 28 as compared to placebo. Other outcomes include day 28 and 90 survival and organ failure evolution. Additionally, pharmacokinetics of micafungin in enrolled patients will be measured and evolution of fungal biomarkers and susceptibility profiles of infecting fungi will also be followed. Discussion This study will help to provide guidelines for treating non-immunocompromized patients with fungal colonization multiple organ failure and sepsis of unknown origin. Trial registration Clinicaltrials.gov number NCT01773876
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Affiliation(s)
- Jean-François Timsit
- University Grenoble 1, Intensive Care Unit, Albert Michallon Hospital, BP 217, 38043 Grenoble, Cedex 9, France.
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Moehring RW, Sloane R, Chen LF, Smathers EC, Schmader KE, Fowler VG, Weber DJ, Sexton DJ, Anderson DJ. Delays in appropriate antibiotic therapy for gram-negative bloodstream infections: a multicenter, community hospital study. PLoS One 2013; 8:e76225. [PMID: 24098449 PMCID: PMC3789716 DOI: 10.1371/journal.pone.0076225] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/21/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gram-negative bacterial bloodstream infection (BSI) is a serious condition with estimated 30% mortality. Clinical outcomes for patients with severe infections improve when antibiotics are appropriately chosen and given early. The objective of this study was to estimate the association of prior healthcare exposure on time to appropriate antibiotic therapy in patients with gram-negative BSI. METHOD We performed a multicenter cohort study of adult, hospitalized patients with gram-negative BSI using time to event analysis in nine community hospitals from 2003-2006. Event time was defined as the first administration of an antibiotic with in vitro activity against the infecting organism. Healthcare exposure status was categorized as community-acquired, healthcare-associated, or hospital-acquired. Time to appropriate therapy among groups of patients with differing healthcare exposure status was assessed using Kaplan-Meier analyses and multivariate Cox proportional hazards models. RESULTS The cohort included 578 patients with gram-negative BSI, including 320 (55%) healthcare-associated, 217 (38%) community-acquired, and 41 (7%) hospital-acquired infections. 529 (92%) patients received an appropriate antibiotic during their hospitalization. Time to appropriate therapy was significantly different among the groups of healthcare exposure status (log-rank p=0.02). Time to first antibiotic administration regardless of drug appropriateness was not different between groups (p=0.3). The unadjusted hazard ratios (HR) (95% confidence interval) were 0.80 (0.65-0.98) for healthcare-associated and 0.72 (0.63-0.82) for hospital-acquired, relative to patients with community-acquired BSI. In multivariable analysis, interaction was found between the main effect and baseline Charlson comorbidity index. When Charlson index was 3, adjusted HRs were 0.66 (0.48-0.92) for healthcare-associated and 0.57 (0.44-0.75) for hospital-acquired, relative to patients with community-acquired infections. CONCLUSIONS Patients with healthcare-associated or hospital-acquired BSI experienced delays in receipt of appropriate antibiotics for gram-negative BSI compared to patients with community-acquired BSI. This difference was not due to delayed initiation of antibiotic therapy, but due to the inappropriate choice of antibiotic.
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Affiliation(s)
- Rebekah W. Moehring
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Medicine, Division of Infectious Diseases, Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
| | - Richard Sloane
- Division of Geriatrics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Luke F. Chen
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Emily C. Smathers
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kenneth E. Schmader
- Division of Geriatrics, Duke University Medical Center, Durham, North Carolina, United States of America
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
| | - Vance G. Fowler
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - David J. Weber
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Daniel J. Sexton
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Deverick J. Anderson
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
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Tak V, Mathur P, Lalwani S, Misra MC. Staphylococcal blood stream infections: epidemiology, resistance pattern and outcome at a level 1 Indian trauma care center. J Lab Physicians 2013; 5:46-50. [PMID: 24014969 PMCID: PMC3758705 DOI: 10.4103/0974-2727.115939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Blood stream infection (BSI)/bacteremia is a potentially life threatening infection and are associated with a high crude mortality. Coagulase negative Staphylococcus (CONS) and Staphylococcus aureus are the most commonly isolated gram positive bacteria from blood culture samples. While S. aureus is a known pathogen causing BSIs, CONS are considered to be common contaminants of blood culture. Of late many studies have challenged this traditional viewpoint. The aim of this study was to determine the epidemiology and significance of Staphylococcus aureus and CONS bacteremia, their resistance patterns and associated mortality in critically ill trauma patients admitted to a level 1 trauma center. Materials and Methods: The study was conducted from January 2009 to June 2011. All patients from whose blood samples yielded a S. aureus or CONS on culture were included in this study. A detailed history was obtained and follow-up of the patients was done. The isolates of Staphylococci were identified to species level. Antibiotic susceptibility was performed by the disc diffusion method and VITEK-2 system. Results: During this 30 month period, total of 10,509 blood samples were received from 2,938 patients. A total of 1,961 samples taken from 905 patients were positive for one or more pathogens. S. aureus/CONS were isolated from 469 samples from 374 patients. Crude mortality amongst the patients having Staphylococcal BSI was 25% (94/374). Conclusion: Staphylococcal blood stream infections are a leading cause of morbidity and mortality.
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Affiliation(s)
- Vibhor Tak
- Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi, India
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Polymicrobial bloodstream infections: Epidemiology and impact on mortality. J Glob Antimicrob Resist 2013; 1:207-212. [PMID: 27873614 DOI: 10.1016/j.jgar.2013.06.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 06/12/2013] [Accepted: 06/24/2013] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to investigate the impact of polymicrobial bloodstream infections (pBSIs) on the outcome of sepsis in an area where antimicrobial resistance is of concern. This was a retrospective analysis of data collected prospectively from patients developing BSI outside of an intensive care unit (non-ICU patients) or after ICU admission. Demographics and clinical characteristics were compared for patients with pBSI versus monomicrobial BSI (mBSI) and following stratification by ICU or non-ICU and severity of sepsis status. Possible risk factors for adverse outcome were explored by multivariate analysis, and outcomes were measured by Cox regression analysis. Among 412 patients with BSI, 47 patients (11.4%) with pBSI were recorded; compared with patients with mBSI, they had significantly higher APACHE II scores and presented more frequently with severe sepsis/septic shock. The all-cause 28-day mortality was significantly higher for pBSI versus mBSI (38.3% vs. 24.7%; P=0.033), whereas appropriateness of treatment was comparable (78.7% vs. 86.6%). Primary bacteraemia by combinations of Enterococcus faecalis, Klebsiella pneumoniae and Acinetobacter baumannii was predominant among pBSIs; in mBSIs, urinary tract infections by Escherichia coli, K. pneumoniae or Pseudomonas aeruginosa predominated. Multivariate analysis demonstrated pBSI as a significant contributor to 28-day mortality (HR=1.86; P=0.039), along with presence of two or more co-morbidities (HR=2.35; P=0.004). In conclusion, pBSIs differed epidemiologically from mBSIs, with the emergence of enterococcal species, and portended an almost two-fold increased risk of 28-day mortality. Prospective studies are warranted to elucidate possibly modifiable factors.
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