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Zakhour J, El Ayoubi LW, Kanj SS. Metallo-beta-lactamases: mechanisms, treatment challenges, and future prospects. Expert Rev Anti Infect Ther 2024; 22:189-201. [PMID: 38275276 DOI: 10.1080/14787210.2024.2311213] [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: 09/30/2023] [Accepted: 01/24/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Metallo-beta-lactamases (MBLs) are responsible for resistance to almost all beta-lactam antibiotics. Found predominantly in Gram-negative bacteria, they severely limit treatment options. Understanding the epidemiology, risk factors, treatment, and prevention of infections caused by MBL-producing organisms is essential to reduce their burden. AREAS COVERED The origins and structure of MBLs are discussed. We describe the mechanisms of action that differentiate MBLs from other beta-lactamases. We discuss the global epidemiology of MBL-producing organisms and their impact on patients' outcomes. By exposing the mechanisms of transmission of MBLs among bacterial populations, we emphasize the importance of infection prevention and control. EXPERT OPINION MBLs are spreading globally and challenging the majority of available antibacterial agents. Genotypic tests play an important role in the identification of MBL production. Phenotypic tests are less specific but may be used in low-resource settings, where MBLs are more predominant. Infection prevention and control are critical to reduce the spread of organisms producing MBL in healthcare systems. New combinations such as avibactam-aztreonam and new agents such as cefiderocol have shown promising results for the treatment of infections caused by MBL-producing organisms. New antibiotic and non-antibiotic agents are being developed and may improve the management of infections caused by MBL-producing organisms.
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Affiliation(s)
- Johnny Zakhour
- Internal Medicine Department, Henry Ford Hospital, Detroit, MI, USA
| | - L'Emir Wassim El Ayoubi
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Paiva-Santos F, Santos-Costa P, Bastos C, Graveto J. Nurses' Adherence to the Portuguese Standard to Prevent Catheter-Associated Urinary Tract Infections (CAUTIs): An Observational Study. NURSING REPORTS 2023; 13:1432-1441. [PMID: 37873827 PMCID: PMC10594504 DOI: 10.3390/nursrep13040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses' adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses' practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses' feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences.
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Affiliation(s)
- Filipe Paiva-Santos
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
| | | | - João Graveto
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
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Pattananandecha T, Sirilun S, Apichai S, Ouirungroj T, Uirungroj P, Ogata F, Kawasaki N, Saenjum C. Pharmaceutical Incompatibility of Lubricating Gel Formulation Reduces Antibacterial Activity of Chlorhexidine Gluconate: In Vitro Study in Northern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12285. [PMID: 36231587 PMCID: PMC9566729 DOI: 10.3390/ijerph191912285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Chlorhexidine gluconate (CHG) is a cationic disinfectant. The positive charge of CHG molecules binds to phospholipid's negative charge in bacterial cell walls, causing membrane disruption. The in vitro kinetic physical, chemical and biological incompatibilities of nine lubricating gels with 1% w/v CHG were investigated. Five containing anionic thickener, two containing nonionic thickener, and two containing cationic thickener were collected from hospitals in northern Thailand. All the anionic and nonionic lubricating gels significantly reduced (p < 0.05) the CHG amount after 5 min of exposure time from 12.54% to 54.99%, respectively. In contrast, the amount of CHG exposed with cationic lubricating gels was maintained. Antibacterial activity was significantly reduced to a 1.17-4.33 log10 reduction for Staphylococcus aureus ATCC25923 and a 1.07-3.52 log10 reduction for Escherichia coli ATCC25922 after 5 min exposure to all anionic and nonionic lubricating gels. In contrast, the two cationic lubricating gels maintained the antibacterial activity of the CHG solution (5.69 ± 0.14 and 5.45 ± 0.17 log10 reduction). The results suggest that anionic and nonionic thickeners in lubricating gel formulations may neutralize the positive charge and reduce the antibacterial activity of CHG, reducing its effectiveness as a disinfectant.
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Affiliation(s)
- Thanawat Pattananandecha
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sasithorn Sirilun
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sutasinee Apichai
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Teerapat Ouirungroj
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Pose Health Care Co., Ltd., 1 Soi Ramintra 107, Ramintra Rd., Kannayao, Bangkok 10230, Thailand
| | - Phisit Uirungroj
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
- Pose Health Care Co., Ltd., 1 Soi Ramintra 107, Ramintra Rd., Kannayao, Bangkok 10230, Thailand
| | - Fumihiko Ogata
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan
| | - Naohito Kawasaki
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan
- Antiaging Center, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan
| | - Chalermpong Saenjum
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
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McCleskey SG, Shek L, Grein J, Gotanda H, Anderson L, Shekelle PG, Keeler E, Morton S, Nuckols TK. Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review. BMJ Qual Saf 2022; 31:308-321. [PMID: 34824163 PMCID: PMC9134991 DOI: 10.1136/bmjqs-2021-013839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/05/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospitals have implemented diverse quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). The economic value of these QI interventions is uncertain. OBJECTIVE To systematically review economic evaluations of QI interventions designed to prevent CAUTI in acute care hospitals. METHODS A search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine's Grey Literature Report, WorldCat, IDWeek conference abstracts and prior systematic reviews was conducted from January 2000 to October 2020.We included English-language studies of any design that evaluated organisational or structural changes to prevent CAUTI in acute care hospitals, and reported programme and infection-related costs.Dual reviewers assessed study design, effectiveness, costs and study quality. For each eligible study, we performed a cost-consequences analysis from the hospital perspective, estimating the incidence rate ratio (IRR) and incremental net cost/savings per hospital over 3 years. Unadjusted weighted regression analyses tested predictors of these measures, weighted by catheter days per study. RESULTS Fifteen unique economic evaluations were eligible, encompassing 74 hospitals. Across 12 studies amenable to standardisation, QI interventions were associated with a 43% decline in infections (mean IRR 0.57, 95% CI 0.44 to 0.70) and wide ranges of net costs (mean US$52 000, 95% CI -$288 000 to $392 000), relative to usual care. CONCLUSIONS QI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value.
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Affiliation(s)
- Sara G McCleskey
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Health Policy & Management, UCLA, Los Angeles, California, USA
| | - Lili Shek
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jonathan Grein
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hiroshi Gotanda
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Laura Anderson
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Center for Observational Research, Amgen, Thousand Oaks, California, USA
| | - Paul G Shekelle
- Department of Medicine, West Los Angeles Vet Administration, Los Angeles, California, USA
- RAND Corporation, Santa Monica, California, USA
| | | | - Sally Morton
- Knowledge Enterprise, Arizona State University, Tempe, Arizona, USA
| | - Teryl K Nuckols
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- RAND Corporation, Santa Monica, California, USA
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Qiao H, Yang J, Wang C. Effect of Cluster Nursing Based on Risk Management Strategy on Urinary Tract Infection in Patients With Severe Craniocerebral Injury. Front Surg 2022; 8:826835. [PMID: 35187052 PMCID: PMC8850279 DOI: 10.3389/fsurg.2021.826835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To observe the effect of cluster nursing based on risk management strategy in the management of urinary tract infection in patients with severe craniocerebral injury. Methods A total of 116 patients with severe craniocerebral injury who were admitted to our hospital from March 2019 to March 2021 were included. They were divided into the control group (58 patients) and the observation group (58 patients). The control group received routine nursing care and the observation group received cluster nursing based on risk management strategy. The incidence of catheter-associated urinary tract infection (CAUTI), the results of bacterial culture on the surface of the urinary catheter, the incidence of nursing risk events, the duration of placing the urinary catheter, the length of hospital stay, and hospital costs as well as the patient satisfaction score were compared between the two groups. The knowledge, attitude, and practice scale for prevention of catheter infection and the competence evaluation scale of nurses were used to evaluate the sense-control ability and core competence of the interveners. Results The total incidence of CAUTI in the observation group was (6.90%) lower than that in the control group (20.69%) (p < 0.05). The bacterial culture results on the catheter surface of patients in the observation group before and after 6 and 12 h of catheter cleaning were better than those of patients in the control group (p < 0.05). The duration of indwelling urinary catheter, hospitalization time, and hospitalization expenses of patients in the observation group were lower than those of patients in the control group (p < 0.05). The incidence rate of nursing risk events in the observation group was (1.72%) lower than that in the control group (11.86%) (p < 0.05). The overall satisfaction score of patients and the control and core ability scores of nursing staff in the observation group were higher than those in the control group (p < 0.05). Conclusion Cluster nursing based on risk management strategy can effectively reduce the incidence of nursing risk events and the probability of UTI in patients with severe craniocerebral injury, shorten the duration of indwelling urinary catheter and hospitalization.
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Affiliation(s)
- Hongbin Qiao
- The Hospital Infection Management Department, Chongqing Southeast Hospital, Chongqing, China
| | - Jing Yang
- The Department of Respiratory and Critical Care Medicine, Chongqing People's Hospital, Chongqing, China
| | - Cui Wang
- The Hospital Infection Management Department, Chongqing Southeast Hospital, Chongqing, China
- *Correspondence: Cui Wang
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Benseler A, Anglim B, Zhao ZY, Walsh C, McDermott CD. Antibiotic prophylaxis for urodynamic testing in women: a systematic review. Int Urogynecol J 2020; 32:27-38. [PMID: 32845398 PMCID: PMC7447964 DOI: 10.1007/s00192-020-04501-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/13/2020] [Indexed: 11/27/2022]
Abstract
Introduction and hypothesis Urinary tract infection is the most common complication after urodynamic studies (UDS). Practice guidelines recommend against antibiotic prophylaxis based on an outdated review of the literature, which advised on the premise of “a lack of good quality studies” and based on an assumed low incidence not consistently supported by the literature. Objectives This systematic review aims to update the assessment of the efficacy of antibiotic prophylaxis compared with placebo or no treatment for prevention of urinary tract infection in females over the age of 18 years undergoing UDS. Methods MEDLINE, EMBASE, COCHRANE, DISSERTATIONS, conference proceedings and clinical trial registries were searched for relevant randomized controlled trials. Two authors independently screened and selected articles, assessed these for quality according to Cochrane guidelines and extracted their data. Results A total of 2633 records were screened, identifying three relevant randomized controlled trials. The one study that was critically appraised as being the least likely biased showed a statistically significant effect of antibiotic prophylaxis in reducing bacteriuria post UDS in female patients. The other two studies included in the review did not. None of the studies included were powered to show a significant change in the incidence of urinary tract infection following UDS in female patients receiving antibiotic prophylaxis versus no prophylaxis. Conclusions Similar to the 2012 Cochrane review on this subject, this systematic review demonstrated that antibiotic prophylaxis may decrease bacteriuria in women post UDS; however, further research is required to assess its effect on urinary tract infections in this context.
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Affiliation(s)
- Anouk Benseler
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Breffini Anglim
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 8-815, 700 University Ave., Toronto, Ontario, Canada
| | - Zi Ying Zhao
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Chris Walsh
- Sidney Liswood Library, Sinai Health System, Toronto, Canada
| | - Colleen D McDermott
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 8-815, 700 University Ave., Toronto, Ontario, Canada.
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Fasugba O, Cheng AC, Gregory V, Graves N, Koerner J, Collignon P, Gardner A, Mitchell BG. Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2019; 19:611-619. [DOI: 10.1016/s1473-3099(18)30736-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/30/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
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Mitchell BG, Fasugba O, Cheng AC, Gregory V, Koerner J, Collignon P, Gardner A, Graves N. Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection: A cost-effectiveness analysis. Int J Nurs Stud 2019; 97:1-6. [PMID: 31129443 DOI: 10.1016/j.ijnurstu.2019.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion METHODS: The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. RESULTS The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. CONCLUSION The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources.
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Affiliation(s)
- Brett G Mitchell
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, 185 Fox Valley Road, Wahroonga, New South Wales 2076, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia.
| | - Oyebola Fasugba
- Nursing Research Institute, Australian Catholic University & St Vincent's Health Australia Sydney, New South Wales, Australia; Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Infectious Prevention and Healthcare Epidemiology Unit, Alfred Hospital, Melbourne, Australia
| | - Victoria Gregory
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, 185 Fox Valley Road, Wahroonga, New South Wales 2076, Australia
| | - Jane Koerner
- School of Nursing, Midwifery and Paramedicine Australian Catholic University, Watson Australia
| | - Peter Collignon
- Australian Capital Territory Pathology, Canberra Hospital and Health Services, Yamba Drive, Garran, Australian Capital Territory 2605, Australia; Medical School, Australian National University, Acton, Australian Capital Territory 2601, Australia
| | - Anne Gardner
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Otter JA, Galletly TJ, Davies F, Hitchcock J, Gilchrist MJ, Dyakova E, Mookerjee S, Holmes AH, Brannigan ET. Planning to halve Gram-negative bloodstream infection: getting to grips with healthcare-associated Escherichia coli bloodstream infection sources. J Hosp Infect 2018; 101:129-133. [PMID: 30059746 DOI: 10.1016/j.jhin.2018.07.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/23/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND A thorough understanding of the local sources, risks, and antibiotic resistance for Escherichia coli bloodstream infection (BSI) is required to focus prevention initiatives and therapy. AIM To review the sources and antibiotic resistance of healthcare-associated E. coli BSI. METHODS Sources and antibiotic resistance profiles of all 250 healthcare-associated (post 48 h) E. coli BSIs that occurred within our secondary and tertiary care hospital group from April 2014 to March 2017 were reviewed. Epidemiological associations with urinary source, gastrointestinal source, and febrile neutropenia-related BSIs were analysed using univariable and multivariable binary logistic regression models. FINDINGS E. coli BSIs increased 9% from 4.0 to 4.4 per 10,000 admissions comparing the 2014/15 and 2016/17 financial years. Eighty-nine cases (36%) had a urinary source; 30 (34%) of these were classified as urinary catheter-associated urinary tract infections (UTIs). Forty-five (18%) were related to febrile neutropenia, and 38 (15%) had a gastrointestinal source. Cases were rarely associated with surgical procedures (11, 4%) or indwelling vascular devices (seven, 3%). Female gender (odds ratio: 2.3; 95% confidence interval: 1.2-4.6) and older age (1.02; 1.00-1.05) were significantly associated with a urinary source. No significant associations were identified for gastrointestinal source or febrile neutropenia-related BSIs. Forty-seven percent of the isolates were resistant to ciprofloxacin, 37% to third-generation cephalosporins, and 22% to gentamicin. CONCLUSION The gastrointestinal tract and febrile neutropenia together accounted for one-third of E. coli BSI locally but were rare associations nationally. These sources need to be targeted locally to reduce an increasing trend of E. coli BSIs.
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Affiliation(s)
- J A Otter
- National Institute for Healthcare Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK; Public Health England, Hammersmith Hospital, London, UK; Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
| | - T J Galletly
- National Institute for Healthcare Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK; Public Health England, Hammersmith Hospital, London, UK; Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - F Davies
- National Institute for Healthcare Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK; Public Health England, Hammersmith Hospital, London, UK; Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - J Hitchcock
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - M J Gilchrist
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - E Dyakova
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - S Mookerjee
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - A H Holmes
- National Institute for Healthcare Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK; Public Health England, Hammersmith Hospital, London, UK; Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - E T Brannigan
- National Institute for Healthcare Research Health Protection Research Unit in HCAI and AMR, Imperial College London, London, UK; Public Health England, Hammersmith Hospital, London, UK; Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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