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Budhiraja A, Karuna T, Khan F, Kumar S, Shaji N, Bajaj E, Purwar S, Pakhare A, Joshi R, Saigal S, Khadanga S. Predictors of thirty-day mortality among patients with blood stream infection with WHO priority pathogens: single centre exploratory study from a referral teaching hospital in central India. IRANIAN JOURNAL OF MICROBIOLOGY 2024; 16:285-292. [PMID: 39005600 PMCID: PMC11245355 DOI: 10.18502/ijm.v16i3.15748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background and Objectives Bloodstream infection (BSI) is defined by the presence of viable microorganisms in the bloodstream. BSI is one of the major causes of sepsis and subsequent adverse clinical outcomes all across the globe. The present study was undertaken to identify clinico-epidemio-microbiological variables associated with 30-day mortality in patients having BSI with WHO priority pathogens. Materials and Methods The study was conducted at a public sector tertiary care institute in central India from April 2019 to March 2021. Blood samples collected from patients with clinical suspicion of sepsis, were processed by automated bacterial culture system and interpreted as per CLSI guidelines. Calculated sample size was 150. Data was analyzed by R software. Results Respiratory tract infection was the most common source (43.3%) of BSI, followed by the gastrointestinal (20%) and urinary tract (18.7%). Among the patients, 33% required invasive mechanical ventilation, and 31% required inotropes. Diabetes mellitus (DM) was the most common co-morbidity (34%). The incidence of multi-drug resistant organisms (MDRO) was 59.3%. Escherichia coli was the most commonly (24%) isolated organism, followed by Klebsiella pneumoniae (17.3%) and Acinetobacter baumannii (16%). Conclusion Higher age, higher qSOFA score / SIRS score / mean SOFA score at presentation had higher mortality. Use of mechanical ventilation and inotropes during treatment and isolation of critical category organisms of WPP and multi drug resistant organisms were independent 30-day mortality predictors.
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Affiliation(s)
- Akshit Budhiraja
- Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Tadepalli Karuna
- Department of Microbiology, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Farhan Khan
- Department of Community and Family Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Shweta Kumar
- Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Namitha Shaji
- Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Ehsaas Bajaj
- Department of General Medicine, Undergraduate Student, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Shashank Purwar
- Department of Microbiology, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Abhijit Pakhare
- Department of Community and Family Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Rajnish Joshi
- Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Saurabh Saigal
- Department of Critical Care, AIIMS Bhopal, Saket Nagar, Bhopal, India
| | - Sagar Khadanga
- Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
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Ohta R, Sano C. Bacterial Translocation As the Origin of Gram-Negative Rods Bloodstream Infection Among Older Patients in Rural Hospitals: A Cross-Sectional Study. Cureus 2023; 15:e50706. [PMID: 38234963 PMCID: PMC10792400 DOI: 10.7759/cureus.50706] [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: 12/17/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Bloodstream infections caused by Gram-negative rods are a pressing concern for the aging global population, particularly in rural settings. This study investigates the prevalence and entry pathways of Gram-negative rod bloodstream infections in elderly patients at a rural Japanese hospital, aiming to clarify the frequency and associated factors of straightforward entry and bacterial translocation. Method In this cross-sectional study, we analyzed electronic medical records of patients over 18 years of age with symptomatic Gram-negative rod bloodstream infections at Unnan City Hospital, Japan, from September 2021 to August 2023. We used multivariate logistic regression to assess factors of age, sex, body mass index, care dependency, and comorbidities. Results Among the participants who met the inclusion criteria, significant differences were observed in age, sex, inpatient status, and prevalence of conditions like respiratory diseases and cancer between the straightforward entry and bacterial translocation groups. Escherichia coli was the most common pathogen identified. Conclusion The study emphasizes the need for tailored medical approaches for elderly patients with bloodstream infections, considering their unique health profiles and risks. It highlights the importance of age, inpatient status, and cancer in determining infection risks, pointing to areas for further research to enhance infection management and healthcare outcomes in older populations.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine, Shimane University Faculty of Medicine, Izumo, JPN
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Alwazzeh MJ, Alnimr A, Al Nassri SA, Alwarthan SM, Alhajri M, AlShehail BM, Almubarak M, Alghamdi NS, Wali HA. Microbiological trends and mortality risk factors of central line-associated bloodstream infections in an academic medical center 2015-2020. Antimicrob Resist Infect Control 2023; 12:128. [PMID: 37981696 PMCID: PMC10659071 DOI: 10.1186/s13756-023-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Despite tremendous efforts to prevent central line-associated bloodstream infections, they still remain life-threatening complications among hospitalized patients with significant morbidity and mortality worldwide. The emerging antibiotic-resistant bacteria and other risk factors, including patient comorbidities, complicate patient management. METHODS A single-center retrospective observational study was conducted at King Fahad Hospital of the University, Eastern Province, Saudi Arabia. Hospitalized patients with confirmed central line-associated bloodstream infections between January 2015 and December 2020 were included. The primary objectives were to investigate the trends in antibiotic susceptibility patterns of the causative agents, coexisting comorbid conditions, and other risk factors associated with mortality. RESULTS A total of 214 patients with confirmed central line-associated bloodstream infections were included (CLABSI). The overall 30-day mortality rate was 33.6%. The infection rates per 1000 central line days for medical, surgical, and pediatric intensive care units were 4.97, 2.99, and 4.56 per 1000 CL days, respectively. The overall microbiological trends showed a predominance of Gram-negative agents, a steady increase of fungal CLABSI up to 24.0% in 2020, and a high prevalence of multidrug resistance up to 47% of bacterial CLABSI. In addition, the study indicates a significant negative surviving correlation with diabetes mellitus, cardiovascular disease, lung disease, chronic kidney disease, and the presence of ≥ 3 comorbidities (P < 0.05). CONCLUSION The microbiological trends of the study population demonstrated a steady increase of CLABSI caused by Candida spp. with a predominance of Gram-negative pathogens. Stratifying the patients according to relevant mortality risk factors, including patient comorbidities, will help reduce CLABSI rates and improve patient outcomes.
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Affiliation(s)
- Marwan Jabr Alwazzeh
- Infectious Disease Division, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Dammam, Al-Khobar, Saudi Arabia.
| | - Amani Alnimr
- Department of Microbiology, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
| | - Samia A Al Nassri
- Infection Control Unit, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
| | - Sara M Alwarthan
- Infectious Disease Division, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Dammam, Al-Khobar, Saudi Arabia
| | - Mashael Alhajri
- Infectious Disease Division, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Dammam, Al-Khobar, Saudi Arabia
| | - Bashayer M AlShehail
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mahdi Almubarak
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nada S Alghamdi
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haytham A Wali
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al- Ahsa, Saudi Arabia
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Christensen JJ, Junker H, Madsen CB, Christiansen CF, Kristensen T, Lund TK, Fallesen M, Kjølsen R, Hansen B, Hansen PK, Jensen US. Performance of QMAC-dRASTTM (Direct Rapid Antimicrobial Susceptibility Testing) - a Newcomer in Phenotypic Automatic AST. Open Microbiol J 2021. [DOI: 10.2174/1874285802115010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
QMAC-dRASTTM is a phenotypic automatized Antibiotic Susceptibility Testing (AST) system based on microfluidic chip technology enabling observation of changes in a single bacterial cell under antibiotic treatment conditions. The 96 wells plate with dried antibiotics comprises 19 and 17 antibiotics for the Gram-Negatives (GNs) and Gram-Positives (GPs), respectively. Categorical (Sensitive, Intermediate or Resistant) results were compared to results obtained by our laboratory standard susceptibility testing procedure and given as Categorical Agreement (CA).
Methods:
In a 3-month period (2019/2020), blood cultures detected positive were included. Excluded were known off-panel strains of QMAC-dRASTTM, such as Gram-positive bacilli, Streptococcus and Candida species. Percentages of CA (CA, %) between QMAC-dRASTTM and routine testing methods used in the laboratory (EUCAST disc diffusion and/or etest/Broth Micro Dilution MIC), were calculated.
Results:
255 positive blood cultures from as many patients were examined. Of the positive blood culture strains, 144 were GNs, and 111 were GPs. An overall combined CA,% of 96.3 (2410 of 2502 determinations) was obtained, and discrepancies were noted in 92 of 2502 test results (3.7%). The percentage of very major errors (VMEs) was 0.7% for GNs and 2.2% for GPs. For 87% of blood culture specimens examined, susceptibility reports were available within 6-7 hours.
Conclusion:
The high CA,% for as well GNs as GPs are promising. The presented time to report data obtained by QMAC-dRASTTM in this study being of 3-8 hours for blood culture specimens examined strongly support a further possible improvement in the workflow for handling blood stream infections.
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Igunma JA, Awopeju TAO, Olonipile FA, Umasoye A. Investigation of Gram-Negative Bacilli Bacteraemia in a Tertiary Hospital in Nigeria: Epidemiology and Antimicrobial Susceptibility Pattern. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2021. [DOI: 10.34172/ijep.2021.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The re-emergence of gram-negative bacilli (GNB) as the predominant cause of bacteraemia remains a major concern, given the increasing trend of antimicrobial resistance among this group of organisms. Prompt and effective empirical antibiotic treatment is vital for preventing adverse outcomes; therefore, a good knowledge of the local bacteria profile is required. Objective: This study was designed to aid the establishment of local antibiogram and empirical treatment for GNB bacteremia in patients referred to the University of Port Harcourt Teaching Hospital (UPTH), Nigeria. Materials and Methods: A total of 230 blood samples were obtained from inpatients in different units/departments from December 2017 to November 2018. The blood cultures were processed using BACTEC 9060 automated blood culture system, and the isolates were identified using MICROBACT 12E identification kits (Oxoid, UK) at the microbiology laboratory of UPTH. Susceptibility and resistance tests were done according to CLSI guidelines. Relevant information was obtained from the laboratory request forms and patients’ clinical files. Results: The prevalence of GNB in the study was 28.9% (71/246). The distribution of GNB bacteraemia was as follows: surgical unit (26.8%), special care baby unit (SCBU) (23.9%), intensive care unit (ICU) (21.1%), and paediatric ward (8.5%). The most common source of bacteraemia was pneumonia (35.2%) followed by puerperal sepsis (15.1%) and urinary tract infection (UTI) (15.1%). Klebsiella pneumoniae was the most frequently isolated gram-negative bacillus (26.6%). The overall resistance rate of extended spectrum lactamase producing Enterobacteriaceae (ESBL) producers, carbapenemase producers, and multi-drug resistant (MDR) organisms was 32.4%, with Acinetobacter baumannii (50%) and Pseudomonas aeruginosa (27.3%) exhibiting the highest level of resistance to carbapenems. Conclusion: This study showed a high MDR rate among GNB causing bacteraemia in patients at UPTH. An urgent review of the current antimicrobial prescription policy and infection control measures is recommended.
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Affiliation(s)
| | | | | | - Aaron Umasoye
- Department Medical Microbiology, University Port Harcourt, Port Harcourt, Nigeria
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Agarwal J, Singh V, Das A, Nath SS, Kumar R, Sen M. Reversing the Trend of Antimicrobial Resistance in ICU: Role of Antimicrobial and Diagnostic Stewardship. Indian J Crit Care Med 2021; 25:635-641. [PMID: 34316142 PMCID: PMC8286411 DOI: 10.5005/jp-journals-10071-23861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Increasing antimicrobial resistance (AMR) among common bacteria combined with the slow development of new antibiotics has posed a challenge to clinicians. Aim and objective To demonstrate whether antimicrobial and diagnostic stewardship program (ASP and DSP)-related interventions improve antibiotic susceptibilities among common bacteria causing bloodstream infections (BSI) in patients admitted to the intensive care unit (ICU) and whether these resulted in changes in the volume of antimicrobial consumption. Materials and methods We compared the susceptibility patterns of gram-negative bacteria (GNB) and gram-positive cocci (GPC) causing BSI and changes in the volume of antibiotics prescribed for the same before and after 2017 by a retrospective analysis. Results Postintervention, there was increased susceptibility of all GNBs to aminoglycosides; Escherichia coli and Klebsiella spp. to beta-lactambeta-lactamase inhibitors (BLBLI) combinations; and Klebsiella spp. and Pseudomonas spp. to carbapenems. Acinetobacter spp., Klebsiella spp., and Pseudomonas spp. showed improved susceptibility to doxycycline, whereas E. coli and Klebsiella spp. showed significantly improved susceptibility to fluoroquinolones. Among GPCs, there was increased susceptibility of Staphylococcus aureus (levofloxacin, clindamycin, and aminoglycoside), coagulase-negative S. aureus (CoNS) (chloramphenicol, levofloxacin, clindamycin, and aminoglycoside), and enterococci (chloramphenicol, levofloxacin, and clindamycin). There was a significant reduction in usage of antimicrobials for the treatment of GPCs (linezolid, doxycycline, chloramphenicol, levofloxacin, BLBLI, macrolide, and cephalosporin) and GNBs (levofloxacin, cephalosporin, carbapenem, and colistin), which caused BSI. Conclusion The present study illustrated that combined ASP and DSP interventions successfully reversed the resistance pattern of organisms causing BSI and resulted in a reduction in antibiotic utilization. How to cite this article Agarwal J, Singh V, Das A, Nath SS, Kumar R, Sen M. Reversing the Trend of Antimicrobial Resistance in ICU: Role of Antimicrobial and Diagnostic Stewardship. Indian J Crit Care Med 2021;25(6):635-641.
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Affiliation(s)
- Jyotsna Agarwal
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikramjeet Singh
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anupam Das
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Soumya S Nath
- Department of Anaesthesiology and Critical Care, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajeev Kumar
- Department of Critical Care Medicine, Vivekananda Polyclinic Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manodeep Sen
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Bajaj A, Mishra B, Loomba PS, Thakur A, Sharma A, Rathod PG, Das M, Bhasin A. Prevalence of Gram-negative Septicemia in a Tertiary Care Center. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2019. [DOI: 10.46347/jmsh.2019.v05i01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Deng S, Gao J, Zhao Z, Tian M, Li Y, Gong Y. Albumin/Procalcitonin Ratio Is a Sensitive Early Marker of Nosocomial Blood Stream Infection in Patients with Intra-Cerebral Hemorrhage. Surg Infect (Larchmt) 2019; 20:643-649. [PMID: 31163000 DOI: 10.1089/sur.2018.260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: This study was performed to investigate the combination of admission serum procalcitonin (PCT) and albumin (alb) concentrations as a diagnostic predictor for discriminating patients with nosocomial blood stream infection (BSI) among those with spontaneous intra-cerebral hemorrhage (ICH). Methods: We conducted a retrospective study on patients with ICH and hospital-acquired BSI. Clinical and microbiological data were compared in patients who experienced nosocomial BSI during a hospital stay and those who did not. Multivariable logistic regression analyses were used to identify independent risk factors for nosocomial BSI. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy of the albumin:PCT ratio. Results: Patients with nosocomial BSI had lower albumin:PCT ratios than those without BSI (11.739 [3.192-38.452] versus 200.000 [40.634-417.500]; p < 0.001). Multivariable logistic regression analysis revealed that the albumin:PCT ratio (odds ratio [OR] 1.006; 95% confidence interval [CI] 1.002-1.011; p = 0.001], white blood cell count (OR 1.129; 95% CI 1.044-1.220; p = 0.002), and shock (OR 4.504; 95% CI 1.774-11.435; p = 0.002) were independent predictors of nosocomial BSI, allowing distinction of patients with the infection from those without. The area under the ROC curve for the albumin:PCT ratio was 0.830 (95% CI 0.768-0.892; p < 0.001). The cut-off value of the albumin:PCT ratio was <1.087 with a sensitivity of 90.6% and a specificity of 98.8%. In the subgroup of 85 patients with nosocomial BSI, the albumin:PCT ratio in patients with shock was lower than that in those without shock (7.154 [2.975-26.267] vs 28.000 [3.818-57.812]; p = 0.027). Conclusion: The albumin:PCT ratio can be used as an early diagnostic predictor for nosocomial BSI in patients with ICH. Additionally, BSI patients with lower albumin:PCT ratios are more likely to experience shock. The albumin:PCT ratio is expected to be a rapid and low-cost tool for clinical practice.
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Affiliation(s)
- Shuixiang Deng
- Department of Critical Care Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiamin Gao
- Department of Critical Care Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Emergency Care, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Zhiyong Zhao
- Department of Critical Care Medicine, First Affiliated Hospital of Xiamen University, Fujian, China
| | - Mi Tian
- Department of Critical Care Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yuming Li
- Department of Critical Care Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Ye Gong
- Department of Critical Care Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China
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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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