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Cooper L, Yu K, Van Benten K, Patkar A, Ye G, Gregory S, Ai C, Gupta V. Hospital mortality and length of stay associated with Enterobacterales positive blood cultures: a multicenter analysis. Microbiol Spectr 2024:e0040224. [PMID: 38953323 DOI: 10.1128/spectrum.00402-24] [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: 02/26/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
Delayed time to antimicrobial susceptibility results can impact patients' outcomes. Our study evaluated the impact of susceptibility turnaround time (TAT) and inadequate empiric antibacterial therapy (IET) in patients with bloodstream infections (BSI) caused by Enterobacterales (ENT) species on in-hospital mortality and length of stay (LOS). This retrospective, multicenter investigation which included 29,570 blood ENT-positive admissions across 161 US healthcare facilities evaluated the association between antimicrobial susceptibility testing (AST) TAT, carbapenem susceptibility, and empiric therapy on post-BSI in-hospital mortality and LOS following an ENT BSI event in adult patients. After adjusting for outcomes covariates, post-BSI in-hospital mortality was significantly higher for patients in the IET vs adequate empiric therapy (AET) group [odds ratio (OR): 1.61 (95% CI: 1.32, 1.98); P < 0.0001], and when AST TAT was >63 h [OR:1.48 (95% CI: 1.16, 1.90); P = 0.0017]. Patients with carbapenem non-susceptible (carb-NS) ENT BSI had significantly higher LOS (16.6 days, 95% CI: 15.6, 17.8) compared to carbapenem susceptible (carb-S, 12.2 days, 95% CI: 11.8, 12.6), (P < 0.0001). Extended AST TAT was significantly associated with longer LOS for TAT of 57-65 h and >65 h (P = 0.005 and P< 0.0001, respectively) compared to TAT ≤42 h (reference). Inadequate empiric therapy (IET), carb-NS, and delayed AST TAT are significantly associated with adverse hospital outcomes in ENT BSI. Workflows that accelerate AST TAT for ENT BSIs and facilitate timely and adequate therapy may reduce post-BSI in-hospital mortality rate and LOS.IMPORTANCEFor patients diagnosed with bloodstream infections (BSI) caused by Enterobacterales (ENT), delayed time to antimicrobial susceptibility (AST) results can significantly impact in-hospital mortality and hospital length of stay. However, this relationship between time elapsed from blood culture collection to AST results has only been assessed, to date, in a limited number of publications. Our study focuses on this important gap using retrospective data from 29,570 blood ENT-positive admissions across 161 healthcare facilities in the US as we believe that a thorough understanding of the dynamic between AST turnaround time, adequacy of empiric therapy, post-BSI event mortality, and hospital length of stay will help guide effective clinical management and optimize outcomes of patients with ENT infections.
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Affiliation(s)
- Lauren Cooper
- Becton, Dickinson and Company, Diagnostic Solutions, Sparks, Maryland, USA
| | - Kalvin Yu
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Kayla Van Benten
- Becton, Dickinson and Company, Diagnostic Solutions, Sparks, Maryland, USA
| | - Anuprita Patkar
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Gang Ye
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Sara Gregory
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - ChinEn Ai
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
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Brandibur TE, Kundnani NR, Boia M, Nistor D, Velimirovici DM, Mada L, Manea AM, Boia ER, Neagu MN, Popoiu CM. Does COVID-19 Infection during Pregnancy Increase the Appearance of Congenital Gastrointestinal Malformations in Neonates? Biomedicines 2023; 11:3105. [PMID: 38137326 PMCID: PMC10740856 DOI: 10.3390/biomedicines11123105] [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: 10/21/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND COVID-19 was an infection that was capable of bringing the entire world to a standstill position within a period of days to months. Despite the advancements in the medical sector, the contagion was difficult to control and costed the lives of millions of people worldwide. Many short- and long-term effects are witnessed even to date in people that contracted the disease. Pregnant females had to suffer not only the devastating effects of the virus, but also the psycho-social impact of the lockdown. The impact of COVID-19 infection during pregnancy causing decreased antenatal care or hypoxemic episodes due to severe respiratory distress and whether it could lead to the appearance of congenital gastrointestinal malformation in neonates is still unclear. The aim of our study was to analyze if COVID-19 infection during pregnancy could increase the incidence of gastric malformations in neonates born from these women. MATERIALS AND METHODS We sifted the files of all neonates admitted into our hospital between January 2022 and December 2022, and based on inclusion and exclusion criteria, we included the cases having gastrointestinal congenital malformations during the COVID-19 pandemic. We performed a single-center, retrospective, observational descriptive study. We further divided the patients based on the anatomical location of the malformation. We also took down details of the evolution of pregnancy and whether the mother had contracted a SARS-CoV-2 infection during the pregnancy. Details regarding the Apgar score, days of intensive care admission, sex, and nutrition were the key findings studied. RESULTS A total of 47 neonates were found to have digestive anomalies, among which, based on the anatomical locations, the number of malformation cases found at the level of the esophagus were 15, while 16 occurred at the level of the pylorus; we found 12 cases of malformation of the duodenum, and four cases had malformation of the rectum. Out of these 47 neonates, 38.3% were females and 61.7% were males. A total of 58% were preemies, among which 9% had intra-uterine growth retardation (IUGR), and 42% were full-term newborns, among which 4% had intra-uterine growth retardation (IUGR). A total of 45% of the births were primiparous pregnancies and 55% were from multiparous females. A total of 14 mothers were found to have tested positive for COVID-19 during the course of pregnancy (p-value = 0.23); many had mild symptoms but were not tested. CONCLUSIONS COVID-19 can affect the wellbeing of the pregnant female and their fetus. Larger studies can help gain extensive knowledge as to whether COVID-19 also has the potential to result in congenital gastrointestinal anomalies in children born from COVID-19 positive mothers. In our study, only a few infants born with this pathology were found to be born from COVID-19 positive mothers. Hence, it is difficult to conclude or exclude a direct correlation between the infection and the congenital malformations.
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Affiliation(s)
- Timea Elisabeta Brandibur
- Department of Neonatology and Puericulture, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Neonatology and Puericulture, “Louis Ţurcanu” Children Emergency Hospital, 300011 Timisoara, Romania
| | - Nilima Rajpal Kundnani
- Discipline of Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Marioara Boia
- Department of Neonatology and Puericulture, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Neonatology and Puericulture, “Louis Ţurcanu” Children Emergency Hospital, 300011 Timisoara, Romania
| | - Daciana Nistor
- Discipline of Physiology, Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Centre for Gene and Cellular Therapies in Cancer, 300723 Timisoara, Romania
| | - Daniel Milan Velimirovici
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania (L.M.)
| | - Leonard Mada
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania (L.M.)
- Syonic SRL, 300254 Timisoara, Romania
| | - Aniko Maria Manea
- Department of Neonatology and Puericulture, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Neonatology and Puericulture, “Louis Ţurcanu” Children Emergency Hospital, 300011 Timisoara, Romania
| | - Eugen Radu Boia
- Department of Oto-Rhino-Laryngology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marioara Nicula Neagu
- Discipline of Physiology, Faculty of Bioengineering of Animal Resources, University of Life Sciences “King Mihai I”, 300645 Timisoara, Romania
| | - Calin Marius Popoiu
- Department XI of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
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