1
|
Klingspor HT, Hällgren A. Factors influencing outcomes in candidemia: A retrospective study of patients in a Swedish county. Mycoses 2024; 67:e13758. [PMID: 38932675 DOI: 10.1111/myc.13758] [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: 11/22/2023] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Candidemia is a diverse condition and associated with a broad spectrum of clinical presentation. As mortality is high, timely diagnosis of candidemia and start of correct therapeutic treatment are essential. OBJECTIVES To investigate characteristics and factors influencing outcomes for patients with candidemia in a Swedish setting. METHOD All positive blood cultures for any Candida species in Östergötland County from 2012 to 2016 were screened. Medical records of patients fulfilling all inclusion criteria and no exclusion criteria were retrospectively reviewed to obtain data on risk factors, diagnostic and therapeutic procedures and at what wards candidemia was diagnosed. Univariate logistic regression and multivariable regression analysis were used to obtain odds ratio to determine risk factors for 30-day all-cause mortality associated with candidemia. A p-value <.05 was considered statistically significant. RESULTS Of all analysed risk factors, increasing age, renal failure with haemodialysis, immunosuppressant treatment, and severity of the infection (i.e. if septic shock was present) were significantly associated with 30-day mortality in univariate analysis (p < .05). Removal of a central venous catheter or an infectious diseases consultant was associated with a significantly lower odds ratio for death at 30 days (p < .05). With multivariable analysis, age, time to start of treatment and infectious disease consultant remained significant (p < .05). CONCLUSION In conclusion, this study provides an update of the epidemiology and outcomes of candidemia in a Swedish setting, highlighting that patients with candidemia are present at various departments and indicates the importance of an infectious disease consultant when candidemia is present.
Collapse
Affiliation(s)
- Hanna Thorold Klingspor
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anita Hällgren
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
2
|
Tiwari A, Krolicka A, Tran TT, Räisänen K, Ásmundsdóttir ÁM, Wikmark OG, Lood R, Pitkänen T. Antibiotic resistance monitoring in wastewater in the Nordic countries: A systematic review. ENVIRONMENTAL RESEARCH 2024; 246:118052. [PMID: 38163547 DOI: 10.1016/j.envres.2023.118052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
The Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) have effectively kept lower antibiotic-resistant bacterial (ARB) pathogen rates than many other countries. However, in recent years, these five countries have encountered a rise in ARB cases and challenges in treating infections due to the growing prevalence of ARB pathogens. Wastewater-based surveillance (WBS) is a valuable supplement to clinical methods for ARB surveillance, but there is a lack of comprehensive understanding of WBS application for ARB in the Nordic countries. This review aims to compile the latest state-of-the-art developments in WBS for ARB monitoring in the Nordic countries and compare them with clinical surveillance practices. After reviewing 1480 papers from the primary search, 54 were found relevant, and 15 additional WBS-related papers were included. Among 69 studies analyzed, 42 dedicated clinical epidemiology, while 27 focused on wastewater monitoring. The PRISMA review of the literature revealed that Nordic countries focus on four major WBS objectives of ARB: assessing ARB in the human population, identifying ARB evading wastewater treatment, quantifying removal rates, and evaluating potential ARB evolution during the treatment process. In both clinical and wastewater contexts, the most studied targets were pathogens producing carbapenemase and extended-spectrum beta-lactamase (ESBL), primarily Escherichia coli and Klebsiella spp. However, vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have received more attention in clinical epidemiology than in wastewater studies, probably due to their lower detection rates in wastewater. Clinical surveillance has mostly used culturing, antibiotic susceptibility testing, and genotyping, but WBS employed PCR-based and metagenomics alongside culture-based techniques. Imported cases resulting from international travel and hospitalization abroad appear to have frequently contributed to the rise in ARB pathogen cases in these countries. The many similarities between the Nordic countries (e.g., knowledge exchange practices, antibiotic usage patterns, and the current ARB landscape) could facilitate collaborative efforts in developing and implementing WBS for ARB in population-level screening.
Collapse
Affiliation(s)
- Ananda Tiwari
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, 70701, Kuopio, Finland.
| | - Adriana Krolicka
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway
| | - Tam T Tran
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway
| | - Kati Räisänen
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Odd-Gunnar Wikmark
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway; Unit for Environmental Science and Management, North West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Rolf Lood
- Department of Clinical Sciences Lund, Division of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Tarja Pitkänen
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, 70701, Kuopio, Finland; Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland.
| |
Collapse
|
3
|
Hassoun-Kheir N, Guedes M, Ngo Nsoga MT, Argante L, Arieti F, Gladstone BP, Kingston R, Naylor NR, Pezzani MD, Pouwels KB, Robotham JV, Rodríguez-Baño J, Tacconelli E, Vella V, Harbarth S, de Kraker MEA. A systematic review on the excess health risk of antibiotic-resistant bloodstream infections for six key pathogens in Europe. Clin Microbiol Infect 2024; 30 Suppl 1:S14-S25. [PMID: 37802750 DOI: 10.1016/j.cmi.2023.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Antimicrobial resistance is a global threat, which requires novel intervention strategies, for which priority pathogens and settings need to be determined. OBJECTIVES We evaluated pathogen-specific excess health burden of drug-resistant bloodstream infections (BSIs) in Europe. METHODS A systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, and grey literature for the period January 1990 to May 2022. STUDY ELIGIBILITY CRITERIA Studies that reported burden data for six key drug-resistant pathogens: carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, third-generation cephalosporin or CR Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. Excess health outcomes compared with drug-susceptible BSIs or uninfected patients. For MRSA and third-generation cephalosporin E. coli and K. pneumoniae BSIs, five or more European studies were identified. For all others, the search was extended to high-income countries. PARTICIPANTS Paediatric and adult patients diagnosed with drug-resistant BSI. INTERVENTIONS Not applicable. ASSESSMENT OF RISK OF BIAS An adapted version of the Joanna-Briggs Institute assessment tool. METHODS OF DATA SYNTHESIS Random-effect models were used to pool pathogen-specific burden estimates. RESULTS We screened 7154 titles, 1078 full-texts and found 56 studies on BSIs. Most studies compared outcomes of drug-resistant to drug-susceptible BSIs (46/56, 82.1%), and reported mortality (55/56 studies, 98.6%). The pooled crude estimate for excess all-cause mortality of drug-resistant versus drug-susceptible BSIs ranged from OR 1.31 (95% CI 1.03-1.68) for CR P. aeruginosa to OR 3.44 (95% CI 1.62-7.32) for CR K. pneumoniae. Pooled crude estimates comparing mortality to uninfected patients were available for vancomycin-resistant Enterococcus and MRSA BSIs (OR of 11.19 [95% CI 6.92-18.09] and OR 6.18 [95% CI 2.10-18.17], respectively). CONCLUSIONS Drug-resistant BSIs are associated with increased mortality, with the magnitude of the effect influenced by pathogen type and comparator. Future research should address crucial knowledge gaps in pathogen- and infection-specific burdens to guide development of novel interventions.
Collapse
Affiliation(s)
- Nasreen Hassoun-Kheir
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
| | - Mariana Guedes
- Department of Medicine, University of Sevilla/Instituto de Biomedicina de Sevilla (IBiS)/Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, Spain; Infectious Diseases and Microbiology Division, Hospital Universitario Virgen Macarena, Sevilla, Spain; Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Marie-Therese Ngo Nsoga
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
| | - Lorenzo Argante
- Department of Vaccine Clinical Statistics, GSK, Siena, Italy
| | - Fabiana Arieti
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Beryl P Gladstone
- The German Center for Infection Research (DZIF)-Clinical Research Unit, Infectious Diseases, Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Rhys Kingston
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, United Kingdon Health Security Agency, London, UK
| | - Nichola R Naylor
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, United Kingdon Health Security Agency, London, UK
| | - Maria D Pezzani
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Koen B Pouwels
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julie V Robotham
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, United Kingdon Health Security Agency, London, UK
| | - Jesús Rodríguez-Baño
- Department of Medicine, University of Sevilla/Instituto de Biomedicina de Sevilla (IBiS)/Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, Spain; Infectious Diseases and Microbiology Division, Hospital Universitario Virgen Macarena, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Venanzio Vella
- Department of Bacterial Vaccine Epidemiology, GSK, Siena, Italy
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
| | - Marlieke E A de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland.
| |
Collapse
|
4
|
Eichel VM, Last K, Brühwasser C, von Baum H, Dettenkofer M, Götting T, Grundmann H, Güldenhöven H, Liese J, Martin M, Papan C, Sadaghiani C, Wendt C, Werner G, Mutters NT. Epidemiology and outcomes of vancomycin-resistant enterococcus infections: a systematic review and meta-analysis. J Hosp Infect 2023; 141:119-128. [PMID: 37734679 DOI: 10.1016/j.jhin.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
Vancomycin-resistant enterococci (VRE) cause many infections in the healthcare context. Knowledge regarding the epidemiology and burden of VRE infections, however, remains fragmented. We aimed to summarize recent studies on VRE epidemiology and outcomes in hospitals, long-term-care facilities (LTCFs) and nursing homes worldwide based on current epidemiological reports. We searched MEDLINE/PubMed, the Cochrane Library, and Web of Science for observational studies, which reported on VRE faecium and faecalis infections in in-patients published between January 2014 and December 2020. Outcomes were incidence, infection rate, mortality, length of stay (LOS), and healthcare costs. We conducted a meta-analysis on mortality (PROSPERO registration number: CRD42020146389). Of 681 identified publications, 57 studies were included in the analysis. Overall quality of evidence was moderate to low. VRE incidence was rarely and heterogeneously reported. VRE infection rate differed highly (1-55%). The meta-analysis showed a higher mortality for VRE faecium bloodstream infections (BSIs) compared with VSE faecium BSIs (risk ratio, RR 1.46; 95% confidence interval (CI) 1.17-1.82). No difference was observed when comparing VRE faecium vs VRE faecalis BSI (RR 1.00, 95% CI 0.52-1.93). LOS was higher in BSIs caused by E. faecium vs E. faecalis. Only three studies reported healthcare costs. In contrast to previous findings, our meta-analysis of included studies indicates that vancomycin resistance independent of VRE species may be associated with a higher mortality. We identified a lack of standardization in reporting outcomes, information regarding healthcare costs, and state-of-the-art microbiological species identification methodology, which may inform the set-up and reporting of future studies.
Collapse
Affiliation(s)
- V M Eichel
- Heidelberg University Hospital, Center for Infectious Diseases, Section of Hospital and Environmental Hygiene, Heidelberg, Germany
| | - K Last
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.
| | - C Brühwasser
- Heidelberg University Hospital, Center for Infectious Diseases, Section of Hospital and Environmental Hygiene, Heidelberg, Germany; Infection Prevention and Hospital Hygiene, University Hospital Innsbruck, Innsbruck, Austria
| | - H von Baum
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | | | - T Götting
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Grundmann
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Güldenhöven
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - J Liese
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - M Martin
- Institute for Infection Prevention and Hospital Hygiene, SLK-Kliniken Heilbronn GmbH, Germany
| | - C Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - C Sadaghiani
- Institute for Infection Prevention and Control, Medical Center - University of Freiburg, Freiburg, Germany
| | - C Wendt
- MVZ Labor Dr. Limbach, Department of Hygiene, Heidelberg, Germany
| | - G Werner
- Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci (NRC), Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - N T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
5
|
Holmbom M, Forsberg J, Fredrikson M, Nilsson M, Nilsson LE, Hanberger H, Hällgren A. Fluoroquinolone-resistant Escherichia coli among the rectal flora is the predominant risk factor for severe infection after transrectal ultrasound-guided prostate biopsy: a prospective observational study. Scand J Urol 2023; 58:32-37. [PMID: 37553957 DOI: 10.2340/sju.v58.11920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/08/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Infection of the prostate gland following biopsy, usually with Escherichia coli, is a common complication, despite the use of antimicrobial prophylaxis. A fluoroquinolone (FQ) is commonly prescribed as prophylaxis. Worryingly, the rate of fluoroquinolone-resistant (FQ-R) E. coli species has been shown to be increasing. OBJECTIVE This study aimed to identify risk factors associated with infection after transrectal ultrasound-guided prostate biopsy (TRUS-Bx). METHODS This was a prospective study on patients undergoing TRUS-Bx in southeast Sweden. Prebiopsy rectal and urine cultures were obtained, and antimicrobial susceptibility and risk-group stratification were determined. Multivariate analyses were performed to identify independent risk factors for post-biopsy urinary tract infection (UTI) and FQ-R E. coli in the rectal flora. RESULTS In all, 283 patients were included, of whom 18 (6.4%) developed post-TRUS-Bx UTIs. Of these, 10 (3.5%) had an UTI without systemic inflammatory response syndrome (SIRS) and 8 (2.8%) had a UTI with SIRS. Being in the medium- or high-risk groups of infectious complications was not an independent risk factor for UTI with SIRS after TRUS-Bx, but low-level FQ-resistance (minimum inhibitory concentration (MIC): 0.125-0.25 mg/L) or FQ-resistance (MIC > 0.5 mg/L) among E. coli in the faecal flora was. Risk for SIRS increased in parallel with increasing degrees of FQ-resistance. Significant risk factor for harbouring FQ-R E.coli was travelling outside Europe within the previous 12 months. CONCLUSION The predominant risk factor for UTI with SIRS after TRUS-Bx was FQ-R E. coli among the faecal flora. The difficulty in identifying this type of risk factor demonstrates a need for studies on the development of a general approach either with rectal swab culture for targeted prophylaxis, or prior rectal preparation with a bactericidal agent such as povidone-iodine before TRUS-Bx to reduce the risk of FQ-R E. coli-related infection.
Collapse
Affiliation(s)
- Martin Holmbom
- Department of Urology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Jon Forsberg
- Department of Urology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences and Forum Östergötland, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Maud Nilsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lennart E Nilsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anita Hällgren
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
6
|
Ljungquist O, Blomstergren A, Merkel A, Sunnerhagen T, Holm K, Torisson G. Incidence, aetiology and temporal trend of bloodstream infections in southern Sweden from 2006 to 2019: a population-based study. Euro Surveill 2023; 28:2200519. [PMID: 36892472 PMCID: PMC9999458 DOI: 10.2807/1560-7917.es.2023.28.10.2200519] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
BackgroundBloodstream infections (BSI) are a public health concern, and infections caused by resistant bacteria further increase the overall BSI burden on healthcare.AimTo provide a population-based estimate of BSI incidence and relate this to the forthcoming demographic ageing western population change.MethodsWe retrieved positive blood cultures taken from patients in the Skåne region, southern Sweden, 2006-2019 from the Clinical Microbiology Department database and estimated incidence rates (IR), stratified by age (0-49, 50-64, 65-79, ≥ 80 years), sex, year, and species and described antimicrobial susceptibility for Enterobacterales.ResultsWe identified 944,375 blood culture sets, and 129,274 (13.7%) were positive. After deduplication and removal of contaminants, 54,498 separate BSI episodes remained. In total, 30,003 BSI episodes (55%) occurred in men. The overall IR of BSI was 307/100,000 person-years, with an average annual increase of 3.0%. Persons ≥ 80 years had the highest IR, 1781/100,000 person-years, as well as the largest increase. Escherichia coli (27%) and Staphylococcus aureus (13%) were the most frequent findings. The proportion of Enterobacterales isolates resistant to fluoroquinolones and third generation cephalosporins increased from 8.4% to 13.6%, and 4.9% to 7.3%, (p for trend < 0.001), with the largest increase in the oldest age group.ConclusionWe report among the highest BSI IRs to date worldwide, with a higher proportion among elderly persons and males, including resistant isolates. Given expected demographic changes, these results indicate a possible substantial future BSI burden, for which preventive measures are needed.
Collapse
Affiliation(s)
- Oskar Ljungquist
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Infectious Diseases, Helsingborg hospital, Helsingborg, Sweden
| | - Adam Blomstergren
- Department of Infectious Diseases, Skåne University hospital, Malmö, Sweden.,Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Adam Merkel
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden.,Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University hospital, Malmö, Sweden.,Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
7
|
Holmbom M, Möller V, Kristinsdottir L, Nilsson M, Rashid MU, Fredrikson M, Berglund B, Östholm Balkhed Å. Risk factors and outcome due to extended-spectrum β-lactamase-producing uropathogenic Escherichia coli in community-onset bloodstream infections: A ten-year cohort study in Sweden. PLoS One 2022; 17:e0277054. [PMID: 36327255 PMCID: PMC9632835 DOI: 10.1371/journal.pone.0277054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To study clinical outcome and risk factors associated with extended-spectrum β-lactamase (ESBL)-producing uropathogenic Escherichia coli (UPEC) in community-onset bloodstream infections (CO-BSI). Methods This was a population-based cohort study including patients with pheno- and genotype-matched ESBL-producing E. coli and non-ESBL- E. coli in urine and blood samples collected in 2009–2018 in southeast Sweden. Seventy-seven episodes of ESBL-UPEC satisfying the inclusion criteria were matched 1:1 with 77 non-ESBL-UPEC for age, gender, and year of culture. Results The most common ST-type and ESBL gene was ST131 (55%), and blaCTX-M-15 (47%), respectively. Risk factors for ESBL-UPEC were: previous genitourinary invasive procedure (RR 4.66; p = 0.005) or history of ESBL-producing E. coli (RR 12.14; p = 0.024). There was significant difference between ESBL-UPEC and non-ESBL-UPEC regarding time to microbiologically appropriate antibiotic therapy (27:15 h vs. 02:14 h; p = <0.001) and hospital days (9 vs. 5; p = <0.001), but no difference in 30-day mortality (3% vs. 3%; p = >0.999) or sepsis within 36 hours (51% vs. 62%; p = 0.623) was observed. Conclusion The predominant risk factors for ESBL-UPEC were history of ESBL-Ec infection and history of genitourinary invasive procedure. The overall mortality was low and the delay in appropriate antibiotic therapy did not increase the risk for 30-day mortality or risk for sepsis within 36 hours among patients infected with ESBL UPEC. However, these results must be regarded with some degree of caution due to the small sample size.
Collapse
Affiliation(s)
- Martin Holmbom
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Urology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- * E-mail:
| | - Vidar Möller
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Loa Kristinsdottir
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Maud Nilsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mamun-Ur Rashid
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences and Forum Östergötland, Faculty of Medicine and Health Sciences, Linköping, Sweden
| | - Björn Berglund
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Åse Östholm Balkhed
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
8
|
Golli AL, Cristea OM, Zlatian O, Glodeanu AD, Balasoiu AT, Ionescu M, Popa S. Prevalence of Multidrug-Resistant Pathogens Causing Bloodstream Infections in an Intensive Care Unit. Infect Drug Resist 2022; 15:5981-5992. [PMID: 36262597 PMCID: PMC9575466 DOI: 10.2147/idr.s383285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Bloodstream infections are the most severe infections that cause the highest mortality rate, especially in patients admitted to the intensive care unit (ICU). In this study, we aimed to analyze the distribution, resistance patterns and prevalence of MDR (multidrug-resistant) pathogens isolated in blood samples collected from patients with severe invasive infections hospitalized in the ICU. Methods A retrospective study of bacterial pathogens was performed on 490 patients admitted to the ICU between 2017 and 2020. The resistance patterns were analyzed using Vitek 2 Compact system. Results In total, 617 bacterial isolates were obtained. Four hundred and twenty-seven isolates (69.21%) were Gram positive and 190 isolates (30.79%) were Gram negative bacteria. The most frequently isolated micro-organisms identified in the blood samples for the entire period (2017-2020) were Coagulase-negative staphylococci (CoNS) (318-51.54%), followed by Klebsiella pneumoniae (70-11.34%), Methicillin-Resistant Staphylococcus aureus (MRSA) (58-9.40%), Acinetobacter baumannii (45-7.29%) and Enterococcus faecalis (42-6.80%). The number of Klebsiella pneumoniae strains significantly increased in 2020, compared to the previous year (p < 0.05). The Acinetobacter baumannii prevalence was significantly higher in the age group of 20-64 years (10.89%) and over 65 years (3.53%) (p < 0.001). The difference between the prevalence of CoNS in the elderly (67.84%) and in adults (20-64 years) (52.47%) was also statistically significant (p < 0.001). High rates of MDR were found for Acinetobacter baumannii (97.77%), Pseudomonas aeruginosa (65%), Klebsiella pneumoniae (50%), Enterococcus faecalis (47.61%) and MRSA (46.55%). More than 60% of the Klebsiella pneumoniae strains were found to be resistant to carbapenems. Conclusion The study revealed an alarming prevalence of MDR strains isolated in blood samples of the patients admitted to the ICU, indicating the necessity of consistent application of the measures to control.
Collapse
Affiliation(s)
- Andreea-Loredana Golli
- Department of Public Health and Management, University of Medicine and Pharmacy of Craiova, Craiova, Romania,Correspondence: Andreea-Loredana Golli, Email
| | - Oana Mariana Cristea
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Ovidiu Zlatian
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Adina-Dorina Glodeanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Andrei Theodor Balasoiu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Mihaela Ionescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Simona Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| |
Collapse
|
9
|
Holmbom M, Andersson M, Grabe M, Peeker R, Saudi A, Styrke J, Aljabery F. Community-onset urosepsis: incidence and risk factors for 30-day mortality - a retrospective cohort study. Scand J Urol 2022; 56:414-420. [PMID: 36127849 DOI: 10.1080/21681805.2022.2123039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression. OBJECTIVES To identify risk factors associated with 30-day mortality in patients with urosepsis. METHODS From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019-2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression. RESULTS Urosepsis was found in 18% (n = 282) of all CO-BSIs. The 30-day all-cause mortality was 14% (n = 38). After multivariable analysis, radiologically detected urinary tract disorder was the predominant risk factor for mortality (OR = 4.63, 95% CI = 1.47-14.56), followed by microbiologically inappropriate empirical antibiotic therapy (OR = 4.19, 95% CI = 1.41-12.48). Time to radiological diagnosis and decompression of obstruction for source control were also important prognostic factors for survival. Interestingly, 15% of blood cultures showed gram-positive species associated with a high 30-day mortality rate of 33%. CONCLUSION The 30-day all-cause mortality from urosepsis was 14%. The two main risk factors for mortality were hydronephrosis caused by obstructive stone in the ureter and inappropriate empirical antibiotic therapy. Therefore, early detection of any urinary tract disorder by imaging followed by source control as required, and antibiotic coverage of both gram-negative pathogens and gram-positive species such as E. faecalis to optimise management, is likely to improve survival in patients with urosepsis.
Collapse
Affiliation(s)
- Martin Holmbom
- Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Maria Andersson
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Grabe
- Department of Translational Medicine, Urologic Cancer Research, Lund University, Malmö, Sweden
| | - Ralph Peeker
- Department of Urology, University of Gothenburg, Gothenburg, Sweden
| | - Aus Saudi
- Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Johan Styrke
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Firas Aljabery
- Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
10
|
Kontula KS, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. Early deaths associated with community-acquired and healthcare-associated bloodstream infections: a population-based study, Finland, 2004 to 2018. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 36082683 PMCID: PMC9461309 DOI: 10.2807/1560-7917.es.2022.27.36.2101067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Bloodstream infections (BSI) cause substantial morbidity and mortality. Aim We explored the role of causative pathogens and patient characteristics on the outcome of community-acquired (CA) and healthcare-associated (HA) BSI, with particular interest in early death. Methods We used national register data to identify all BSI in Finland during 2004–18. We determined the origin of BSI, patients´ underlying comorbidities and deaths within 2 or 30 days from specimen collection. A time-dependent Cox model was applied to evaluate the impact of patient characteristics and causative pathogens on the hazard for death at different time points. Results A total of 173,715 BSI were identified; 22,474 (12.9%) were fatal within 30 days and, of these, 6,392 (28.4%) occurred within 2 days (7.9 deaths/100,000 population). The 2-day case fatality rate of HA-BSI was higher than that of CA-BSI (5.4% vs 3.0%). Patients who died within 2 days were older than those alive on day 3 (76 vs 70 years) and had more severe comorbidities. Compared with other BSI, infections leading to death within 2 days were more often polymicrobial (11.8% vs 6.3%) and caused by Pseudomonas aeruginosa (6.2% vs 2.0%), fungi (2.9% vs 1.4%) and multidrug-resistant (MDR) pathogens (2.2% vs 1.8%), which were also predictors of death within 2 days in the model. Conclusions Overrepresentation of polymicrobial, fungal, P. aeruginosa and MDR aetiology among BSI leading to early death is challenging concerning the initial antimicrobial treatment. Our findings highlight the need for active prevention and prompt recognition of BSI and appropriate antimicrobial treatment.
Collapse
Affiliation(s)
- Keiju Sk Kontula
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kirsi Skogberg
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
11
|
Duan X, Zhang R, Zhang X, Ding X, Sun T. Identification of Prognostic Factors in Patients With Streptococcus Bloodstream Infection. Front Med (Lausanne) 2022; 9:832007. [PMID: 35559342 PMCID: PMC9087728 DOI: 10.3389/fmed.2022.832007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/14/2022] Open
Abstract
Aim The purpose of this study was to explore prognostic factors of bloodstream infections (BSIs), a common severe infection and a major cause of mortality worldwide, so as to construct a prognosis model of patients with BSI. Materials and Methods Clinical and biochemical test data were obtained retrospectively from the medical records of 562 patients with BSI who had been treated at a single center; the end point was 60 days of all-cause death. The chi-square test was used to compare the mortality of patients grouped by the types of antibiotic treatment. The logistic regression analysis was adopted to identify prognostic factors; the Kaplan–Meier survival curve and log-rank test were conducted to compare the survival rate of patients with different prognostic factors; the receiver operating characteristic (ROC) curve was used to estimate the predictive value of different prognostic factors. Results Of the 562 patients, 455 survived (80.96%), and 107 died (19.04%). The mortality rate of patients treated with a combination of antibiotics (25.40%) was higher than that treated with a single antibiotic (15.82%). Univariate analysis identified 19 prognostic factors for patients with BSI, including gender, age, diabetes, malignant tumor (non-blood system), total hospitalization time, alanine aminotransferase, aspartate aminotransferase, total protein, albumin, total bilirubin, direct bilirubin, creatinine, ratio of granulocytes, fibrinogen, D-dimer, platelet, C-reactive protein, shock, and respiratory failure (P < 0.05). Multivariate analysis indicated that albumin (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.89–0.99), fibrinogen (OR = 0.61, 95%CI: 0.46–0.82), shock (OR = 16.61, 95%CI: 7.00–39.41), and respiratory failure (OR = 47.53, 95%CI: 19.93–133.64) were independent factors. The combination of four indicators demonstrated a favorable predictive value for the 60-day outcome of patients with BSI, with an area under the ROC of 0.96 (95%CI: 0.94–0.99), sensitivity of 90.65%, specificity of 94.95%, and accuracy of 94.13%. Conclusions Shock, respiratory failure, albumin, and fibrinogen are potential independent prognostic factors for 60-day mortality.
Collapse
Affiliation(s)
- Xiaoguang Duan
- General ICU, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruifang Zhang
- General ICU, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojuan Zhang
- General ICU, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianfei Ding
- General ICU, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tongwen Sun
- General ICU, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
12
|
Ljungquist O, Persmark A, Grabe M, Jakobsen AK, Gerdtsson A, Torisson G, Bjartell A, Riesbeck K. Increasing rates of urinary- and bloodstream infections following transrectal prostate biopsy in South Sweden. BJU Int 2022; 130:478-485. [PMID: 35174613 PMCID: PMC9541606 DOI: 10.1111/bju.15713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/20/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- O Ljungquist
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - A Persmark
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - M Grabe
- Department of Translational Medicine, Division of Urological Cancers, Faculty of Medicine, Lund University, Sweden
| | | | - A Gerdtsson
- Department of Translational Medicine, Division of Urological Cancers, Faculty of Medicine, Lund University, Sweden
| | - G Torisson
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - A Bjartell
- Department of Translational Medicine, Division of Urological Cancers, Faculty of Medicine, Lund University, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - K Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
13
|
Alonso-Menchén D, Muñoz P, Sánchez-Carrillo C, Pérez-Latorre L, Bouza E. Unresolved issues in the epidemiology and diagnosis of bacteremia: an opinion paper. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:519-537. [PMID: 35892171 PMCID: PMC9728596 DOI: 10.37201/req/066.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Bacteremia is an important cause of morbidity and mortality worldwide and, despite the diagnostic and therapeutic advances of the last decades, the evidence supporting many diagnostic aspects of bacteremia is scarce. Information on the epidemiological evolution of this entity is limited and many methodological aspects of blood culture collection and analysis are under discussion. Furthermore, the recommendations of the main scientific societies on many of these aspects are variable and, in many cases, have not been updated recently. In this scenario, we have arranged a series of questions on different aspects of bacteremia and reviewed the literature trying to find proper answers for them. We offer our opinion on the topics where the evidence was weak. The topics covered include epidemiological aspects of bacteremia, indications for blood culture extraction, methods for obtaining and incubating samples, or ways of transmitting results from the microbiology laboratory. We do not intend to summarize the current clinical practice guidelines, nor will we deal with the therapeutic management of this entity. The aim of this paper is to review the current perspective on the diagnosis of bacteremia with a critical approach, to point out the gaps in the literature, to offer the opinion of a team dedicated to infectious diseases and clinical microbiology, and to identify some areas of knowledge on which future studies should focus.
Collapse
Affiliation(s)
- David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute,Correspondence: David Alonso Menchén, MD. Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón. Calle Doctor Esquerdo 46, 28007 Madrid, Spain. E-mail:
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute,Medicine Department, School of Medicine, Universidad Complutense de Madrid,,CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute
| | - Leire Pérez-Latorre
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute,CIBER Enfermedades Infecciosas-CIBERINFEC, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón,,Gregorio Marañón Health Research Institute,Medicine Department, School of Medicine, Universidad Complutense de Madrid,,CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
| |
Collapse
|
14
|
Ingefors E, Tverring J, Nafaa F, Jönsson N, Karlsson Söbirk S, Kjölvmark C, Ljungquist O. Low 30-day mortality and low carbapenem-resistance in a decade of Acinetobacter bacteraemia in South Sweden. Infect Ecol Epidemiol 2021; 12:2009324. [PMID: 34912503 PMCID: PMC8667949 DOI: 10.1080/20008686.2021.2009324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background The aim of this study was to provide a descriptive account of carbapenem resistance and risk factors for mortality from invasive Acinetobacter infections in the south of Sweden. Methods Blood isolates with growth of Acinetobacter species between 2010 and 2019 in Skåne county were subtyped using MALDI-TOF and subjected to susceptibility testing against clinically relevant antibiotics. Association between risk factors and 30-day mortality were analysed in univariate and multivariate logistic regression models. Results There were 179 bacteraemia episodes in 176 patients included in the study. The 30-day all-cause mortality was 16%. In all, two percent of Acinetobacter strains were carbapenem resistant. Independent risk factors associated with 30-day mortality in the multivariate regression model were Acinetobacter growth in all blood cultures drawn at the day of bacteraemia onset (OR 5.0, 95% CI: 1.8 to 13.7, p= 0.002), baseline functional capacity (1-4 points, OR 2.0, 95% CI: 1.2 to 3.4, p= 0.010) and correct empiric antibiotics at time of culture (OR 3.5 95% CI: 1.0 to 11.8, p= 0.045). Conclusion This study on Acinetobacter bacteraemia in South Sweden found low 30-day mortality and low carbapenem-resistance rates compared to previous international studies which may be due to a higher rate of contaminant findings.
Collapse
Affiliation(s)
- Erik Ingefors
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
| | - Jonas Tverring
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.,Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Fatima Nafaa
- Clinical Microbiology, Infection Prevention and Control, Region Skåne, Lund, Sweden
| | - Niklas Jönsson
- Clinical Microbiology, Infection Prevention and Control, Region Skåne, Lund, Sweden
| | - Sara Karlsson Söbirk
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Clinical Microbiology, Infection Prevention and Control, Region Skåne, Lund, Sweden
| | - Charlott Kjölvmark
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
| | - Oskar Ljungquist
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.,Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
15
|
Holmbom M, Andersson M, Berg S, Eklund D, Sobczynski P, Wilhelms D, Moberg A, Fredrikson M, Balkhed ÅÖ, Hanberger H. Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case-control study. BMJ Open 2021; 11:e052582. [PMID: 34794994 PMCID: PMC8603295 DOI: 10.1136/bmjopen-2021-052582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden. METHODS A retrospective case-control study of 1624 patients with CA-BSI (2015-2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality. RESULTS Of the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6-52) for non-survivors and 7 hours (3-24) for survivors (p<0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p<0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p<0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p<0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p<0.01. In a multivariable model, prehospital delay >24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p<0.01. CONCLUSION Prehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.
Collapse
Affiliation(s)
- Martin Holmbom
- Department of Urology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maria Andersson
- Department of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sören Berg
- Division of Cardiothoracic Anesthesia and Intensive Care, Department of Medicine and Health Science, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Dan Eklund
- Department of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Pernilla Sobczynski
- Department of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Daniel Wilhelms
- Department of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anna Moberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences and Forum Östergötland, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Åse Östholm Balkhed
- Department of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Department of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
16
|
Kontula KSK, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004-2018. Emerg Infect Dis 2021; 27. [PMID: 34546161 PMCID: PMC8462341 DOI: 10.3201/eid2710.204826] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A 2-fold increase in incidence and death during this period emphasizes the need for additional prevention efforts. We evaluated the incidence, outcomes, and causative agents of bloodstream infections (BSI) in Finland during 2004–2018 by using data from the national registries. We identified a total of 173,715 BSIs; annual incidence increased from 150 to 309 cases/100,000 population. BSI incidence rose most sharply among persons >80 years of age. The 1-month case-fatality rate decreased from 13.0% to 12.6%, but the 1-month all-cause mortality rate rose from 20 to 39 deaths/100,000 population. BSIs caused by Escherichia coli increased from 26% to 30% of all BSIs. BSIs caused by multidrug-resistant microbes rose from 0.4% to 2.8%, mostly caused by extended-spectrum β-lactamase-producing E. coli. We observed an increase in community-acquired BSIs, from 67% to 78%. The proportion of patients with severe underlying conditions rose from 14% to 23%. Additional public health and healthcare prevention efforts are needed to curb the increasing trend in community-acquired BSIs and antimicrobial drug–resistant E. coli.
Collapse
|
17
|
Zou H, Jia X, He X, Su Y, Zhou L, Shen Y, Sheng C, Liao A, Li C, Li Q. Emerging Threat of Multidrug Resistant Pathogens From Neonatal Sepsis. Front Cell Infect Microbiol 2021; 11:694093. [PMID: 34322398 PMCID: PMC8312093 DOI: 10.3389/fcimb.2021.694093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Multidrug-resistant (MDR) pathogens are responsible for a substantial burden of morbidity and mortality from neonatal sepsis; however, data on these sepsis-related pathogens among hospitalized neonates in China are not well characterized. In this study, a total of 240 strains were isolated from four Women and Children's hospitals in Southwest China between 2014 and 2019. Of these included pathogens, 104 (43.33%) were gram-positive bacteria, 129 (53.75%) were gram-negative bacteria, and 7 (2.92%) were fungi. Escherichia coli (E. coli, 34.01%) and Klebsiella pneumoniae (K. pneumoniae, 15.35%) were the main pathogen of neonate bacteremia. ST167 were the most prevalent STs in E. coli and ST11 in K. pneumoniae. Our study found that E. coli (62.71%) was the predominate pathogen of early-onset sepsis, among which 64.86% were MDR. Late-onset sepsis was mainly caused by K. pneumoniae (28.31%) and E. coli (24.78%), with showing that 78.33% of these pathogens were MDR. Notably, the prevalence of EO/LO pathogens were quite different from Indian and south of China. Moreover, we found that bla CTX-M (42.06%) was most dominant resistant genes with about a third isolates (31.09%) were positive for bla CTX-M-15. All the carbapenem-resistant K. pneumoniae were positive for NDM-1. Moreover, late-onset sepsis and antibiotic exposure were significantly associated with MDR infection. Emerging multi-resistant pathogens of sepsis posts a serious threat to neonatal outcomes and emphasizes an urgent need to control their further spread.
Collapse
Affiliation(s)
- Hua Zou
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaojiong Jia
- Department of Laboratory Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao He
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yan Su
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Ligang Zhou
- Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yan Shen
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Chenglin Sheng
- Department of Laboratory Medicine, Wan Zhou Health Center for Women and Children, Chongqing, China
| | - Ang Liao
- Department of Laboratory Medicine, Yong Chuan Health Center for Women and Children, Chongqing, China
| | - Chunli Li
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| | - Qiuhong Li
- Department of Laboratory Medicine, Chongqing Health Center for Women and Children, Chongqing, China
| |
Collapse
|
18
|
Tong SYC, Davis JS. Combination Therapy for Staphylococcus aureus Bacteremia: Hopes Dashed Again. Clin Infect Dis 2021; 72:e204-e205. [PMID: 32667976 DOI: 10.1093/cid/ciaa994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/10/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| |
Collapse
|
19
|
Correction: Low incidence of antibiotic-resistant bacteria in south-east Sweden: An epidemiologic study on 9268 cases of bloodstream infection. PLoS One 2020; 15:e0234276. [PMID: 32470069 PMCID: PMC7259693 DOI: 10.1371/journal.pone.0234276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|