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Wozniak H, Tabah A, Barbier F, Ruckly S, Loiodice A, Akova M, Leone M, Conway Morris A, Bassetti M, Arvaniti K, Ferrer R, de Bus L, Paiva JA, Bracht H, Mikstacki A, Alsisi A, Valeanu L, Prazak J, Timsit JF, Buetti N. Hospital-acquired bloodstream infections in critically ill cirrhotic patients: a post-hoc analysis of the EUROBACT-2 international cohort study. Ann Intensive Care 2024; 14:70. [PMID: 38698291 PMCID: PMC11065852 DOI: 10.1186/s13613-024-01299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Hospital-acquired bloodstream infections are common in the intensive care unit (ICU) and have a high mortality rate. Patients with cirrhosis are especially susceptible to infections, yet there is a knowledge gap in the epidemiological distinctions in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients in the ICU. It has been suggested that cirrhotic patients, present a trend towards more gram-positive infections, and especially enterococcal infections. This study aims to describe epidemiological differences in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients hospitalized in the ICU regarding infection sources, microorganisms and mortality. METHODS Using prospective Eurobact-2 international cohort study data, we compared hospital-acquired bloodstream infections sources and microorganisms in cirrhotic and non-cirrhotic patients. The association between Enterococcus faecium and cirrhosis was studied using a multivariable mixed logistic regression. The association between cirrhosis and mortality was assessed by a multivariable frailty Cox model. RESULTS Among the 1059 hospital-acquired bloodstream infections patients included from 101 centers, 160 had cirrhosis. Hospital-acquired bloodstream infection source in cirrhotic patients was primarily abdominal (35.6%), while it was pulmonary (18.9%) for non-cirrhotic (p < 0.01). Gram-positive hospital-acquired bloodstream infections accounted for 42.3% in cirrhotic patients compared to 33.2% in non-cirrhotic patients (p = 0.02). Hospital-acquired bloodstream infections in cirrhotic patients were most frequently caused by Klebsiella spp (16.5%), coagulase-negative Staphylococci (13.7%) and E. faecium (11.5%). E. faecium bacteremia was more frequent in cirrhotic patients (11.5% versus 4.5%, p < 0.01). After adjusting for possible confounding factors, cirrhosis was associated with higher E. faecium hospital-acquired bloodstream infections risk (Odds ratio 2.5, 95% CI 1.3-4.5, p < 0.01). Cirrhotic patients had increased mortality compared to non-cirrhotic patients (Hazard Ratio 1.3, 95% CI 1.01-1.7, p = 0.045). CONCLUSIONS Critically ill cirrhotic patients with hospital-acquired bloodstream infections exhibit distinct epidemiology, with more Gram-positive infections and particularly Enterococcus faecium.
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Affiliation(s)
- Hannah Wozniak
- Division of Critical Care, Department of Acute Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Stéphane Ruckly
- Université de Paris, INSERM, IAME UMR 1137, Paris, 75018, France
- ICUREsearch, Biometry, Fontaine, 38600, France
| | | | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK
- JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Liesbet de Bus
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jose Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Hendrik Bracht
- Central Interdisciplinary Emergency Medicine, University Hospital Ulm, Ulm, Germany
| | - Adam Mikstacki
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland
| | - Adel Alsisi
- ICU Department, Prime Hospital, Dubai, United Arab Emirates
- Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Liana Valeanu
- Cardiac Anesthesiology and Intensive Care Department I, Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, Bucharest, Romania
| | - Josef Prazak
- Department of Intensive Care Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jean-François Timsit
- Université Paris- Cité, INSERM, IAME UMR 1137, Paris, 75018, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Niccolò Buetti
- Université Paris- Cité, INSERM, IAME UMR 1137, Paris, 75018, France
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, Faculty of Medicine, University Hospitals, University of Geneva, Geneva, Switzerland
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She P, Li L, Yang Y, Zhou L, Huang G, Xiao D, Wu Y. Lusutrombopag as a Repurposing Drug in Combination with Aminoglycosides against Vancomycin-Resistant Enterococcus. ACS Infect Dis 2024; 10:1327-1338. [PMID: 38567846 DOI: 10.1021/acsinfecdis.3c00737] [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] [Indexed: 04/13/2024]
Abstract
Due to the widespread abuse of antibiotics, drug resistance in Enterococcus has been increasing. However, the speed of antibiotic discovery cannot keep pace with the acquisition of bacterial resistance. Thus, drug repurposing is a proposed strategy to solve the crises. Lusutrombopag (LP) has been approved as a thrombopoietin receptor agonist by the Food and Drug Administration. This study demonstrated that LP exhibited significant antimicrobial activities against vancomycin-resistant Enterococcus in vitro with rare resistance occurrence. Further, LP combined with tobramycin exhibited synergistic antimicrobial effects in vitro and in vivo against Enterococcus. No in vitro or in vivo detectable toxicity was observed when using LP. Mechanism studies indicated that the disrupted proton motive force may account for LP's antimicrobial activity. In summary, these results demonstrate that LP has the previously undocumented potential to serve as an antibacterial agent against refractory infections caused by Enterococcus.
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Affiliation(s)
- Pengfei She
- Department of Laboratory Medicine, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Linhui Li
- Department of Laboratory Medicine, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Yifan Yang
- Department of Laboratory Medicine, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Linying Zhou
- Department of Laboratory Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine (The First Hospital of Changsha), Central South University, Changsha 410005, China
| | - Guanqing Huang
- Department of Laboratory Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine (The First Hospital of Changsha), Central South University, Changsha 410005, China
| | - Dan Xiao
- Department of Laboratory Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine (The First Hospital of Changsha), Central South University, Changsha 410005, China
| | - Yong Wu
- Department of Laboratory Medicine, The Affiliated Changsha Hospital of Xiangya School of Medicine (The First Hospital of Changsha), Central South University, Changsha 410005, China
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3
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Sasano H, Hanada K. Assessing Clinical Outcomes of Vancomycin Treatment in Adult Patients with Vancomycin-Susceptible Enterococcus faecium Bacteremia. Antibiotics (Basel) 2023; 12:1577. [PMID: 37998779 PMCID: PMC10668815 DOI: 10.3390/antibiotics12111577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE Enterococcal bacteremia is associated with high mortality and long-term hospitalization. Here, we aimed to investigate the clinical outcomes and evaluate the risk factors for mortality in adult patients treated with vancomycin (VCM) for vancomycin-susceptible Enterococcus faecium (E. faecium) bacteremia. METHODS This is a retrospective, record-based study. The data were collected from inpatients at a single university hospital between January 2009 and December 2020. The area under the curve (AUC) of VCM was calculated using the Bayesian approach. The primary outcome was a 30-day in-hospital mortality. RESULTS A univariate analysis showed significant differences in the concomitant use of vasopressors, history of the use of no clinically relevant activity antimicrobial agents against E. faecium, VCM plasma trough concentration, and renal dysfunction during VCM administration between the 30-day in-hospital mortality and survival groups. However, the groups' AUC/minimum inhibitory concentration (MIC) were not significantly different. A multivariate analysis suggested that concomitant vasopressors may be an independent risk factor for 30-day in-hospital mortality (odds ratio, 7.81; 95% confidence interval, 1.16-52.9; p = 0.035). The VCM plasma trough concentrations and the AUC/MIC in the mortality group were higher than those in the surviving group. No association between the AUC/MIC and the treatment effect in E. faecium bacteremia was assumed, because the known, target AUC/MIC were sufficiently achieved in the mortality group. CONCLUSIONS There may be no association between the AUC/MIC and the treatment effect in E. faecium bacteremia. When an immunocompromised host develops E. faecium bacteremia with septic shock, especially when a vasopressor is used in a patient with unstable hemodynamics, it may be difficult to treat it, despite efforts to ensure the appropriate AUC/MIC and therapeutic vancomycin concentration levels.
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Affiliation(s)
- Hiroshi Sasano
- Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan;
- Department of Pharmacy, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
| | - Kazuhiko Hanada
- Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan;
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Pantazi AC, Kassim MAK, Nori W, Tuta LA, Mihai CM, Chisnoiu T, Balasa AL, Mihai L, Lupu A, Frecus CE, Lupu VV, Chirila SI, Badescu AG, Hangan LT, Cambrea SC. Clinical Perspectives of Gut Microbiota in Patients with Chronic Kidney Disease and End-Stage Kidney Disease: Where Do We Stand? Biomedicines 2023; 11:2480. [PMID: 37760920 PMCID: PMC10525496 DOI: 10.3390/biomedicines11092480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
The gut microbiota (GM) plays a vital role in human health, with increasing evidence linking its imbalance to chronic kidney disease and end-stage kidney disease. Although the exact methods underlying kidney-GM crosstalk are not fully understood, interventions targeting GM were made and lay in three aspects: diagnostic, predictive, and therapeutic interventions. While these interventions show promising results in reducing uremic toxins and inflammation, challenges remain in the form of patient-specific GM variability, potential side effects, and safety concerns. Our understanding of GMs role in kidney disease is still evolving, necessitating further research to elucidate the causal relationship and mechanistic interactions. Personalized interventions focusing on specific GM signatures could enhance patient outcomes. However, comprehensive clinical trials are needed to validate these approaches' safety, efficacy, and feasibility.
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Affiliation(s)
| | | | - Wassan Nori
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Liliana Ana Tuta
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
- Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Cristina Maria Mihai
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
- Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Tatiana Chisnoiu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
- Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Adriana Luminita Balasa
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
- Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Larisia Mihai
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
- Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Ancuta Lupu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Corina Elena Frecus
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
- Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Vasile Valeriu Lupu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Sergiu Ioachim Chirila
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
| | | | - Laurentiu-Tony Hangan
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
| | - Simona Claudia Cambrea
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania (L.A.T.)
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Barani M, Paknia F, Roostaee M, Kavyani B, Kalantar-Neyestanaki D, Ajalli N, Amirbeigi A. Niosome as an Effective Nanoscale Solution for the Treatment of Microbial Infections. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9933283. [PMID: 37621700 PMCID: PMC10447041 DOI: 10.1155/2023/9933283] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/27/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023]
Abstract
Numerous disorders go untreated owing to a lack of a suitable drug delivery technology or an appropriate therapeutic moiety, particularly when toxicities and side effects are a major concern. Treatment options for microbiological infections are not fulfilled owing to significant adverse effects or extended therapeutic options. Advanced therapy options, such as active targeting, may be preferable to traditional ways of treating infectious diseases. Niosomes can be defined as microscopic lamellar molecules formed by a mixture of cholesterol, nonionic surfactants (alkyl or dialkyl polyglycerol ethers), and sometimes charge-inducing agents. These molecules comprise both hydrophilic and hydrophobic moieties of varying solubilities. In this review, several pathogenic microbes such as Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Plasmodium, Leishmania, and Candida spp. have been evaluated. Also, the development of a proper niosomal formulation for the required application was discussed. This review also reviews that an optimal formulation is dependent on several aspects, including the choice of nonionic surfactant, fabrication process, and fabrication parameters. Finally, this review will give information on the effectiveness of niosomes in treating acute microbial infections, the mechanism of action of niosomes in combating microbial pathogens, and the advantages of using niosomes over other treatment modalities.
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Affiliation(s)
- Mahmood Barani
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Paknia
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran 14115-154, Iran
| | - Maryam Roostaee
- Department of Chemistry, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Batoul Kavyani
- Department of Medical Microbiology (Bacteriology & Virology), Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Davood Kalantar-Neyestanaki
- Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medical Microbiology (Bacteriology & Virology), Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Narges Ajalli
- Department of Chemical Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Alireza Amirbeigi
- Department of General Surgery, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Sharad N, Srivastava S, Singh P, Puraswani M, Srivastav S, Malhotra R, Trikha A, Mathur P. Secondary Bacterial Infections in Mucormycosis-COVID-19 Cases: Experience during the Second COVID-19 Wave in India. Microbiol Spectr 2022; 10:e0091922. [PMID: 36301096 PMCID: PMC9769615 DOI: 10.1128/spectrum.00919-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/09/2022] [Indexed: 01/05/2023] Open
Abstract
In the second wave of COVID-19 in India, there was a new challenge in the form of mucormycosis. Coinfection with mucormycosis was perilous as both conditions required a prolonged hospital stay, thus serving as an ideal platform for secondary infections. Using a retrospective observational study, we studied secondary infections and their impact on the outcome in COVID-19 patients with mucormycosis. The outcome in these patients was evaluated and compared with COVID-19 patients with mucormycosis but without any secondary infection. SPSS V-20 was used for data analysis. Fifty-five patients tested positive for mucormycosis (55/140; 39.28). Twelve out of these 55 (21.8%) developed secondary infections during their hospital stay. Bloodstream infection was the most common (42.86%) secondary infection. The Gram-negative (GN) organisms were more common (11/16; 68.75%) compared with the Gram-positives (GP) (5/16; 31.25%). But the most common isolate was Enterococcus faecium (5/16; 31.25%). A high percentage of microorganisms isolated were multidrug-resistant (15/16; 93.75%). Two out of five (40%) isolates of Enterococcus faecium were vancomycin-resistant (VRE). High resistance to carbapenems was noted in the GN isolates (9/11; 81.81%). The comparison of length of stay in both subgroups was statistically significant (P value <0.001). When compared, the length of stay in people with adverse outcomes was also statistically significant (P value <0.001). Procalcitonin (PCT) had a positive predictive value for the development of secondary bacterial infections (P value <0.001). Antimicrobial stewardship and strict infection control practices are the need of the hour. IMPORTANCE Although our knowledge about COVID-19 and secondary infections in patients is increasing daily, little is known about the secondary infections in COVID-19-mucormycosis patients. Thus, we have intended to share our experience regarding this subgroup. The importance of this study is that it brings to light the type of secondary infections seen in COVID-19-mucormycosis patients. These secondary infections were partially responsible for the mortality and morbidity of the unfortunate ones. We, as health care workers, can learn the lesson and disseminate the knowledge so that in similar situations, health care workers, even in other parts of the world, know what to expect.
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Affiliation(s)
- Neha Sharad
- Department of Microbiology, AIIMS, New Delhi, India
| | | | - Parul Singh
- Department of Microbiology, AIIMS, New Delhi, India
| | - Mamta Puraswani
- Department of Laboratory Medicine, JPNATC, AIIMS, New Delhi, India
| | - Sharad Srivastav
- Department of Laboratory Medicine, JPNATC, AIIMS, New Delhi, India
| | | | - Anjan Trikha
- Department of Anaesthesia, AIIMS, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNATC, AIIMS, New Delhi, India
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7
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Muacevic A, Adler JR, Gia Binh N, Lan Huong M, Dao XC, Thi Phuong Thuy P, Van Thanh D, Takeshita N, Quoc Anh N, Ohmagari N. The Epidemiology of Healthcare-Associated Bloodstream Infection in an Adult Intensive Care Unit: A Retrospective Cohort Study in a Single Tertiary Care Hospital in Hanoi, Vietnam. Cureus 2022; 14:e31879. [PMID: 36579254 PMCID: PMC9792326 DOI: 10.7759/cureus.31879] [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: 11/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare-associated infections (HAIs), including bloodstream infections (BSIs) in the intensive care unit (ICU), are growing global public health problems. While high-income countries have reported the burden of HAIs precisely, low- and middle-income countries (LMICs), including Vietnam, often lack surveillance systems for HAIs. In Vietnam, few reports described HAI-associated BSIs. Therefore, in this study, we aim to clarify the characteristics of HAI-associated BSI in an adult ICU. Materials and methods We conducted a retrospective cohort study of HAI-associated BSI in the adult ICU of Bach Mai Hospital (BMH), Vietnam, between December 2013 and August 2015. For every case identified with bacteremia, we collected characteristics and laboratory findings of the case and followed the length of hospital stay and seven-day and 30-day survival. Predictors of 30-day mortality were analyzed using univariate and multivariate analyses. Results Among the 90 cases identified, the median age of the study cohort was 57 (range: 18-90) years, and 59 (65.6%) were male. Chronic heart disease was the most frequent comorbidity (n = 26, 28.9%). The pathogens isolated were mostly Candida spp. (n = 26, 26.3%) and Enterococcus spp. (n = 19, 19.2%). Among the 90 patients with confirmed HAI-associated BSI, 34 (37.8%) patients survived, while 31 (34.4%) patients died in 30 days. In multivariate analysis, chronic heart disease tended to increase with 30-day all-cause mortality (odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.0-11.9, p = 0.051). Conclusions Our retrospective cohort study is the largest investigation to describe HAI-associated BSI in an adult ICU in a tertiary care hospital in Vietnam. Improved laboratory detection and infection surveillance systems are needed to reduce HAI-associated BSI.
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Hirai J, Asai N, Hagihara M, Kishino T, Kato H, Sakanashi D, Ohashi W, Mikamo H. Comparative Effectiveness of Ampicillin/Sulbactam versus Cefazolin as Targeted Therapy for Bacteremia Caused by Beta-Lactamase-Producing Methicillin-Sensitive Staphylococcus aureus: A Single-Center Retrospective Study. Antibiotics (Basel) 2022; 11:1505. [PMID: 36358161 PMCID: PMC9686817 DOI: 10.3390/antibiotics11111505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 02/06/2024] Open
Abstract
Cefazolin (CFZ) is the first-line treatment for beta-lactamase-producing methicillin-sensitive Staphylococcus aureus (BP-MSSA) infection. In 2019, Japan experienced a CFZ shortage because of foreign object inclusion in a batch. Ampicillin/sulbactam (SAM) was preferred in many cases as definitive therapy for the treatment of BP-MSSA bacteremia to preserve broad-spectrum antibiotic stock. However, there are no previous studies reporting the clinical efficacy of SAM for BP-MSSA bacteremia. We aimed to compare the clinical efficacy and adverse effects of SAM versus CFZ in patients with BP-MSSA bacteremia. In total, 41 and 30 patients treated with SAM and CFZ, respectively, were identified. The baseline characteristics were similar in both groups. No significant differences were observed in length of hospital stay and all 30-day mortality between the two groups (p = 0.270 and 0.643, respectively). Moreover, no intergroup difference in 90-day mortality was found (hazard ratio 1.02, 95% confidential interval 0.227-4.53). Adverse effects, such as liver dysfunction, were less in the CFZ group than in the SAM group (p = 0.030). Therefore, in cases of poor CFZ supply or in patients allergic to CFZ and penicillinase-stable penicillins, SAM can be an effective therapeutic option for bacteremia due to BP-MSSA with attention of adverse effects, such as liver dysfunction.
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Affiliation(s)
- Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1103, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1103, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1103, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1103, Japan
| | - Mao Hagihara
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Nagakute 480-1103, Japan
| | - Takaaki Kishino
- Department of Emergency and Critical Care Medicine, Aichi Medical University Hospital, Nagakute 480-1103, Japan
| | - Hideo Kato
- Department of Pharmacy, Mie University Hospital, Tsu 514-8507, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1103, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute 480-1103, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1103, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1103, Japan
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Mussa M, Martínez Pérez-Crespo PM, Lopez-Cortes LE, Retamar-Gentil P, Sousa-Dominguez A, Goikoetxea-Aguirre AJ, Reguera-Iglesias JM, León Jiménez E, Fernández-Natal I, Armiñanzas-Castillo C, Boix-Palop L, Cuquet-Pedragosa J, Morán Rodríguez MÁ, Fernandez-Suarez J, del Arco-Jiménez A, Jóver-Saenz A, Bahamonde-Carrasco A, Galan-Sanchez F, Sánchez-Calvo JM, Smithson-Amat A, Vinuesa-García D, Sánchez-Porto A, López-Hernández I, Rodríguez-Baño J. Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project. Microbiol Spectr 2022; 10:e0005122. [PMID: 35771010 PMCID: PMC9431494 DOI: 10.1128/spectrum.00051-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/10/2022] [Indexed: 12/07/2022] Open
Abstract
Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus faecalis and E. faecium are associated with inappropriate empirical treatment and worse outcomes compared to other etiologies. The objective of this study was to investigate the risk factors for enterococcal BT-BSI. Patients with BT-BSI from the PROBAC cohort, including consecutive patients with BSI in 26 Spanish hospitals between October 2016 and March 2017, were selected; episodes caused by E. faecalis or E. faecium and other causes were compared. Independent predictors for enterococci were identified by logistic regression, and a predictive score was developed. Eight hundred fifty episodes of BT-BSI were included; 73 (8.5%) were due to target Enterococcus spp. (48 [66%] were E. faecium and 25 [34%] E. faecalis). By multivariate analysis, the variables independently associated with Enterococcus spp. were (OR; 95% confidence interval): cholangiocarcinoma (4.48;1.32 to 15.25), hospital acquisition (3.58;2.11 to 6.07), use of carbapenems in the previous month (3.35;1.45 to 7.78), biliary prosthesis (2.19;1.24 to 3.90), and moderate or severe chronic kidney disease (1.55;1.07 to 2.26). The AUC of the model was 0.74 [95% CI0.67 to 0.80]. A score was developed, with 7, 6, 5, 4, and 2 points for these variables, respectively, with a negative predictive value of 95% for a score ≤ 6. A model, including cholangiocarcinoma, biliary prosthesis, hospital acquisition, previous carbapenems, and chronic kidney disease showed moderate prediction ability for enterococcal BT-BSI. Although the score will need to be validated, this information may be useful for deciding empirical therapy in biliary tract infections when bacteremia is suspected. IMPORTANCE Biliary tract infections are frequent, and a significant cause of morbidity and mortality. Bacteremia is common in these infections, particularly in the elderly and patients with cancer. Inappropriate empirical treatment has been associated with increased risk of mortality in bacteremic cholangitis, and the probability of receiving inactive empirical treatment is higher in episodes caused by enterococci. This is because many of the antimicrobial agents recommended in guidelines for biliary tract infections lack activity against these organisms. To the best of our knowledge, this is the first study analyzing the predictive factors for enterococcal BT-BSI and deriving a predictive score.
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Affiliation(s)
- Marco Mussa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain
| | - Pedro María Martínez Pérez-Crespo
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
- Hospital Universitario de Valme, Sevilla, Spain
| | - Luis Eduardo Lopez-Cortes
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
| | - Pilar Retamar-Gentil
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Inmaculada López-Hernández
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
| | - Jesús Rodríguez-Baño
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
| | - the PROBAC REIPI/GEIH-SEIMC/SAEI group
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy
- UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain
- Hospital Universitario de Vigo, Vigo, Spain
- Hospital de Cruces, Bilbao, Spain
- Hospital Regional de Málaga, Málaga, Spain
- Hospital Universitario de Valme, Sevilla, Spain
- Complejo Asistencial Universitario de León, León, Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Hospital Universitari Mútua de Terrasa, Barcelona, Spain
- Hospital General Granollers, Barcelona, Spain
- Hospital Universitario de Burgos, Burgos, Spain
- Hospital Universitario Central de Asturias, Oviedo, Spain
- Hospital Costa del Sol, Marbella, Spain
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Hospital de El Bierzo, Ponferrada, Spain
- Hospital Universitario Puerta del Mar, Cadiz, Spain
- Hospital de Jerez de la Frontera, Jerez de la Frontera, Spain
- Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
- Hospital Universitario San Cecilio, Granada, Spain
- Hospital del SAS de La Línea de la Concepción, Cádiz, Spain
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Genetic Diversity, Antimicrobial Resistance, and Virulence Factors of Enterococcus Faecalis Isolates Obtained from Stool Samples of Hospitalized Patients. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm-121379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Enterococcus faecalis rapidly develops resistance to different antibiotics, thereby resulting in serious nosocomial infections associated with high mortality rates and different problems in the healthcare systems. Objectives: This study aimed to analyze the genetic diversity, antimicrobial resistance, and virulence factors of E. faecalis isolates obtained from the stool samples of patients in a hospital in the center of Iran. Methods: In this cross-sectional descriptive-analytical study, 108 stool samples were collected from September 2019 to February 2020 from 108 patients hospitalized in a hospital in the center of Iran. Enterococcus faecalis isolates were detected using the ddlE gene detection technique, and antimicrobial resistance testing was performed using the disc agar diffusion method. Moreover, polymerase chain reaction (PCR) was used to detect antimicrobial resistance genes and virulence factors. Genetic diversity was also analyzed by enterobacterial repetitive intergenic consensus using PCR (ERIC-PCR). The BioNumerics software was used to construct a dendrogram. Results: Of 108 isolates, 50 samples were E. faecalis (46.2%). The prevalence of multidrug resistance among E. faecalis isolates was 62%, and most isolates were resistant to antibiotics tetracycline (70%), erythromycin (68%), and rifampin (60%). Among the E. faecalis isolates, the most prevalent antimicrobial resistance genes were ermB (96%), aph (2′′) Ia (66%), aac(6′)-Ie (40%), and ermC (30%), and the most prevalent virulence genes were gelE (78%), asa1 (74%), and esp (74%). The genetic diversity analysis showed 25 ERIC types in two major clusters (ie, clusters H and J) and eight minor clusters (ie, clusters A-G and I). There was no significant difference between clusters H and J in terms of antimicrobial resistance and resistance genes (P > 0.05). In contrast, the prevalence of the asa1 gene was significantly higher in cluster J than in cluster H (P < 0.05). Conclusions: This study showed the high prevalence of multidrug resistance, and high heterogeneity among the E. faecalis isolates obtained from the stool samples of hospitalized patients.
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11
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Effect of Antimicrobial Stewardship on Oral Quinolone Use and Resistance Patterns over 8 Years (2013-2020). Antibiotics (Basel) 2021; 10:antibiotics10111426. [PMID: 34827364 PMCID: PMC8615025 DOI: 10.3390/antibiotics10111426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 11/18/2021] [Indexed: 12/24/2022] Open
Abstract
Since 2014, several global and national guidelines have been introduced to address the problem of antimicrobial resistance. We conducted a campaign in a tertiary hospital to promote appropriate quinolone use through educational lectures in 2018. The aim of this retrospective study was to evaluate the changes in the following: prescription characteristics, trend of oral quinolone use, and antibiotic susceptibility of bacteria from 2013 to 2020. Antimicrobial use was assessed as days of therapy per 1000 patient-days. We found a significant reduction in unnecessary antibiotic prescriptions between December 2013 and December 2020. Significant negative trends were detected in the use of quinolones over 8 years (outpatients, coefficient = −0.15655, p < 0.001; inpatients, coefficient = −0.004825, p = 0.0016). In particular, the monthly mean use of quinolones among outpatients significantly decreased by 11% from 2013 to 2014 (p < 0.05) and reduced further by 31% from 2017 to 2020 (p < 0.001). A significant positive trend was observed in the susceptibility of Pseudomonas aeruginosa to levofloxacin (p < 0.001). These results demonstrate that the use of oral quinolones was further reduced following educational intervention and the bacterial susceptibility improved with optimal quinolone usage compared to that in 2013.
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12
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Uda A, Onuma K, Shigemura K, Kitagawa K, Yan Y, Osawa K, Yano I, Miyara T. Impact of Cefazolin Shortage on Clinical Outcomes of Adult Patients with Bacteremia Caused by Methicillin-Susceptible Staphylococcus aureus in a Tertiary Care University Hospital. Antibiotics (Basel) 2021; 10:antibiotics10101247. [PMID: 34680827 PMCID: PMC8532967 DOI: 10.3390/antibiotics10101247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
Cefazolin is an essential antibiotic used for treating bacteremia; in particular, it is recommended as a first-line agent for infections caused by methicillin-susceptible Staphylococcusaureus (MSSA). In March 2019, problems with a major antibiotic supplier caused a critical shortage of cefazolin in Japan; however, the impact of the cefazolin shortage on clinical outcomes remains unknown. This study aimed to evaluate the effect of the cefazolin shortage in patients with MSSA bacteremia. Data from 75 patients were compared between the pre-shortage (March 2018–January 2019, n = 39) and post-shortage (March 2019–January 2020, n = 36) periods. There were no significant differences in the demographic characteristics between the two groups, and the cefazolin shortage did not worsen clinical outcomes such as adverse drug reactions, treatment failure, and 30-day mortality. In the post-shortage group, ampicillin/sulbactam and benzylpenicillin were more frequently administered as alternative antibiotics for empirical and definitive therapy (10% vs. 31%, p = 0.042; 0% vs. 19%, p = 0.004, respectively). Multivariate analysis revealed that the broad-spectrum antibiotics for definitive therapy, such as antipseudomonal penicillin, were associated with treatment failure in patients with MSSA bacteremia (OR = 17, p = 0.003). Hence, narrow-spectrum antibiotics should be prescribed for MSSA bacteremia as alternatives during a cefazolin shortage.
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Affiliation(s)
- Atsushi Uda
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan;
- Correspondence: ; Tel.: +81-78-382-5111
| | - Kenichiro Onuma
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Department of Clinical Laboratory, Kobe University Hospital, Kobe 650-0017, Japan
| | - Katsumi Shigemura
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Koichi Kitagawa
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Division of Advanced Medical Science, Kobe University Graduate School of Science, Technology and Innovation, Kobe 657-8501, Japan
| | - Yonmin Yan
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Kayo Osawa
- Department of Medical Technology, Kobe Tokiwa University, Kobe 653-0838, Japan;
| | - Ikuko Yano
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan;
| | - Takayuki Miyara
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
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