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Ru X, Chen S, Chen D, Shao Q, Shao W, Ye Q. Simulating the clinical manifestations and disease progression of human sepsis: A monobacterial injection approach for animal modeling. Virulence 2024; 15:2395835. [PMID: 39219264 PMCID: PMC11370922 DOI: 10.1080/21505594.2024.2395835] [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: 01/15/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, with great clinical heterogeneity, high morbidity, and high mortality. At the same time, there are many kinds of infection sources, the pathophysiology is very complex, and the pathogenesis has not been fully elucidated. An ideal animal model of sepsis can accurately simulate clinical sepsis and promote the development of sepsis-related pathogenesis, treatment methods, and prognosis. The existing sepsis model still uses the previous Sepsis 2.0 modelling standard, which has some problems, such as many kinds of infection sources, poor repeatability, inability to take into account single-factor studies, and large differences from clinical sepsis patients. To solve these problems, this study established a new animal model of sepsis. The model uses intravenous tail injection of a single bacterial strain, simplifying the complexity of multibacterial infection, and effectively solving the above problems.
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Affiliation(s)
- Xuanwen Ru
- Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Simiao Chen
- Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danlei Chen
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qingyi Shao
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenxia Shao
- Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Ye
- Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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2
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Viasus D, Gudiol C, Carratalà J. Treatment of multidrug-resistant Gram-negative bloodstream infections in critically ill patients: an update. Curr Opin Crit Care 2024; 30:448-455. [PMID: 39150047 DOI: 10.1097/mcc.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW This review describes the latest information in the management of bloodstream infections caused by multidrug-resistant Gram-negative bacilli (MDRGNB) in critically ill patients. RECENT FINDINGS The prevalence of bloodstream infections due to MDRGNB is high, and they pose a significant risk in critically ill patients. Recently, novel antimicrobial agents, including new β-lactam/β-lactamase inhibitor combinations and cefiderocol, have been introduced for treating these infections. Concurrently, updated guidelines have been issued to aid in treatment decisions. Prompt diagnosis and identification of resistance patterns are crucial for initiating effective antibiotic therapy. Current studies, especially with observational design, and with limited sample sizes and patients with bacteremia, suggest that the use of these new antibiotics is associated with improved outcomes in critically ill patients with MDRGNB bloodstream infections. SUMMARY For critically ill patients with bloodstream infections caused by MDRGNB, the use of newly developed antibiotics is recommended based on limited observational evidence. Further randomized clinical trials are necessary to determine the most effective antimicrobial therapies among the available options.
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Affiliation(s)
- Diego Viasus
- Department of Medicine, Division of Health Sciences, Universidad del Norte and Hospital Universidad del Norte, Barranquilla, Colombia
| | - Carlota Gudiol
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
- Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
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Beurton A, Kooistra EJ, De Jong A, Schiffl H, Jourdain M, Garcia B, Vimpère D, Jaber S, Pickkers P, Papazian L. Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review. Curr Obes Rep 2024; 13:545-563. [PMID: 38573465 DOI: 10.1007/s13679-024-00562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, acute respiratory distress syndrome, organ support including mechanical ventilation and prolonged length of stay. The relationship among obesity; COVID-19; and respiratory, thrombotic, and renal complications upon admission to the ICU is unclear. RECENT FINDINGS The predominant effect of a hyperinflammatory status or a cytokine storm has been suggested in patients with obesity, but more recent studies have challenged this hypothesis. Numerous studies have also shown increased mortality among critically ill patients with obesity and COVID-19, casting doubt on the obesity paradox, with survival advantages with overweight and mild obesity being reported in other ICU syndromes. Finally, it is now clear that the increase in the global prevalence of overweight and obesity is a major public health issue that must be accompanied by a transformation of our ICUs, both in terms of equipment and human resources. Research must also focus more on these patients to improve their care. In this review, we focused on the central role of obesity in critically ill patients during this pandemic, highlighting its specificities during their stay in the ICU, identifying the lessons we have learned, and identifying areas for future research as well as the future challenges for ICU activity.
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Affiliation(s)
- Alexandra Beurton
- Department of Intensive Care, Hôpital Tenon, APHP, Paris, France.
- UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.
| | - Emma J Kooistra
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
| | - Audrey De Jong
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Helmut Schiffl
- Division of Nephrology, Department of Internal Medicine IV, University Hospital LMU Munich, Munich, Germany
| | - Mercedes Jourdain
- CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France
| | - Bruno Garcia
- CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France
| | - Damien Vimpère
- Anesthesia and Critical Care Department, Hôpital Necker, APHP, Paris, France
| | - Samir Jaber
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France
- Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands
| | - Laurent Papazian
- Intensive Care Unit, Centre Hospitalier de Bastia, Bastia, Corsica, France
- Aix-Marseille University, Marseille, France
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Morecchiato F, Coppi M, Chilleri C, Antonelli A, Giani T, Rossolini GM. Evaluation of Quantamatrix dRAST TM system for rapid antimicrobial susceptibility testing of bacterial isolates from positive blood cultures, in comparison with commercial Micronaut broth microdilution system. Diagn Microbiol Infect Dis 2024; 110:116436. [PMID: 39003931 DOI: 10.1016/j.diagmicrobio.2024.116436] [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: 05/08/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
Antimicrobial susceptibility testing (AST) from blood culture (BC) may take several days, limiting the eventual impact on antimicrobial stewardship. Hence, rapid AST systems represent a valuable support in shorting the time-to-response. In this work, the Quantamatrix dRASTTM system (dRAST) was evaluated for rapid AST on 100 monomicrobial BCs (50 Gram-negatives and 50 Gram-positives), including several isolates with clinically relevant resistance mechanisms. AST results were provided in 6-hours, on average. Compared to Micronaut (Merlin) system based on broth microdilution, dRAST exhibited an overall categorical agreement of 92.5 %, essential agreement of 89.0 %, and mean bias of 15.9 %. Category overestimation (potentially leading to unnecessary high-dosage treatment or to exclude active agents) and category underestimation (potentially leading to underdosing or using ineffective agents) were observed in 4.3 % and 3.1 % of cases, respectively. Even though several issues were reported, results confirmed the potential contribution of dRAST to shorten the BCs clinical microbiology workflow and management.
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Affiliation(s)
- Fabio Morecchiato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Chiara Chilleri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Tommaso Giani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy.
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Costa EG, Venturini S, Colussi GL, Pratesi C, Villalta D, Sabena A, Grembiale A, Pontoni E, Bramuzzo I, Barbato G, Balbi M, Doretto P, Avolio M, Basaglia G, Crapis M, Tonizzo M, Fagiuoli S, Grazioli S. Diagnostic role of CD64 expression on neutrophils as biomarker for blood stream infection in liver cirrhosis: some preliminary findings. LE INFEZIONI IN MEDICINA 2024; 32:363-368. [PMID: 39282535 PMCID: PMC11392555 DOI: 10.53854/liim-3203-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/17/2024] [Indexed: 09/19/2024]
Abstract
Background The expression of CD64 on neutrophils (nCD64), measured using flow cytometry, has been proposed as a biomarker for bloodstream infections (BSI). However, data regarding its use in the setting of liver cirrhosis are lacking. Methods We compared nCD64 levels in 15 cirrhotic patients with BSI to those in 19 controls, including outpatients with stable decompensated cirrhosis without infection. Additionally, we compared nCD64 with C-reactive protein (CRP) and procalcitonin (PCT) in infected hospitalized cirrhotic patients. Results Cirrhotic patients with infection had higher levels of nCD64 compared to controls (6.0 [5.4-7.1] vs. 2.0 [1.5-2.2]; p<0.001). Among infected patients, a correlation between nCD64 (AUC=0.934 [0.875-0.982 95% CI]), CRP (AUC=0.972 [0.942-0.993 95% CI]), and PCT (AUC=0.859 [0.739-0.953 95% CI]) was observed. However, in our sample of cirrhotic individuals, nCD64 values were not significantly different between patients with worse prognosis and those with positive outcomes (p=0.448), and its expression was not influenced by Gram stain. Conclusions In our cohort, nCD64 appears to be a promising new biomarker for BSI. Additional prospective studies are needed to confirm its role and limitations in conjunction with other biomarkers and rapid microbiology in the diagnostic multidisciplinary pathway for septic cirrhotic patients.
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Affiliation(s)
- Elena Garlatti Costa
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Sergio Venturini
- Department of Infectious Diseases, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Gian Luca Colussi
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Chiara Pratesi
- Department of Laboratory Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Danilo Villalta
- Department of Immunology and Allergology, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Anna Sabena
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Alessandro Grembiale
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Elisa Pontoni
- Department of Emergency Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Igor Bramuzzo
- Department of Infectious Diseases, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Giuseppe Barbato
- Department of Emergency Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Massimiliano Balbi
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of San Vito al Tagliamento, Italy
| | - Paolo Doretto
- Department of Laboratory Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Manuela Avolio
- Department of Microbiology and Virology, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Giancarlo Basaglia
- Department of Microbiology and Virology, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Hospital of Bergamo, Italy
| | - Silvia Grazioli
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, Hospital of Pordenone, Italy
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Chen C, Guan Q, Li D, Sheng B, Zhang Z, Hu Y. Clinical characteristics and risk factor analysis of recipients with multidrug-resistant bacterial bloodstream infections after liver transplantation: a single-centre retrospective study. J Pharm Policy Pract 2024; 17:2390072. [PMID: 39170607 PMCID: PMC11338205 DOI: 10.1080/20523211.2024.2390072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
Background The clinical characteristics and associated risk factors for recipients who experience multidrug-resistant organism (MDRO) bloodstream infections after liver transplantation are poorly understood. This study aimed to analyse the clinical characteristics and epidemiology of pathogenic bacteria and identify associated risk factors in patients who underwent MDRO after liver transplantation. Method We retrospectively collected data on recipients who developed bloodstream infections after liver transplantation between 2018 and 2023. Recipients were divided into MDRO and non-MDRO groups based on blood culture results. We explored the risk factors for MDRO bloodstream infections post-transplantation and summarised the clinical features, pathogen epidemiology, and prognosis. A multivariate logistic regression analysis was conducted to identify significant risk factors. Results A total of 463 liver transplant recipients were studied, and 73 developed blood infections. There were 29 MDRO cases. The mean duration of the episodes was 26 days (range: 1-474 days). Among these patients, 22 (30.1%) developed blood infections without fever (temperature < 37.3°C), and 33 patients (45.2%) had a white blood cell count between 4 and 10 × 10⁹/L. Among the 108 positive blood cultures, 29 genera were detected, predominantly gram-negative bacilli (n = 64, 58.2%). The detection rate for multidrug-resistant bacilli was 31.8% (35/110), with the abdomen being the most common site of origin (21.3%). Factors such as a history of preoperative intensive care unit (ICU) hospitalisation (p < 0.001) and a preoperative international normalised ratio (INR) > 2 (p < 0.048) were identified as risk factors in multivariate regression analysis. Conclusion Multidrug-resistant bacterial bloodstream infections after liver transplantation tend to occur early in the postoperative period (<30 days) and are associated with high mortality and a lack of specific clinical manifestations. A history of preoperative intensive care unit (ICU) hospitalisation and an international normalised ratio (INR) > 2 may be risk factors for multidrug-resistant bacterial bloodstream infections after liver transplantation.
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Affiliation(s)
- Chuanlin Chen
- School of Clinical Medicine, Qinghai University, Xining, People’s Republic of China
| | - Qinghua Guan
- Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Desheng Li
- School of Clinical Medicine, Qinghai University, Xining, People’s Republic of China
| | - Bo Sheng
- Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Zhenyu Zhang
- Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Yongfang Hu
- Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
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Chen L, Wang Y. Survival analysis of famotidine administration routes in non-traumatic intracerebral hemorrhage patients: based on the MIMIC-IV database. Expert Rev Pharmacoecon Outcomes Res 2024. [PMID: 39155563 DOI: 10.1080/14737167.2024.2394113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE This project aims to compare the survival outcomes of non-traumatic intracerebral hemorrhage (ICH) patients with different famotidine administration routes, and explore the risk factors influencing patients' clinical outcomes. METHODS Data of patients admitted to the ICU from 2008 to 2019 and receiving famotidine therapy were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients selected for ICU admission > 1 day and treated with famotidine were divided into the group via intravenous (IV) dosing and the group via non-intravenous (Non-IV) dosing. Cox analysis and bilateral stepwise regression were utilized to determine independent prognostic factors affecting patient survival. Survival of patients on different routes of administration before and after propensity score matching (PSM) was compared using Kaplan - Meier (K-M) survival curves. RESULTS This investigation included 351 patients. After PSM was matched with a 1:2 ratio, 109 patients were clustered in the IV group and 84 patients in the Non-IV group. Cox multivariate results uncovered that survival prognosis in ICH patients receiving famotidine was associated with age (HR = 1.031, 95%CI:1.011-1.050, p = 0.002), chloride ion levels (HR = 1.061, 95%CI:1.027-1.096, p < 0.001), blood urea nitrogen (BUN) (HR = 1.034, 95%CI:1.007-1.062, p = 0.012), intracranial pressure (ICP) (HR = 1.059, 95%CI:1.027-1.092, p < 0.001), red blood cell distribution width (RDW) (HR = 1.156, 95%CI:1.030-1.299, p = 0.014), mechanical ventilation (HR = 2.526, 95%CI:1.341-4.760, p = 0.004), antibiotic use (HR = 0.331, 95%CI:0.144-0.759, p = 0.009), and Non-IV route (HR = 0.518, 95%CI:0.283-0.948, p = 0.033). The K-M curve results indicated that the 30-day survival rate of Non-IV group ICH patients was substantially higher than that of IV group patients (before PSM, p = 0.036; after PSM, p = 0.011). In the subgroup analysis of age, ICP, mechanical ventilation, and antibiotic use, there was a great heterogeneity interaction between the administration of famotidine and the 30-day mortality rate (P for interaction < 0.05). The Non-IV route considerably reduced the risk of death in patients with normal ICP (7-15 mmHg) (HR = 0.518, 95%CI:0.283-0.948, p = 0.033). CONCLUSION Among ICH patients receiving famotidine, those receiving famotidine via Non-IV have a better 30-day survival rate compared to those receiving IV, especially in patients with normal ICP (7-15 mmHg).
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Affiliation(s)
- Ling Chen
- Department of Gynaecology, People's Hospital Affiliated to Cangzhou Medical College, Cangzhou, China
| | - Yan Wang
- Department of Basic Medicine, Cangzhou Medical College, Cangzhou, China
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Oliveira AM, Oliveira A, Vidal R, Gonçalves-Pereira J. Infectious Foci, Comorbidities and Its Influence on the Outcomes of Septic Critically Ill Patients. Microorganisms 2024; 12:1705. [PMID: 39203547 PMCID: PMC11357211 DOI: 10.3390/microorganisms12081705] [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] [Received: 07/31/2024] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
Sepsis is among the most frequent diagnoses on admission to the intensive care unit (ICU). A systemic inflammatory response, activated by uncontrolled infection, fosters hypoperfusion and multiorgan failure and often leads to septic shock and mortality. These infections arise from a specific anatomic source, and how the infection foci influence the outcomes is unknown. All patients admitted to the ICU of Hospital de Vila Franca de Xira, between 1 January 2017 and 31 June 2023, were screened for sepsis and categorized according to their infection foci. During the study period, 1296 patients (32.2%) had sepsis on admission. Their mean age was 67.5 ± 15.3 and 58.1% were male; 73.0% had community-acquired infections. The lung was the main focus of infection. Septic shock was present in 37.9% of the patients and was associated with hospital mortality. Severe imbalances were noted in its incidence, and there was lower mortality in lung infections. The hospital-acquired infections had a slightly higher mortality but, after adjustment, this difference was non-significant. Patients with secondary bacteremia had a worse prognosis (one-year adjusted hazard ratio of 1.36, 95% confidence interval 1.06-1.74, p = 0.015), especially those with an isolated non-fermenting Gram-negative infection. Lung, skin, and skin structure infections and peritonitis had a worse prognosis, whilst urinary, biliary tract, and other intra-abdominal infections had a better one-year outcome.
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Affiliation(s)
- Ana Maria Oliveira
- Unidade Cuidados Intensivos, Unidade Local de Saúde Estuário do Tejo, 2600-009 Vila Franca de Xira, Portugal; (A.M.O.); (A.O.)
| | - André Oliveira
- Unidade Cuidados Intensivos, Unidade Local de Saúde Estuário do Tejo, 2600-009 Vila Franca de Xira, Portugal; (A.M.O.); (A.O.)
| | - Raquel Vidal
- Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal;
| | - João Gonçalves-Pereira
- Unidade Cuidados Intensivos, Unidade Local de Saúde Estuário do Tejo, 2600-009 Vila Franca de Xira, Portugal; (A.M.O.); (A.O.)
- Grupo de Investigação e Desenvolvimento em Infeção e Sépsis, Clínica Universitária de Medicina Intensiva, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
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Calvi GDS, Cartaxo GNJ, Carretoni QL, da Silva ALM, de Moraes DN, Pradella JGDC, Costa MS. Inhibition of Development and Metabolism of Dual-Species Biofilms of Candida albicans and Candida krusei ( Pichia kudriavzevii) by Organoselenium Compounds. Pharmaceuticals (Basel) 2024; 17:1078. [PMID: 39204183 PMCID: PMC11359205 DOI: 10.3390/ph17081078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
Although Candida albicans is the most frequently identified Candida species in clinical settings, a significant number of infections related to the non-albicans Candida (NAC) species, Candida krusei, has been reported. Both species are able to produce biofilms and have been an important resistance-related factor to antimicrobial resistance. In addition, the microbial relationship is common in the human body, contributing to the formation of polymicrobial biofilms. Considering the great number of reports showing the increase in cases of resistance to the available antifungal drugs, the development of new and effective antifungal agents is critical. The inhibitory effect of Organoselenium Compounds (OCs) on the development of Candida albicans and Candida krusei was recently demonstrated, supporting the potential of these compounds as efficient antifungal drugs. In addition, OCs were able to reduce the viability and the development of biofilms, a very important step in colonization and infection caused by fungi. Thus, the objective of this study was to investigate the effect of the Organoselenium Compounds (p-MeOPhSe)2, (PhSe)2, and (p-Cl-PhSe)2 on the development of dual-species biofilms of Candida albicans and Candida krusei produced using either RPMI-1640 or Sabouraud Dextrose Broth (SDB) media. The development of dual-species biofilms was evaluated by the determination of both metabolic activity, using a metabolic assay based on the reduction of XTT (2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide sodium salt) assay and identification of either Candida albicans and Candida krusei on CHROMagar Candida medium. Biofilm formation using RPMI-1640 was inhibited in 90, 55, and 20% by 30 µM (p-MeOPhSe)2, (PhSe)2, and (p-Cl-PhSe)2, respectively. However, biofilms produced using SDB presented an inhibition of 62, 30 and 15% in the presence of 30 µM (p-MeOPhSe)2, (PhSe)2, and (p-Cl-PhSe)2, respectively. The metabolic activity of 24 h biofilms was inhibited by 35, 30 and 20% by 30 µM (p-MeOPhSe)2, (PhSe)2, and (p-Cl-PhSe)2, respectively, with RPMI-1640; however, 24 h biofilms formed using SDB were not modified by the OCs. In addition, a great reduction in the number of CFUs of Candida albicans (93%) in biofilms produced using RPMI-1640 in the presence of 30 µM (p-MeOPhSe)2 was observed. However, biofilms formed using SDB and treated with 30 µM (p-MeOPhSe)2 presented a reduction of 97 and 69% in the number of CFUs of Candida albicans and Candida krusei, respectively. These results demonstrated that Organoselenium Compounds, mainly (p-MeOPhSe)2, are able to decrease the metabolic activity of dual-species biofilms by reducing both Candida albicans and Candida krusei cell number during biofilm formation using either RPMI-1640 or SDB. Taken together, these results demonstrated the potential of the OCs to inhibit the development of dual-species biofilms of Candida albicans and Candida krusei.
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Affiliation(s)
| | | | | | | | | | | | - Maricilia Silva Costa
- Instituto de Pesquisa & Desenvolvimento—IP&D, Universidade do Vale do Paraíba—UNIVAP, Av. Shishima Hifumi, 2911, São José dos Campos 12244-390, SP, Brazil; (G.d.S.C.); (G.N.J.C.); (Q.L.C.); (A.L.M.d.S.); (D.N.d.M.); (J.G.d.C.P.)
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Chandroulis I, Schinas G, de Lastic AL, Polyzou E, Tsoupra S, Davoulos C, Kolosaka M, Niarou V, Theodoraki S, Ziazias D, Kosmopoulou F, Koutsouri CP, Gogos C, Akinosoglou K. Patterns, Outcomes and Economic Burden of Primary vs. Secondary Bloodstream Infections: A Single Center, Cross-Sectional Study. Pathogens 2024; 13:677. [PMID: 39204277 PMCID: PMC11357390 DOI: 10.3390/pathogens13080677] [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] [Received: 06/30/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
Bloodstream infections (BSIs) can be primary or secondary, with significant associated morbidity and mortality. Primary bloodstream infections (BSIs) are defined as infections where no clear infection source is identified, while secondary BSIs originate from a localized infection site. This study aims to compare patterns, outcomes, and medical costs between primary and secondary BSIs and identify associated factors. Conducted at the University Hospital of Patras, Greece, from May 2016 to May 2018, this single-center retrospective cohort study included 201 patients with confirmed BSIs based on positive blood cultures. Data on patient characteristics, clinical outcomes, hospitalization costs, and laboratory parameters were analyzed using appropriate statistical methods. Primary BSIs occurred in 22.89% (46 patients), while secondary BSIs occurred in 77.11% (155 patients). Primary BSI patients were younger and predominantly nosocomial, whereas secondary BSI was mostly community-acquired. Clinical severity scores (SOFA, APACHE II, SAPS, and qPitt) were significantly higher in primary compared to secondary BSI. The median hospital stay was longer for primary BSI (21 vs. 12 days, p < 0.001). Although not statistically significant, mortality rates were higher in primary BSI (43.24% vs. 26.09%). Total care costs were significantly higher for primary BSI (EUR 4388.3 vs. EUR 2530.25, p = 0.016), driven by longer hospital stays and increased antibiotic costs. This study underscores the distinct clinical and economic challenges of primary versus secondary BSI and emphasizes the need for prompt diagnosis and tailored antimicrobial therapy. Further research should focus on developing specific management guidelines for primary BSI and exploring interventions to reduce BSI burden across healthcare settings.
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Affiliation(s)
| | - Georgios Schinas
- School of Medicine, University of Patras, 265 04 Rio, Greece; (G.S.); (A.-L.d.L.); (E.P.); (S.T.); (F.K.); (K.A.)
| | - Anne-Lise de Lastic
- School of Medicine, University of Patras, 265 04 Rio, Greece; (G.S.); (A.-L.d.L.); (E.P.); (S.T.); (F.K.); (K.A.)
| | - Eleni Polyzou
- School of Medicine, University of Patras, 265 04 Rio, Greece; (G.S.); (A.-L.d.L.); (E.P.); (S.T.); (F.K.); (K.A.)
- Department of Internal Medicine, University General Hospital of Patras, 265 04 Rio, Greece;
| | - Stamatia Tsoupra
- School of Medicine, University of Patras, 265 04 Rio, Greece; (G.S.); (A.-L.d.L.); (E.P.); (S.T.); (F.K.); (K.A.)
- Department of Internal Medicine, University General Hospital of Patras, 265 04 Rio, Greece;
| | - Christos Davoulos
- Department of Internal Medicine, University General Hospital of Patras, 265 04 Rio, Greece;
| | | | - Vasiliki Niarou
- Department of Emergency Care, University General Hospital of Patras, 265 04 Rio, Greece;
| | - Spyridoula Theodoraki
- Department of Internal Medicine, General Hospital of Agrinion, 301 31 Agrinio, Greece;
| | - Dimitrios Ziazias
- Department of Internal Medicine, General Hospital of Nikaia-Pireaus “Agios Panteleimon”, 184 54 Nikaia, Greece;
| | - Foteini Kosmopoulou
- School of Medicine, University of Patras, 265 04 Rio, Greece; (G.S.); (A.-L.d.L.); (E.P.); (S.T.); (F.K.); (K.A.)
| | | | - Charalambos Gogos
- School of Medicine, University of Patras, 265 04 Rio, Greece; (G.S.); (A.-L.d.L.); (E.P.); (S.T.); (F.K.); (K.A.)
- Department of Internal Medicine and Infectious Diseases, Metropolitan General Hospital, 155 62 Athens, Greece
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 265 04 Rio, Greece; (G.S.); (A.-L.d.L.); (E.P.); (S.T.); (F.K.); (K.A.)
- Department of Internal Medicine, University General Hospital of Patras, 265 04 Rio, Greece;
- Division of Infectious Diseases, University General Hospital of Patras, 265 04 Rio, Greece
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11
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Velho TR, Raquel H, Figueiredo N, Neves-Costa A, Pedroso D, Santos I, Willmann K, Moita LF. Immunomodulatory Effects and Protection in Sepsis by the Antibiotic Moxifloxacin. Antibiotics (Basel) 2024; 13:742. [PMID: 39200042 PMCID: PMC11350752 DOI: 10.3390/antibiotics13080742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 09/01/2024] Open
Abstract
Sepsis is a leading cause of death in Intensive Care Units. Despite its prevalence, sepsis remains insufficiently understood, with no substantial qualitative improvements in its treatment in the past decades. Immunomodulatory agents may hold promise, given the significance of TNF-α and IL-1β as sepsis mediators. This study examines the immunomodulatory effects of moxifloxacin, a fluoroquinolone utilized in clinical practice. THP1 cells were treated in vitro with either PBS or moxifloxacin and subsequently challenged with lipopolysaccharide (LPS) or E. coli. C57BL/6 mice received intraperitoneal injections of LPS or underwent cecal ligation and puncture (CLP), followed by treatment with PBS, moxifloxacin, meropenem or epirubicin. Atm-/- mice underwent CLP and were treated with either PBS or moxifloxacin. Cytokine and organ lesion markers were quantified via ELISA, colony-forming units were assessed from mouse blood samples, and DNA damage was evaluated using a comet assay. Moxifloxacin inhibits the secretion of TNF-α and IL-1β in THP1 cells stimulated with LPS or E. coli. Intraperitoneal administration of moxifloxacin significantly increased the survival rate of mice with severe sepsis by 80% (p < 0.001), significantly reducing the plasma levels of cytokines and organ lesion markers. Notably, moxifloxacin exhibited no DNA damage in the comet assay, and Atm-/- mice were similarly protected following CLP, boasting an overall survival rate of 60% compared to their PBS-treated counterparts (p = 0.003). Moxifloxacin is an immunomodulatory agent, reducing TNF-α and IL-1β levels in immune cells stimulated with LPS and E. coli. Furthermore, moxifloxacin is also protective in an animal model of sepsis, leading to a significant reduction in cytokines and organ lesion markers. These effects appear unrelated to its antimicrobial activity or induction of DNA damage.
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Affiliation(s)
- Tiago R. Velho
- Department of Cardiothoracic Surgery, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal;
- Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal (N.F.); (A.N.-C.); (D.P.)
| | - Helena Raquel
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal (N.F.); (A.N.-C.); (D.P.)
| | - Nuno Figueiredo
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal (N.F.); (A.N.-C.); (D.P.)
- Department of General Surgery, Hospital Lusíadas Lisboa, 1500-458 Lisbon, Portugal
| | - Ana Neves-Costa
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal (N.F.); (A.N.-C.); (D.P.)
| | - Dora Pedroso
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal (N.F.); (A.N.-C.); (D.P.)
| | - Isa Santos
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal (N.F.); (A.N.-C.); (D.P.)
- Department of General Surgery, Hospital de São Bernardo, Unidade Local de Saúde da Arrábida, 2910-446 Setúbal, Portugal
| | - Katharina Willmann
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal (N.F.); (A.N.-C.); (D.P.)
| | - Luís F. Moita
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal (N.F.); (A.N.-C.); (D.P.)
- Center for Disease Mechanisms Research, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisbon, Portugal
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Hoyler M, Niederman MS, Girardi NI. What every intensivist should know about..Patient safety huddles in the ICU. J Crit Care 2024; 82:154788. [PMID: 38553353 DOI: 10.1016/j.jcrc.2024.154788] [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: 08/04/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 06/01/2024]
Abstract
Patient safety huddles are brief, multidisciplinary conversations that focus on a specific topic or event. Huddles have been shown to improve communication among healthcare providers in a variety of settings, including the intensive care unit (ICU). This paper presents key features of patient safety huddles and describes the ways in which huddle techniques may be particularly relevant to the practice of critical care.
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Affiliation(s)
- Margo Hoyler
- Division of Critical Care Medicine, Department of Anesthesiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Natalia Ivascu Girardi
- Division of Critical Care Medicine, Department of Anesthesiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
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13
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Al Shaqri EJ, Balkhair A. Relationship of C-reactive Protein/Serum Albumin Ratio and qPitt Bacteremia Score With An All-Cause In-Hospital Mortality in Patients With Bloodstream Infections. Cureus 2024; 16:e66584. [PMID: 39252713 PMCID: PMC11382806 DOI: 10.7759/cureus.66584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Bloodstream infections remain a major cause of morbidity and mortality despite notable advances in their diagnosis and treatment. C-reactive protein/serum albumin ratio and the quick Pitt bacteremia score are two useful tools for clinicians to assess severity and predict mortality risk in patients with sepsis attributable to bloodstream infections. This study examined the relationship between C-reactive protein/serum albumin ratio and Q Pitt bacteremia score with all-cause in-hospital mortality in patients with bloodstream infections. METHODS Hospitalized adult patients with bacteremic bloodstream infections between January 1, 2020, and December 31, 2021, were retrospectively reviewed. Patients' demographics and clinical and laboratory data were retrieved from patient electronic records. C-reactive protein/albumin ratio was calculated using CRP (mg/L) and serum albumin (g/L) values obtained within 24 hours of blood culture collection and quick Pitt bacteremia score was calculated for each patient with each of the five variables of the score determined within 24 hours of blood culture collection and each patient was assigned a numerical score of 0-5 accordingly. The relationship between C-reactive protein/albumin ratio and quick Pitt bacteremia score with all-cause in-hospital mortality was determined. RESULTS A total of 187 hospitalized adult patients with non-repeat bacteremic bloodstream infections were identified. Escherichia coli was the most common Gram-negative blood isolate while Staphylococcus aureus was the predominant Gram-positive isolate. One hundred and five (56.1%) patients were male with a cohort mean age of 56.9 ± 2.7 years. All-cause in-hospital mortality was 27.3%. The mean CRP/albumin ratio (8.6 ±1.7) and mean quick Pitt bacteremia score (2.8 ±0.4) were significantly higher in patients with bloodstream infections who died during their hospitalization compared to those who survived. The all-cause in-hospital mortality was 8%, 12%, 22%, 46%, 93%, and 100% for patients with quick Pitt scores of 0, 1, 2, 3, 4, and 5, respectively. CONCLUSION In hospitalized patients with bacteremic bloodstream infections, an incremental increase in quick Pitt bacteremia score and mean C-reactive protein/albumin ratio of >8 was associated with higher mortality.
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Affiliation(s)
- Eyad J Al Shaqri
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
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14
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Lai LM, Zhu XY, Zhao R, Chen Q, Liu JJ, Liu Y, Yuan L. Tropheryma whipplei detected by metagenomic next-generation sequencing in bronchoalveolar lavage fluid. Diagn Microbiol Infect Dis 2024; 109:116374. [PMID: 38805857 DOI: 10.1016/j.diagmicrobio.2024.116374] [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: 02/06/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
Whipple's disease is a chronic systemic infectious disease that mainly affects the gastrointestinal tract. In some cases, Tropheryma whipplei can cause infection at the implant site or even throughout the body. In this study, we collected alveolar lavage fluid samples from patients with Tropheryma whipplei from 2020 to 2022, and retrospectively analyzed the clinical data of Tropheryma whipplei positive patients. Patient's past history, clinical manifestations, laboratory examinations, chest CT findings, treatment, and prognosis were recorded. 16 BALFs (70/1725, 4.0 %) from 16 patients were positive for Tropheryma whipplei. 8 patients were male with an average age of 50 years. The main clinical symptoms of patients included fever (9/16), cough (7/16), dyspnea (7/16), and expectoration (5/16), but neurological symptoms and arthralgia were rare. Cardiovascular and cerebrovascular diseases were the most common comorbidity (n=8). The main laboratory characteristics of the patient are red blood cell count, hemoglobin, total protein and albumin below normal levels (11/16), and/or creatinine above normal levels(14/16). Most chest computed tomography mainly show focal or patchy heterogeneous infection (n=5) and pleural effusion (n=8). Among the 6 samples, Tropheryma whipplei was the sole agent, and Klebsiella pneumoniae was the most common detected other pathogens. Metagenomic next-generation sequencing technology has improved the detection rate and attention of Tropheryma whipplei. Further research is needed to distinguish whether Tropheryma whipplei present in respiratory samples is a pathogen or an innocent bystander.
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Affiliation(s)
- Lan Min Lai
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Xin Yu Zhu
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Rui Zhao
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Qiang Chen
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Jiao Jiao Liu
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Yang Liu
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China
| | - Lei Yuan
- Department of Clinical laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, PR China.
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15
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Chen HY, Tseng HY, Chen CL, Lin YC, Liang SJ, Tu CY, Chen WC, Hsueh PR. The real-world impact of the BioFire FilmArray blood culture identification 2 panel on antimicrobial stewardship among patients with bloodstream infections in intensive care units with a high burden of drug-resistant pathogens. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:580-593. [PMID: 38942661 DOI: 10.1016/j.jmii.2024.06.004] [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: 04/09/2024] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The increasing prevalence of drug-resistant pathogens leads to delays in adequate antimicrobial treatment in intensive care units (ICU). The real-world influence of the BioFire FilmArray Blood Culture Identification 2 (BCID2) panel on pathogen identification, diagnostic concordance with conventional culture methods, and antimicrobial stewardship in the ICU remains unexplored. METHODS This retrospective observational study, conducted from July 2021 to August 2023, involved adult ICU patients with positive blood cultures who underwent BCID2 testing. The concordance between BCID2 and conventional culture results was examined, and its impact on antimicrobial stewardship was assessed through a comprehensive retrospective review of patient records by intensivists. RESULTS A total of 129 blood specimens from 113 patients were analysed. Among these patients, a high proportion of drug-resistant strains were noted, including carbapenem-resistant Klebsiella pneumoniae (CRKP) (57.1%), carbapenem-resistant Acinetobacter calcoaceticus-baumannii complex (100%), methicillin-resistant Staphylococcus aureus (MRSA) (70%), and vancomycin-resistant Enterococcus faecium (VRE) (100%). The time from blood culture collection to obtaining BCID2 results was significantly shorter than conventional culture (46.2 h vs. 86.9 h, p < 0.001). BCID2 demonstrated 100% concordance in genotype-phenotype correlation in antimicrobial resistance (AMR) for CRKP, carbapenem-resistant Escherichia coli, MRSA, and VRE. A total of 40.5% of patients received inadequate empirical antimicrobial treatment. The antimicrobial regimen was adjusted or confirmed in 55.4% of patients following the BCID2 results. CONCLUSIONS In the context of a high burden of drug-resistant pathogens, BCID2 demonstrated rapid pathogen and AMR detection, with a noticeable impact on antimicrobial stewardship in BSI in the ICU.
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Affiliation(s)
- Hsu-Yuan Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - How-Yang Tseng
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chieh-Lung Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Chao Lin
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Shinn-Jye Liang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Cheng Chen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; PhD Program for Aging, School of Medicine, China Medical University, Taichung, Taiwan; Department of Laboratory Medicine, School of Medicine, China Medical University, Taichung, Taiwan.
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16
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Fodil S, Urbina T, Bredin S, Mayaux J, Lafarge A, Missri L, Maury E, Demoule A, Pene F, Mariotte E, Ait-Oufella H. Bloodstream infections among patients receiving therapeutic plasma exchanges in the intensive care unit: a 10 year multicentric study. Ann Intensive Care 2024; 14:117. [PMID: 39073720 PMCID: PMC11286886 DOI: 10.1186/s13613-024-01346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/29/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Therapeutic plasma exchanges (TPE), which affect the humoral response, are often performed in combination with immunosuppressive drugs. For this reason, TPE may be associated with an increased susceptibility to infections. We aimed to describe blood stream infection (BSI) incidence in ICU patients treated with TPE and to identify associated risk factors. METHODS We retrospectively included patients that had received at least one session of TPE in the ICU of one of the 4 participating centers (all in Paris, France) between January 1st 2010 and December 31th 2019. Patients presenting with a BSI during ICU stay were compared to patients without such an infection. Risk factors for BSI were identified by a multivariate logistic regression model. RESULTS Over 10 years in the 4 ICUs, 387 patients were included, with a median of 5 [2-7] TPE sessions per patient. Most frequent indications for TPE were thrombotic microangiopathy (47%), central nervous system inflammatory disorders (11%), hyperviscosity syndrome (11%) and ANCA associated vasculitis (8.5%). Thirty-one patients (8%) presented with a BSI during their ICU stay, a median of 7 [3-11] days after start of TPE. In a multivariate logistic regression model, diabetes (OR 3.32 [1.21-8.32]) and total number of TPE sessions (OR 1.14 [1.08-1.20]) were independent risk factors for BSI. There was no difference between TPE catheter infection related BSI (n = 11 (35%)) and other sources of BSI (n = 20 (65%)) regarding catheter insertion site (p = 0.458) or rate of TPE catheter related deep vein thrombosis (p = 0.601). ICU course was severe in patients presenting with BSI when compared to patients without BSI, with higher need for mechanical ventilation (45% vs 18%, p = 0.001), renal replacement therapy (42% vs 20%, p = 0.011), vasopressors (32% vs 12%, p = 0.004) and a higher mortality (19% vs 5%, p = 0.010). CONCLUSION Blood stream infections are frequent in patients receiving TPE in the ICU, and are associated with a severe ICU course. Vigilant monitoring is crucial particularly for patients receiving a high number of TPE sessions.
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Affiliation(s)
- Sofiane Fodil
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Tomas Urbina
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Swann Bredin
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Mayaux
- Service de Médecine Intensive-Réanimation, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Lafarge
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Louaï Missri
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Alexandre Demoule
- Service de Médecine Intensive-Réanimation, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frederic Pene
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Mariotte
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
- Inserm U970, Cardiovascular Research Center, Université Paris-Cité, Paris, France.
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17
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P A A, Ragunathan L, Sanjeevi T, Sasi AC, Kanniyan K, Yadav R, Sambandam R. Breaking boundaries in microbiology: customizable nanoparticles transforming microbial detection. NANOSCALE 2024; 16:13802-13819. [PMID: 38990141 DOI: 10.1039/d4nr01680g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
The detection and identification of microorganisms are crucial in microbiology laboratories. Traditionally, detecting and identifying microbes require extended periods of incubation, significant manual effort, skilled personnel, and advanced laboratory facilities. Recent progress in nanotechnology has provided novel opportunities for detecting and identifying bacteria, viruses, and microbial metabolites using customized nanoparticles. These improvements are thought to have the ability to surpass the constraints of existing procedures and make a substantial contribution to the development of rapid microbiological diagnosis. This review article examines the customizability of nanoparticles for detecting bacteria, viruses, and microbial metabolites and discusses recent cutting-edge studies demonstrating the use of nanotechnology in biomedical research.
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Affiliation(s)
- Aboobacker P A
- Department of Microbiology, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry 607402, India.
| | - Latha Ragunathan
- Department of Microbiology, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry 607402, India.
| | - Thiyagarajan Sanjeevi
- Department of Medical Biotechnology, Aarupadai Veedu Medical College, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry 607402, India
| | - Aravind C Sasi
- Department of Microbiology, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry 607402, India.
| | - Kavitha Kanniyan
- Department of Microbiology, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry 607402, India.
| | - Richa Yadav
- Department of Microbiology, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry 607402, India.
| | - Ravikumar Sambandam
- Department of Medical Biotechnology, Aarupadai Veedu Medical College, Vinayaka Mission's Research Foundation (DU), Kirumampakkam, Puducherry 607402, India
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18
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Lin YC, Yang KY, Peng CK, Chan MC, Sheu CC, Feng JY, Wang SH, Huang WH, Chen CM, Chen DH, Chen CL. Clinical outcomes of carbapenem-resistant gram-negative bacterial bloodstream infection in patients with end-stage renal disease in intensive care units: a multicenter retrospective observational study. Infection 2024:10.1007/s15010-024-02343-5. [PMID: 38995550 DOI: 10.1007/s15010-024-02343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Carbapenem-resistant gram-negative bacteria (CRGNB) present a considerable global threat due to their challenging treatment and increased mortality rates, with bloodstream infection (BSI) having the highest mortality rate. Patients with end-stage renal disease (ESRD) undergoing renal replacement therapy (RRT) face an increased risk of BSI. Limited data are available regarding the prognosis and treatment outcomes of CRGNB-BSI in patients with ESRD in intensive care units (ICUs). METHODS This multi-center retrospective observational study included a total of 149 ICU patients with ESRD and CRGNB-BSI in Taiwan from January 2015 to December 2019. Clinical and microbiological outcomes were assessed, and multivariable regression analysis was used to evaluate the independent risk factors for day-28 mortality and the impact of antimicrobial therapy regimen on treatment outcomes. RESULTS Among the 149 patients, a total of 127 patients (85.2%) acquired BSI in the ICU, with catheter-related infections (47.7%) and pneumonia (32.2%) being the most common etiologies. Acinetobacter baumannii (49.0%) and Klebsiella pneumoniae (31.5%) were the most frequently isolated pathogens. The day-28 mortality rate from BSI onset was 52.3%, and in-hospital mortality was 73.2%, with survivors experiencing prolonged hospital stays. A higher Sequential Organ Failure Assessment (SOFA) score (adjusted hazards ratio [aHR], 1.25; 95% confidence interval [CI] 1.17-1.35) and shock status (aHR, 2.12; 95% CI 1.14-3.94) independently predicted day-28 mortality. Colistin-based therapy reduced day-28 mortality in patients with shock, a SOFA score of ≥ 13, and Acinetobacter baumannii-related BSI. CONCLUSIONS CRGNB-BSI led to high mortality in critically ill patients with ESRD. Day-28 mortality was independently predicted by a higher SOFA score and shock status. In patients with higher disease severity and Acinetobacter baumannii-related BSI, colistin-based therapy improved treatment outcomes.
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Affiliation(s)
- Yu-Chao Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cancer and Immunology Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Cheng Chan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Huei Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Hsuan Huang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Min Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ding-Han Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Chieh-Lung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
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Biniek JP, Schwab F, Graf K, Vonberg RP. Adherence to Antibiotic Prescription Guidelines in Four Community Hospitals in Germany. Antibiotics (Basel) 2024; 13:635. [PMID: 39061317 PMCID: PMC11274007 DOI: 10.3390/antibiotics13070635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
This retrospective study aimed to assess and compare guideline adherence and treatment costs in the management of urinary tract infections (UTIs) and bloodstream infections (BSIs) in German tertiary hospitals from January 2019 to December 2020. The study analyzed 586 patient records, with 65% diagnosed with UTIs and 35% with BSIs. Antibiotic treatment was given to 98% of patients, but only 65% received microbiological diagnostics. Bacterial growth was observed in 86% of patients with cultures taken, with Escherichia coli being the leading pathogen. The treatment was intravenous in 63% of cases, with Ceftriaxone as the leading antibiotic agent. The guideline adherence was found to be low, at 33%. Multivariable logistic regression analysis revealed that patients with urogenital risk factors (OR = 1.589; p < 0.001) and increasing age (OR = 1.01; p = 0.007) were significantly more likely to receive guideline-concordant treatment for UTIs and BSIs. Additionally, complicating factors such as diabetes and renal dysfunction were associated with higher adherence rates, underscoring the importance of targeted antibiotic stewardship interventions.
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Affiliation(s)
- Joachim Peter Biniek
- Department of Hospital Hygiene, Paracelsus-Hospital am Silbersee, 30851 Langenhagen, Germany; (J.P.B.)
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany
| | - Karolin Graf
- Department of Hospital Hygiene, Paracelsus-Hospital am Silbersee, 30851 Langenhagen, Germany; (J.P.B.)
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, 30625 Hannover, Germany
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20
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Liu H, Xie X, Wang Y, Wang X, Jin X, Zhang X, Wang Y, Zhu Z, Qi W, Jiang H. Development and validation of risk prediction model for bacterial infections in acute liver failure patients. Eur J Gastroenterol Hepatol 2024; 36:916-923. [PMID: 38829944 PMCID: PMC11136268 DOI: 10.1097/meg.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/15/2024] [Indexed: 06/05/2024]
Abstract
Infections significantly increase mortality in acute liver failure (ALF) patients, and there are no risk prediction models for early diagnosis and treatment of infections in ALF patients. This study aims to develop a risk prediction model for bacterial infections in ALF patients to guide rational antibiotic therapy. The data of ALF patients admitted to the Second Hospital of Hebei Medical University in China from January 2017 to January 2022 were retrospectively analyzed for training and internal validation. Patients were selected according to the updated 2011 American Association for the Study of Liver Diseases position paper on ALF. Serological indicators and model scores were collected within 24 h of admission. New models were developed using the multivariate logistic regression analysis. An optimal model was selected by receiver operating characteristic (ROC) analysis, Hosmer-Lemeshow test, the calibration curve, the Brier score, the bootstrap resampling, and the decision curve analysis. A nomogram was plotted to visualize the results. A total of 125 ALF patients were evaluated and 79 were included in the training set. The neutrophil-to-lymphocyte ratio and sequential organ failure assessment (SOFA) were integrated into the new model as independent predictive factors. The new SOFA-based model outperformed other models with an area under the ROC curve of 0.799 [95% confidence interval (CI): 0.652-0.926], the superior calibration and predictive performance in internal validation. High-risk individuals with a nomogram score ≥26 are recommended for antibiotic therapy. The new SOFA-based model demonstrates high accuracy and clinical utility in guiding antibiotic therapy in ALF patients.
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Affiliation(s)
- Huimin Liu
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases
| | - Xiaoli Xie
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases
| | - Yan Wang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases
| | - Xiaoting Wang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases
| | - Xiaoxu Jin
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, Shijiazhuang, Hebei, China
| | - Yameng Wang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, Shijiazhuang, Hebei, China
| | - Zongyi Zhu
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases
| | - Wei Qi
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases
| | - Huiqing Jiang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases
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21
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Deng J, An Y, Kang M. Using the CLSI rAST breakpoints of Enterobacterales in positive blood cultures. Diagn Microbiol Infect Dis 2024; 109:116335. [PMID: 38703531 DOI: 10.1016/j.diagmicrobio.2024.116335] [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: 12/14/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The objective of this study was to provide the clinic with rapid and accurate results of antimicrobial susceptibility testing for the treatment of patients with bloodstream infections. To achieve this, we applied the Clinical and Laboratory Standards Institute (CLSI) blood culture direct rapid antimicrobial susceptibility test (rAST) to assess the susceptibility of the most common Enterobacterales found in blood cultures. METHODS In this study, we utilized the CLSI blood culture direct rapid antimicrobial susceptibility test to assess the susceptibility (rAST) of the most common Enterobacterales present in blood cultures. We chose this method for its simplicity in analysis, and our aim was to predict minimum inhibitory concentrations (MICs) using the rAST. As a benchmark, we assumed that Broth Macrodilution method (BMD) results were 100% accurate. For data evaluation, we employed the terms categorical agreement (CA), very major errors (VME), and major errors (ME). RESULTS Our findings demonstrate that the CLSI rAST method is reliable for rapidly determining the in vitro susceptibility of Enterobacterales to common antimicrobial drugs in bloodstream infections. We achieved a concordance rate of 90% in classification within a 10-hour timeframe. We identified a total of 112 carbapenem-resistant Enterobacterales (CRE) strains, and there was no significant difference in the detection rate of CRE at 6, 10, and 16 hours. This suggests that CRE can be identified as early as 6 hours. CONCLUSION The CLSI rAST is a valuable tool that can be utilized in clinical practice to quickly determine the susceptibility of Enterobacterales to antimicrobial drugs within 10 hours. This capability can greatly assist in the clinical management of patients with bloodstream infections.
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Affiliation(s)
- Jin Deng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - YunHe An
- Department of Laboratory Medicine, Ding Zhou City People's Hospital, Hebei, China
| | - Mei Kang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
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22
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Kokkoris S, Angelopoulos E, Gkoufa A, Christodouli F, Ntaidou T, Theodorou E, Dimopoulou G, Vasileiadis I, Kremmydas P, Routsi C. The Diagnostic Accuracy of Procalcitonin and Its Combination with Other Biomarkers for Candidemia in Critically Ill Patients. J Clin Med 2024; 13:3557. [PMID: 38930085 PMCID: PMC11204834 DOI: 10.3390/jcm13123557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The aim of this study was to investigate the usefulness of serum procalcitonin (PCT), C-reactive protein (CRP), neutrophil to lymphocyte count ratio (NLR), and their combination, in distinguishing candidemia from bacteremia in intensive care unit (ICU) patients. Methods: This is a retrospective study in ICU patients with documented bloodstream infections (BSIs) and with both serum PCT and CRP measurements on the day of the positive blood sample. Illness severity was assessed by sequential organ failure assessment (SOFA) score on both admission and BSI day. Demographic, clinical, and laboratory data, including PCT and CRP levels and NLR on the day of the BSI, were recorded. Results: A total of 63 patients were included in the analysis, of whom 32 had bacteremia and 31 had candidemia. PCT, CRP, and NLR values were all significantly lower in candidemia compared with bacteremia (0.29 (0.14-0.69) vs. 1.73 (0.5-6.9) ng/mL, p < 0.001, 6.3 (2.4-11.8) vs. 19 (10.7-24.8) mg/dl, p < 0.001 and 6 (3.7-8.6) vs. 9.8 (5.3-16.3), p = 0.001, respectively). PCT was an independent risk factor for candidemia diagnosis (OR 0.153, 95%CI: 0.04-0.58, p = 0.006). A multivariable model consisting of the above three variables had better predictive ability (AUC-ROC = 0.88, p < 0.001), for candidemia diagnosis, as compared to that of PCT, CRP, and NLR, whose AUC-ROCs were all lower (0.81, p < 0.001, 0.78, p < 0.001, and 0.68, p = 0.015, respectively). Conclusions: A combination of routinely available laboratory tests, such as PCT, CRP, and NLR, could prove useful for the early identification of ICU patients with candidemia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Christina Routsi
- First Department of Critical Care Medicine and Pulmonary Services, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, 45-47 Ipsilantou Street, 10676 Athens, Greece; (S.K.); (E.A.); (A.G.); (F.C.); (T.N.); (E.T.); (G.D.); (I.V.); (P.K.)
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23
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Margalit I, Yahav D, Hoffman T, Tabah A, Ruckly S, Barbier F, Singer P, Timsit JF, Prendki V, Buetti N. Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study. Infection 2024:10.1007/s15010-024-02304-y. [PMID: 38869773 DOI: 10.1007/s15010-024-02304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/20/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI). METHODS Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019-2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge). RESULTS Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time. CONCLUSIONS Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients.
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Affiliation(s)
- Ili Margalit
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel.
- Faculty of Medical & Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medical & Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Tomer Hoffman
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medical & Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Alexis Tabah
- Intensive Care Unit, Redclife Hospital, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stéphane Ruckly
- IAME UMR 1137, INSERM, Université de Paris, 75018, Paris, France
- ICUREsearch, Biometry, 38600, Fontaine, France
| | - François Barbier
- Service de Médecine Intensive‑Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45100, Orléans, France
| | - Pierre Singer
- Faculty of Medical & Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jean-François Timsit
- IAME UMR 1137, INSERM, Université de Paris, 75018, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Omdurman Maternity Hospital Rue Henri Huchard, 75877, Paris, France
| | - Virginie Prendki
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Infection Control Programme and World Health Organization Collaborating Center, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Niccolò Buetti
- IAME UMR 1137, INSERM, Université de Paris, 75018, Paris, France
- Infection Control Programme and World Health Organization Collaborating Center, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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24
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Hua MM, Li J, Zheng J, Wang JJ, Liu C, Zhang Y, Zhang ZF, Cao XL, Shen H. Molecular Characteristics of Salmonella Spp. Responsible for Bloodstream Infections in a Tertiary Hospital in Nanjing, China, 2019-2021. Infect Drug Resist 2024; 17:2363-2377. [PMID: 38894888 PMCID: PMC11182758 DOI: 10.2147/idr.s459941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Objective To investigate the clinical and molecular characteristics of Salmonella spp. causing bloodstream infections (BSIs) in our hospital. Methods We studied 22 clinical Salmonella isolates from BSIs and 16 from non-BSIs, performing antimicrobial susceptibility testing (AST) and whole genome sequencing (WGS). The analysis included serovars, antibiotic resistance genes (ARGs), virulence factors (VFs), sequence types (STs), plasmid replicons, and genetic relationships. We also assessed pathogenicity of the isolates causing BSIs through growth, biofilm formation, and anti-serum killing assays. Results WGS analysis identified 13 Salmonella serovars, with four responsible for BSIs. S. Enteritidis was the most prevalent serovar, involved in 19 (50.0%) cases. BSIs were caused by 17S. Enteritidis, two S. Typhimurium, two S. Munster and one S. Diguel. Of the 38 isolates, 27 (71.1%) exhibited high resistance to ampicillin, and 24 (63.2%) to ampicillin/sulbactam. Thirty-six types of ARGs were identified, with blaTEM-1B (n = 25, 65.8%) being the most frequent. Ten plasmid replicons were found; the combination of IncFIB(S)-IncFII(S)-IncX1 was the most common in S. Enteritidis (94.7%). Fifteen STs were identified, among which ST11 was the most prevalent and clonally disseminated, primarily responsible for BSIs. A total of 333 different VFs were detected, 177 of which were common across all strains. No significant differences were observed between the BSI and non-BSI isolates in terms of resistance rates, ARGs, plasmid replicons, and VFs, except for seven VFs. No strong pathogenicity was observed in the BSI-causing isolates. Conclusion BSIs were predominantly caused by clonally disseminated S. Enteritidis ST11, the majority of which carried multiple ARGs, VFs and plasmid replicons. This study provides the first data on clonally disseminated S. Enteritidis ST11 causing BSIs, highlighting the urgent need for enhanced infection control measures.
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Affiliation(s)
- Miao-Miao Hua
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, People’s Republic of China
| | - Jia Li
- Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China
| | - Jie Zheng
- Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China
| | - Jing-Jing Wang
- Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China
| | - Chang Liu
- Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China
| | - Yan Zhang
- Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China
| | - Zhi-Feng Zhang
- Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China
| | - Xiao-Li Cao
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, People’s Republic of China
- Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China
| | - Han Shen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, People’s Republic of China
- Department of Laboratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China
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Zebian G, Kreitmann L, Houard M, Piantoni A, Piga G, Ruffier des Aimes S, Holik B, Wallet F, Labreuche J, Nseir S. Immunosuppression at ICU admission is not associated with a higher incidence of ICU-acquired bacterial bloodstream infections: the COCONUT study. Ann Intensive Care 2024; 14:83. [PMID: 38837065 PMCID: PMC11153408 DOI: 10.1186/s13613-024-01314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Immunosuppression at intensive care unit (ICU) admission has been associated with a higher incidence of ICU-acquired infections, some of them related to opportunistic pathogens. However, the association of immunosuppression with the incidence, microbiology and outcomes of ICU-acquired bacterial bloodstream infections (BSI) has not been thoroughly investigated. METHODS Retrospective single-centered cohort study in France. All adult patients hospitalized in the ICU of Lille University-affiliated hospital for > 48 h between January 1st and December 31st, 2020, were included, regardless of their immune status. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, hematopoietic stem cell and solid organ transplants, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic immune deficiency. The primary objective was to compare the 28-day cumulative incidence of ICU-acquired bacterial BSI between immunocompromised and non-immunocompromised patients. Secondary objectives were to assess the microbiology and outcomes of ICU-acquired bacterial BSI in the two groups. RESULTS A total of 1313 patients (66.9% males, median age 62 years) were included. Among them, 271 (20.6%) were immunocompromised at ICU admission. Severity scores at admission, the use of invasive devices and antibiotic exposure during ICU stay were comparable between groups. Both prior to and after adjustment for pre-specified baseline confounders, the 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between immunocompromised and non-immunocompromised patients. The distribution of bacteria was comparable between groups, with a majority of Gram-negative bacilli (~ 64.1%). The proportion of multidrug-resistant bacteria was also similar between groups. Occurrence of ICU-acquired bacterial BSI was associated with a longer ICU length-of-stay and a longer duration of invasive mechanical ventilation, with no significant association with mortality. Immune status did not modify the association between occurrence of ICU-acquired bacterial BSI and these outcomes. CONCLUSION The 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between patients with and without immunosuppression at ICU admission.
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Affiliation(s)
- Ghadi Zebian
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Louis Kreitmann
- Department of Intensive Care Medicine, Imperial College Healthcare NHS Trust, London, UK
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, W12 0HS, UK
| | - Marion Houard
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Antoine Piantoni
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Gaetan Piga
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Sarah Ruffier des Aimes
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Bérénice Holik
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Frédéric Wallet
- Laboratoire de Bactériologie-Hygiène, CHU de Lille, Centre de Biologie Pathologie, 59000, Lille, France
| | | | - Saad Nseir
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France.
- Inserm U1285, Université de Lille, CNRS, UMR 8576-UGSF, 59000, Lille, France.
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Jiang S, Zhao D, Wang C, Liu X, Yang Q, Bao X, Dong T, Li G, Gu Y, Ye Y, Sun B, Xu S, Zhou X, Fan L, Tang L. Clinical evaluation of droplet digital PCR in the early identification of suspected sepsis patients in the emergency department: a prospective observational study. Front Cell Infect Microbiol 2024; 14:1358801. [PMID: 38895732 PMCID: PMC11183271 DOI: 10.3389/fcimb.2024.1358801] [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: 12/20/2023] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
Background Rapid and accurate diagnosis of the causative agents is essential for clinical management of bloodstream infections (BSIs) that might induce sepsis/septic shock. A considerable number of suspected sepsis patients initially enter the health-care system through an emergency department (ED), hence it is vital to establish an early strategy to recognize sepsis and initiate prompt care in ED. This study aimed to evaluate the diagnostic performance and clinical value of droplet digital PCR (ddPCR) assay in suspected sepsis patients in the ED. Methods This was a prospective single-centered observational study including patients admitted to the ED from 25 October 2022 to 3 June 2023 with suspected BSIs screened by Modified Shapiro Score (MSS) score. The comparison between ddPCR and blood culture (BC) was performed to evaluate the diagnostic performance of ddPCR for BSIs. Meanwhile, correlative analysis between ddPCR and the inflammatory and prognostic-related biomarkers were conducted to explore the relevance. Further, the health economic evaluation of the ddPCR was analyzed. Results 258 samples from 228 patients, with BC and ddPCR performed simultaneously, were included in this study. We found that ddPCR results were positive in 48.13% (103 of 214) of episodes, with identification of 132 pathogens. In contrast, BC only detected 18 positives, 88.89% of which were identified by ddPCR. When considering culture-proven BSIs, ddPCR shows an overall sensitivity of 88.89% and specificity of 55.61%, the optimal diagnostic power for quantifying BSI through ddPCR is achieved with a copy cutoff of 155.5. We further found that ddPCR exhibited a high accuracy especially in liver abscess patients. Among all the identified virus by ddPCR, EBV has a substantially higher positive rate with a link to immunosuppression. Moreover, the copies of pathogens in ddPCR were positively correlated with various markers of inflammation, coagulation, immunity as well as prognosis. With high sensitivity and specificity, ddPCR facilitates precision antimicrobial stewardship and reduces health care costs. Conclusions The multiplexed ddPCR delivers precise and quantitative load data on the causal pathogen, offers the ability to monitor the patient's condition and may serve as early warning of sepsis in time-urgent clinical situations as ED. Importance Early detection and effective administration of antibiotics are essential to improve clinical outcomes for those with life-threatening infection in the emergency department. ddPCR, an emerging tool for rapid and sensitive pathogen identification used as a precise bedside test, has developed to address the current challenges of BSI diagnosis and precise treatment. It characterizes sensitivity, specificity, reproducibility, and absolute quantifications without a standard curve. ddPCR can detect causative pathogens and related resistance genes in patients with suspected BSIs within a span of three hours. In addition, it can identify polymicrobial BSIs and dynamically monitor changes in pathogenic microorganisms in the blood and can be used to evaluate antibiotic efficacy and survival prognosis. Moreover, the copies of pathogens in ddPCR were positively correlated with various markers of inflammation, coagulation, immunity. With high sensitivity and specificity, ddPCR facilitates precision antimicrobial stewardship and reduces health care costs.
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Affiliation(s)
- Sen Jiang
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Dongyang Zhao
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Chunxue Wang
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Xiandong Liu
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Qian Yang
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Xiaowei Bao
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Tiancao Dong
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Gen Li
- School of Medicine, Tongji University, Shanghai, China
- Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Gu
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Yangqin Ye
- School of Medicine, Tongji University, Shanghai, China
- Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bingke Sun
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Shumin Xu
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Xiaohui Zhou
- School of Medicine, Tongji University, Shanghai, China
- Research Center for Translational Medicine, Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Lieying Fan
- School of Medicine, Tongji University, Shanghai, China
- Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lunxian Tang
- Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
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Nohra E, Appelbaum RD, Farrell MS, Carver T, Jung HS, Kirsch JM, Kodadek LM, Mandell S, Nassar AK, Pathak A, Paul J, Robinson B, Cuschieri J, Stein DM. Fever and infections in surgical intensive care: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open 2024; 9:e001303. [PMID: 38835635 PMCID: PMC11149120 DOI: 10.1136/tsaco-2023-001303] [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: 11/03/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Abstract
The evaluation and workup of fever and the use of antibiotics to treat infections is part of daily practice in the surgical intensive care unit (ICU). Fever can be infectious or non-infectious; it is important to distinguish between the two entities wherever possible. The evidence is growing for shortening the duration of antibiotic treatment of common infections. The purpose of this clinical consensus document, created by the American Association for the Surgery of Trauma Critical Care Committee, is to synthesize the available evidence, and to provide practical recommendations. We discuss the evaluation of fever, the indications to obtain cultures including urine, blood, and respiratory specimens for diagnosis of infections, the use of procalcitonin, and the decision to initiate empiric antibiotics. We then describe the treatment of common infections, specifically ventilator-associated pneumonia, catheter-associated urinary infection, catheter-related bloodstream infection, bacteremia, surgical site infection, intra-abdominal infection, ventriculitis, and necrotizing soft tissue infection.
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Affiliation(s)
- Eden Nohra
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel D Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Thomas Carver
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hee Soo Jung
- Department of Surgery, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jordan Michael Kirsch
- Department of Surgery, Westchester Medical Center/ New York Medical College, Valhalla, NY, USA
| | - Lisa M Kodadek
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel Mandell
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aussama Khalaf Nassar
- Department of Surgery, Section of Acute Care Surgery, Stanford University, Stanford, California, USA
| | - Abhijit Pathak
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jasmeet Paul
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Bryce Robinson
- Department of Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Joseph Cuschieri
- Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Deborah M Stein
- Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA
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Dai Y, Zhu X, Chang W, Lu H, Nie Z, Wu Y, Yao H, Chen Y, Xiao Y, Chu X. Clinical and economic evaluation of blood culture whole process optimisation in critically ill adult patients with positive blood cultures. Int J Antimicrob Agents 2024; 63:107176. [PMID: 38642811 DOI: 10.1016/j.ijantimicag.2024.107176] [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: 10/02/2023] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES Optimising blood culture processing is important to ensure that bloodstream infections are accurately diagnosed while minimising adverse events caused by antibiotic abuse. This study aimed to evaluate the impact of optimised blood culture processes on antibiotic use, clinical outcomes and economics in intensive care unit (ICU) patients with positive blood cultures. METHODS From March 2020 to October 2021, this microbiology laboratory implemented a series of improvement measures, including the clinical utility of Fastidious Antimicrobial Neutralization (FAN® PLUS) bottles for the BacT/Alert Virtuo blood culture system, optimisation of bottle reception, graded reports and an upgraded laboratory information system. A total of 122 ICU patients were included in the pre-optimisation group from March 2019 to February 2020, while 179 ICU patients were included in the post-optimisation group from November 2021 to October 2022. RESULTS Compared with the pre-optimisation group, the average reporting time of identification and antimicrobial sensitivity was reduced by 16.72 hours in the optimised group. The time from admission to targeted antibiotic therapy within 24 hours after receiving both the Gram stain report and the final report were both significantly less in the post-optimisation group compared with the pre-optimisation group. The average hospitalisation time was reduced by 6.49 days, the average antimicrobial drug cost lowered by $1720.85 and the average hospitalisation cost by $9514.17 in the post-optimisation group. CONCLUSIONS Optimising blood culture processing was associated with a significantly increased positive detection rate, a remarkable reduction in the length of hospital stay and in hospital costs for ICU patients with bloodstream infections.
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Affiliation(s)
- Yuanyuan Dai
- Department of Clinical Laboratory, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xiongfeng Zhu
- Department of Critical Care Medicine, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Wenjiao Chang
- Department of Clinical Laboratory, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Huaiwei Lu
- Department of Clinical Laboratory, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Zhengchao Nie
- Department of Clinical Laboratory, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Yongqin Wu
- Department of Clinical Laboratory, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Haifeng Yao
- Department of Information Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - Xinmin Chu
- Department of Clinical Laboratory, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.
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Buetti N, Tabah A, Setti N, Ruckly S, Barbier F, Akova M, Aslan AT, Leone M, Bassetti M, Morris AC, Arvaniti K, Paiva JA, Ferrer R, Qiu H, Montrucchio G, Cortegiani A, Kayaaslan B, De Bus L, De Waele JJ, Timsit JF. The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections. Intensive Care Med 2024; 50:873-889. [PMID: 38498170 PMCID: PMC11164726 DOI: 10.1007/s00134-024-07348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/05/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). METHODS We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. RESULTS Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality. CONCLUSION Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients.
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Affiliation(s)
- Niccolò Buetti
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland.
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
| | - 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
| | - Nour Setti
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
| | - Stéphane Ruckly
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Biostatistic Department, Outcomerea, 93700, Drancy, France
| | - François Barbier
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45000, Orléans, France
- Institut Maurice Rapin, Hôpital Henri Mondor, Créteil, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - 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, Hills Road, Cambridge, CB2 0QQ, UK
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Infection and Sepsis ID Group, Porto, Portugal
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, University of Palermo, Via del Vespro129, 90127, Palermo, Italy
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jean-François Timsit
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75877, Paris Cedex, France
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Hanczvikkel A, Tóth Á, Kopcsóné Németh IA, Bazsó O, Závorszky L, Buzgó L, Lesinszki V, Göbhardter D, Ungvári E, Damjanova I, Erőss A, Hajdu Á. Nosocomial outbreak caused by disinfectant-resistant Serratia marcescens in an adult intensive care unit, Hungary, February to March 2022. Euro Surveill 2024; 29:2300492. [PMID: 38940004 PMCID: PMC11212457 DOI: 10.2807/1560-7917.es.2024.29.26.2300492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/01/2024] [Indexed: 06/29/2024] Open
Abstract
In 2022, an outbreak with severe bloodstream infections caused by Serratia marcescens occurred in an adult intensive care unit (ICU) in Hungary. Eight cases, five of whom died, were detected. Initial control measures could not stop the outbreak. We conducted a matched case-control study. In univariable analysis, the cases were more likely to be located around one sink in the ICU and had more medical procedures and medications than the controls, however, the multivariable analysis was not conclusive. Isolates from blood cultures of the cases and the ICU environment were closely related by whole genome sequencing and resistant or tolerant against the quaternary ammonium compound surface disinfectant used in the ICU. Thus, S. marcescens was able to survive in the environment despite regular cleaning and disinfection. The hospital replaced the disinfectant with another one, tightened the cleaning protocol and strengthened hand hygiene compliance among the healthcare workers. Together, these control measures have proved effective to prevent new cases. Our results highlight the importance of multidisciplinary outbreak investigations, including environmental sampling, molecular typing and testing for disinfectant resistance.
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Affiliation(s)
- Adrienn Hanczvikkel
- ECDC Fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary
| | - Ákos Tóth
- National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary
| | | | - Orsolya Bazsó
- North-Pest Central Hospital - Military Hospital (ÉPC-HK), Budapest, Hungary
| | - Lőrinc Závorszky
- North-Pest Central Hospital - Military Hospital (ÉPC-HK), Budapest, Hungary
| | - Lilla Buzgó
- National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary
| | - Virág Lesinszki
- National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary
| | - Dániel Göbhardter
- National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary
| | - Erika Ungvári
- National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary
| | - Ivelina Damjanova
- National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary
| | - Attila Erőss
- North-Pest Central Hospital - Military Hospital (ÉPC-HK), Budapest, Hungary
| | - Ágnes Hajdu
- National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary
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Li Y, Huang K, Yin J, Tan Z, Zhou M, Dai J, Yi B. Clinical evaluation of a multiplex droplet digital PCR for pathogen detection in critically ill COVID-19 patients with bloodstream infections. Infection 2024; 52:1027-1039. [PMID: 38127118 PMCID: PMC11143000 DOI: 10.1007/s15010-023-02157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Nosocomial bloodstream infections (nBSI) have emerged as a clinical concern for physicians treating COVID-19 patients. In this study, we aimed to evaluate the effectiveness of a multiplex ddPCR in detecting bacterial pathogens in the blood of COVID-19 critically ill patients. METHODS This prospective diagnostic study included RT-PCR-confirmed COVID-19 patients admitted to our hospital from December 2022 to February 2023. A multiplex ddPCR assay was used to detect common bacterial pathogens and AMR genes in blood samples of the patients, along with antimicrobial susceptibility testing (AST). The diagnostic performance of the ddPCR assay was evaluated by comparing the results with those obtained through blood culture and clinical diagnosis. Additionally, the ability of ddPCR in detecting bacterial resistance was compared with the AST results. RESULTS Of the 200 blood samples collected from 184 patients, 45 (22.5%) were positive using blood culture, while 113 (56.5%) were positive for bacterial targets using the ddPCR assay. The ddPCR assay outperformed blood culture in pathogen detection rate, mixed infection detection rate, and fungal detection rate. Acinetobacter baumannii and Klebsiella pneumoniae were the most commonly detected pathogens in COVID-19 critically ill patients, followed by Enterococcus and Streptococcus. Compared to blood culture, ddPCR achieved a sensitivity of 75.5%, specificity of 51.0%, PPV of 30.9%, and NPV of 87.8%, respectively. However, there were significant differences in sensitivity among different bacterial species, where Gram-negative bacteria have the highest sensitivity of 90.3%. When evaluated on the ground of clinical diagnosis, the sensitivity, specificity, PPV and NPV of ddPCR were 78.1%, 90.5%, 94.7%, and 65.5%, respectively. In addition, the ddPCR assay detected 23 cases of blaKPC, which shown a better consistent with clinical test results than other detected AMR genes. Compared to blaKPC, there were few other AMR genes detected, indicating that the application of other AMR gene detection in the COVID-19 critically ill patients was limited. CONCLUSION The multiplex ddPCR assay had a significantly higher pathogen detection positivity than the blood culture, which could be an effective diagnostic tool for BSIs in COVID-19 patients and to improve patient outcomes and reduce the burden of sepsis on the healthcare system, though there is room for optimization of the panels used.- Adjusting the targets to include E. faecalis and E. faecium as well as Candida albicans and Candida glabrata could improve the ddPCR' s effectiveness. However, further research is needed to explore the potential of ddPCR in predicting bacterial resistance through AMR gene detection.
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Affiliation(s)
- Yanbing Li
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Kangkang Huang
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Jun Yin
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Zheren Tan
- Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Manli Zhou
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Jiaoyang Dai
- Department of Laboratory Medicine, Xiangya Medical School, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Bin Yi
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
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Fonseca J, Cano-Sarabia M, Cortés P, Saldo J, Montpeyó D, Lorenzo J, Llagostera M, Imaz I, Maspoch D. Metal-Organic Framework-Based Antimicrobial Touch Surfaces to Prevent Cross-Contamination. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2403813. [PMID: 38771625 DOI: 10.1002/adma.202403813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/30/2024] [Indexed: 05/22/2024]
Abstract
Infection diseases are a major threat to global public health, with nosocomial infections being of particular concern. In this context, antimicrobial coatings emerge as a promising prophylactic strategy to reduce the transmission of pathogens and control infections. Here, antimicrobial door handle covers to prevent cross-contamination are prepared by incorporating iodine-loaded UiO-66 microparticles into a potentially biodegradable polyurethane polymer (Baycusan eco E 1000). These covers incorporate MOF particles that serve as both storage reservoirs and delivery systems for the biocidal iodine. Under realistic touching conditions, the door handle covers completely inhibit the transmission of Gram-positive bacterial species (Staphylococcus aureus, and Enterococcus faecalis), Gram-negative bacterial species (Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii), and fungi (Candida albicans). The covers remain effective even after undergoing multiple contamination cycles, after being cleaned, and when tinted to improve discretion and usability. Furthermore, as the release of iodine from the door handle covers follow hindered Fickian diffusion, their antimicrobial lifetime is calculated to be as long as approximately two years. Together, these results demonstrate the potential of these antimicrobial door handle covers to prevent cross-contamination, and underline the efficacy of integrating MOFs into innovative technologies.
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Affiliation(s)
- Javier Fonseca
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Barcelona, 08193, Spain
- Departament de Química, Facultat de Ciències, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, 08193, Spain
| | - Mary Cano-Sarabia
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Barcelona, 08193, Spain
- Departament de Química, Facultat de Ciències, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, 08193, Spain
| | - Pilar Cortés
- Departament de Genètica i Microbiologia, Facultat de Ciències, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, 08193, Spain
| | - Jordi Saldo
- Centre d'Innovació, Recerca i Transferència en Tecnologia dels Aliments (CIRTTA), Departament de Ciència Animal i dels Aliments, Facultat de Veterinària, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, 08193, Spain
| | - David Montpeyó
- Institut de Biotecnologia i Biomedicina, Departament de Bioquímica i de Biologia Molecular, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, 08193, Spain
| | - Julia Lorenzo
- Institut de Biotecnologia i Biomedicina, Departament de Bioquímica i de Biologia Molecular, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, 08193, Spain
- Centro de Investigación Biomédica en Red, Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Cerdanyola del Vallès, Barcelona, 08193, Spain
| | - Montserrat Llagostera
- Departament de Genètica i Microbiologia, Facultat de Ciències, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, 08193, Spain
| | - Inhar Imaz
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Barcelona, 08193, Spain
| | - Daniel Maspoch
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and The Barcelona Institute of Science and Technology, Campus UAB, Bellaterra, Barcelona, 08193, Spain
- Departament de Química, Facultat de Ciències, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Barcelona, 08193, Spain
- ICREA, Pg. Lluís Companys 23, Barcelona, 08010, Spain
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Wu Z, Yao Y, Li X, Cai H, Wang G, Yu W, Lou H, Chen Q, Zeng Z, Yu H, Xia J, Yu Y, Zhou H. Sensitive and rapid identification of pathogens by droplet digital PCR in a cohort of septic patients: a prospective diagnostic study. Infect Dis (Lond) 2024:1-12. [PMID: 38753988 DOI: 10.1080/23744235.2024.2354312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND There is a critical need for a rapid and sensitive pathogen detection method for septic patients. This study aimed to investigate the diagnostic efficacy of Digital droplet polymerase chain reaction (ddPCR) in identifying pathogens among suspected septic patients. METHODS We conducted a prospective pilot diagnostic study to clinically validate the multiplex ddPCR panel in diagnosing suspected septic patients. A total of 100 sepsis episodes of 89 patients were included in the study. RESULTS In comparison to blood culture, the ddPCR panel exhibited an overall sensitivity of 75.0% and a specificity of 69.7%, ddPCR yielded an additional detection rate of 17.0% for sepsis cases overall, with a turnaround time of 2.5 h. The sensitivity of ddPCR in the empirical antibiotic treatment and the non-empirical antibiotic treatment group were 78.6% versus 80.0% (p > 0.05). Antimicrobial resistance genes were identified in a total of 13 samples. Whenever ddPCR detected the genes beta-lactamase-Klebsiella pneumoniae carbapenemase (blaKPC) or beta-lactamase-New Delhi metallo (blaNDM), these findings corresponded to the cultivation of carbapenem-resistant gram-negative bacteria. Dynamic ddPCR monitoring revealed a consistent alignment between the quantitative ddPCR results and the trends observed in C-reactive protein and procalcitonin levels. CONCLUSIONS Compared to blood culture, ddPCR exhibited higher sensitivity for pathogen diagnosis in suspected septic patients, and it provided pathogen and drug resistance information in a shorter time. The quantitative results of ddPCR generally aligned with the trends seen in C-reactive protein and procalcitonin levels, indicating that ddPCR can serve as a dynamic monitoring tool for pathogen load in septic patients.
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Affiliation(s)
- Zhenping Wu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yake Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xi Li
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Hongliu Cai
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guobin Wang
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenqiao Yu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Lou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhu Zeng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Yu
- Pilot Gene Technology (Hangzhou) Co., Ltd, Hangzhou, China
| | - Jiang Xia
- Pilot Gene Technology (Hangzhou) Co., Ltd, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Liang Q, Ding S, Chen J, Chen X, Xu Y, Xu Z, Huang M. Prediction of carbapenem-resistant gram-negative bacterial bloodstream infection in intensive care unit based on machine learning. BMC Med Inform Decis Mak 2024; 24:123. [PMID: 38745177 PMCID: PMC11095031 DOI: 10.1186/s12911-024-02504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Predicting whether Carbapenem-Resistant Gram-Negative Bacterial (CRGNB) cause bloodstream infection when giving advice may guide the use of antibiotics because it takes 2-5 days conventionally to return the results from doctor's order. METHODS It is a regional multi-center retrospective study in which patients with suspected bloodstream infections were divided into a positive and negative culture group. According to the positive results, patients were divided into the CRGNB group and other groups. We used the machine learning algorithm to predict whether the blood culture was positive and whether the pathogen was CRGNB once giving the order of blood culture. RESULTS There were 952 patients with positive blood cultures, 418 patients in the CRGNB group, 534 in the non-CRGNB group, and 1422 with negative blood cultures. Mechanical ventilation, invasive catheterization, and carbapenem use history were the main high-risk factors for CRGNB bloodstream infection. The random forest model has the best prediction ability, with AUROC being 0.86, followed by the XGBoost prediction model in bloodstream infection prediction. In the CRGNB prediction model analysis, the SVM and random forest model have higher area under the receiver operating characteristic curves, which are 0.88 and 0.87, respectively. CONCLUSIONS The machine learning algorithm can accurately predict the occurrence of ICU-acquired bloodstream infection and identify whether CRGNB causes it once giving the order of blood culture.
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Affiliation(s)
- Qiqiang Liang
- General Intensive Care Unit and Key Laboratory of Multiple Organ Failure, China National Ministry of Education, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 1511, Jianghong Road, Bingjiang District, Hangzhou, Zhejiang, China
| | - Shuo Ding
- General Intensive Care Unit and Key Laboratory of Multiple Organ Failure, China National Ministry of Education, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 1511, Jianghong Road, Bingjiang District, Hangzhou, Zhejiang, China
| | - Juan Chen
- General Intensive Care Unit and Key Laboratory of Multiple Organ Failure, China National Ministry of Education, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 1511, Jianghong Road, Bingjiang District, Hangzhou, Zhejiang, China
| | - Xinyi Chen
- General Intensive Care Unit and Key Laboratory of Multiple Organ Failure, China National Ministry of Education, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 1511, Jianghong Road, Bingjiang District, Hangzhou, Zhejiang, China
| | - Yongshan Xu
- General Intensive Care Unit and Key Laboratory of Multiple Organ Failure, China National Ministry of Education, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 1511, Jianghong Road, Bingjiang District, Hangzhou, Zhejiang, China
| | - Zhijiang Xu
- Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Man Huang
- General Intensive Care Unit and Key Laboratory of Multiple Organ Failure, China National Ministry of Education, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 1511, Jianghong Road, Bingjiang District, Hangzhou, Zhejiang, China.
- Laboratory Chief, Key Laboratory of Multiple Organ Failure, China National Ministry of Education, Hangzhou, Zhejiang, China.
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Clodi-Seitz T, Baumgartner S, Turner M, Mader T, Hind J, Wenisch C, Zoufaly A, Presterl E. Point-of-Care Method T2Bacteria ®Panel Enables a More Sensitive and Rapid Diagnosis of Bacterial Blood Stream Infections and a Shorter Time until Targeted Therapy than Blood Culture. Microorganisms 2024; 12:967. [PMID: 38792796 PMCID: PMC11124434 DOI: 10.3390/microorganisms12050967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 04/25/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Rapid diagnosis and identification of pathogens are pivotal for appropriate therapy of blood stream infections. The T2Bacteria®Panel, a culture-independent assay for the detection of Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa in blood, was evaluated under real-world conditions as a point-of-care method including patients admitted to the internal medicine ward due to suspected blood stream infection. METHODS Patients were assigned to two groups (standard of care-SOC vs. T2). In the SOC group 2 × 2 blood culture samples were collected, in the T2 group the T2Bacteria®Panel was performed additionally for pathogen identification. RESULTS A total of 94 patients were included. Pathogens were detected in 19 of 50 patients (38%) in the T2 group compared to 16 of 44 patients (36.4%) in the SOC group. The median time until pathogen detection was significantly shorter in the T2 group (4.5 h vs. 60 h, p < 0.001), as well as the time until targeted therapy (antibiotic with the narrowest spectrum and maximal effectiveness) (6.4 h vs. 42.2 h, p = 0.043). CONCLUSIONS The implementation of the T2Bacteria®Panel for patients with sepsis leads to an earlier targeted antimicrobial therapy resulting in earlier sufficient treatment and decreased excessive usage of broad-spectrum antimicrobials.
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Affiliation(s)
- Tamara Clodi-Seitz
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Sebastian Baumgartner
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Michael Turner
- Department of Rheumatology and Osteology, Klinik Favoriten, 1100 Vienna, Austria
| | - Theresa Mader
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Julian Hind
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Christoph Wenisch
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
| | - Alexander Zoufaly
- Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, 1100 Vienna, Austria
- Faculty of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria
| | - Elisabeth Presterl
- Department of Hospital Epidemiology and Infection Control, Medical University of Vienna, 1090 Vienna, Austria
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Liu Y, Li F, Fang Y, Zhong Q, Xiao Y, Zheng Y, Zhu J, Zhao C, Cao X, Xiong J, Hu L. Clinical Characteristics, Prognosis and Treatment of Bloodstream Infections with Enterobacter Cloacae Complex in a Chinese Tertiary Hospital: A Retrospective Study. Infect Drug Resist 2024; 17:1811-1825. [PMID: 38741943 PMCID: PMC11090197 DOI: 10.2147/idr.s460744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
Objective This research aimed to analyze the clinical characteristics, prognosis, and antimicrobial treatment of bloodstream infections (BSI) caused by Enterobacter cloacae complex (ECC). Methods The clinical data of patients with bloodstream infections caused by Enterobacter cloacae complex from April 2017 to June 2023 were collected retrospectively. These data were then analyzed in subgroups based on the detection results of extended-spectrum β-lactamase (ESBL), 30-day mortality, and the type of antimicrobial agent used (β-lactam/β-lactamase inhibitor combinations (BLICs) or carbapenems). Results The proportion of ESBL-producing Enterobacter cloacae complex was 32.5% (37/114). Meanwhile, ICU admission, receiving surgical treatment within 3 months, and biliary tract infection were identified as risk factors for ESBL-producing ECC-BSI. Additionally, immunocompromised status and Sequential Organ Failure Assessment (SOFA) score ≥ 6.0 were identified as independent risk factors of 30-day mortality in patients with ECC-BSI (n = 108). Further analysis in BSI patients caused by non-ESBL-producing ECC revealed that patients treated with BLICs (n = 45) had lower SOFA scores and lower incidence of hypoproteinemia and sepsis compared with patients treated with carbapenems (n = 20). Moreover, in non-ESBL-producing ECC-BSI patients, the univariate Cox regression analysis indicated a significantly lower 30-day mortality rate in patients treated with BLICs compared to those treated with carbapenems (hazard ratios (HR) [95% CI] 0.190 [0.055-0.662], P = 0.009; adjusted HR [95% CI] 0.106 [0.013-0.863], P = 0.036). Conclusion This study investigated the factors influencing the susceptibility to infection by ESBL-producing strains and risk factors for 30-day mortality in ECC-BSI patients. The results revealed that ESBL-negative ECC-BSI patients treated with BLICs exhibited significantly lower 30-day mortality compared to those treated with carbapenems. BLICs were found to be more effective in ECC-BSI patients with milder disease (ESBL-negative and SOFA ≤6.0).
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Affiliation(s)
- Yanhua Liu
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Fuxing Li
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Youling Fang
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Qiaoshi Zhong
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Yanping Xiao
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Yunwei Zheng
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Junqi Zhu
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Chuwen Zhao
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Xingwei Cao
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Jianqiu Xiong
- Department of Nursing, the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
| | - Longhua Hu
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People’s Republic of China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China
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Liporaci F, Carlotti D, Carlotti A. A machine learning model for the early diagnosis of bloodstream infection in patients admitted to the pediatric intensive care unit. PLoS One 2024; 19:e0299884. [PMID: 38691554 PMCID: PMC11062549 DOI: 10.1371/journal.pone.0299884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/16/2024] [Indexed: 05/03/2024] Open
Abstract
Bloodstream infection (BSI) is associated with increased morbidity and mortality in the pediatric intensive care unit (PICU) and high healthcare costs. Early detection and appropriate treatment of BSI may improve patient's outcome. Data on machine-learning models to predict BSI in pediatric patients are limited and neither study included time series data. We aimed to develop a machine learning model to predict an early diagnosis of BSI in patients admitted to the PICU. This was a retrospective cohort study of patients who had at least one positive blood culture result during stay at a PICU of a tertiary-care university hospital, from January 1st to December 31st 2019. Patients with positive blood culture results with growth of contaminants and those with incomplete data were excluded. Models were developed using demographic, clinical and laboratory data collected from the electronic medical record. Laboratory data (complete blood cell counts with differential and C-reactive protein) and vital signs (heart rate, respiratory rate, blood pressure, temperature, oxygen saturation) were obtained 72 hours before and on the day of blood culture collection. A total of 8816 data from 76 patients were processed by the models. The machine committee was the best-performing model, showing accuracy of 99.33%, precision of 98.89%, sensitivity of 100% and specificity of 98.46%. Hence, we developed a model using demographic, clinical and laboratory data collected on a routine basis that was able to detect BSI with excellent accuracy and precision, and high sensitivity and specificity. The inclusion of vital signs and laboratory data variation over time allowed the model to identify temporal changes that could be suggestive of the diagnosis of BSI. Our model might help the medical team in clinical-decision making by creating an alert in the electronic medical record, which may allow early antimicrobial initiation and better outcomes.
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Affiliation(s)
- Felipe Liporaci
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Danilo Carlotti
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Ana Carlotti
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Hernández-Pabón JC, Tabares B, Gil Ó, Lugo-Sánchez C, Santana A, Barón A, Firacative C. Candida Non- albicans and Non- auris Causing Invasive Candidiasis in a Fourth-Level Hospital in Colombia: Epidemiology, Antifungal Susceptibility, and Genetic Diversity. J Fungi (Basel) 2024; 10:326. [PMID: 38786681 PMCID: PMC11122357 DOI: 10.3390/jof10050326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Increasingly common and associated with healthcare settings, Candida infections are very important, since some species of this genus can develop antifungal resistance. We contribute data on the epidemiology, antifungal susceptibility, and genetic diversity of Candida non-albicans and non-auris affecting critically ill patients in a fourth-level hospital in Colombia. Ninety-seven isolates causing invasive infections, identified by conventional methods over 18 months, were studied. Data from patients affected by these yeasts, including sex, age, comorbidities, treatment, and outcome, were analysed. The antifungal susceptibility of the isolates was determined, and the ribosomal DNA was sequenced. Candida parapsilosis, Candida tropicalis, Candida glabrata, Candida dubliniensis, and Candida guilliermondii caused 48.5% of all cases of invasive candidiasis. The species were mainly recovered from blood (50%). Patients were mostly men (53.4%), between 18 days and 93 years old, hospitalized in the ICU (70.7%). Overall mortality was 46.6%, but patients in the ICU, using antibiotics, with diabetes mellitus, or with C. glabrata infections were more likely to die. Resistant isolates were identified in C. parapsilosis, C. tropicalis, and C. glabrata. This study provides epidemiological data for the surveillance of emerging Candida species, highlighting their clinical impact, as well as the emergence of antifungal resistance and clonal dispersal.
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Affiliation(s)
- Juan Camilo Hernández-Pabón
- Group MICROS Research Incubator, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia; (J.C.H.-P.); (Ó.G.); (C.L.-S.)
| | - Bryan Tabares
- Unidad de Extensión Hospitalaria, Hospital Universitario Mayor Méderi, Bogota 111411, Colombia;
| | - Óscar Gil
- Group MICROS Research Incubator, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia; (J.C.H.-P.); (Ó.G.); (C.L.-S.)
| | - Carlos Lugo-Sánchez
- Group MICROS Research Incubator, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia; (J.C.H.-P.); (Ó.G.); (C.L.-S.)
| | - Aldair Santana
- Clinical Laboratory and Transfusion Service, Hospital Universitario Mayor Méderi, Bogota 111411, Colombia;
| | - Alfonso Barón
- Department of Medical Clinics, Hospital Universitario Mayor Méderi, Bogota 111411, Colombia;
| | - Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad de Rosario, Bogota 111221, Colombia
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Li F, Zheng Y, Zhao C, Zhu J, Hang Y, Fang Y, Hu L. GC-IMS facilitates identification of carbapenem-resistant Klebsiella pneumoniae in simulated blood cultures. AMB Express 2024; 14:40. [PMID: 38656563 PMCID: PMC11043319 DOI: 10.1186/s13568-024-01708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024] Open
Abstract
This study aimed to identify carbapenem-resistant Klebsiella pneumoniae (CRKP) based on changes in levels of its volatile organic compounds (VOCs) in simulated blood cultures (BCs) using the gas chromatography-ion mobility spectrometry (GC-IMS) technique. A comprehensive analysis of volatile metabolites produced by Klebsiella pneumoniae (K. pneumoniae) in BC bottles was conducted using GC-IMS. Subsequently, the released VOCs were analyzed to examine differences in VOC release between CRKP and carbapenem-susceptible Klebsiella pneumoniae (CSKP). A total of 54 VOCs were detected, of which 18 (6 VOCs found in both monomer and dimer forms) were successfully identified. The VOCs produced by K. pneumoniae in BC bottles (BacT/ALERT® SA) were primarily composed of organic acids, alcohols, esters, and ketones. The content of certain VOCs was significantly different between CRKP and CSKP after the addition of imipenem (IPM). Moreover, the inclusion of carbapenemase inhibitors facilitated the identification of carbapenemase-producing K. pneumoniae based on the variations in VOCs. This study demonstrates the utility of GC-IMS technology in identifying CRKP, and reveals that changes in VOCs are closely related to the growth and metabolism of K. pneumoniae, indicating that they can be leveraged to promote early identification of CRKP bacteremia. However, further in-depth studies and experiments are needed to validate our findings.
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Affiliation(s)
- Fuxing Li
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No.1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yunwei Zheng
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No.1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Chuwen Zhao
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No.1, Nanchang, 330006, Jiangxi, People's Republic of China
- School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Junqi Zhu
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No.1, Nanchang, 330006, Jiangxi, People's Republic of China
- School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Yaping Hang
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No.1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Youling Fang
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No.1, Nanchang, 330006, Jiangxi, People's Republic of China
- School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Longhua Hu
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No.1, Nanchang, 330006, Jiangxi, People's Republic of China.
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Tanzarella ES, Cutuli SL, Lombardi G, Cammarota F, Caroli A, Franchini E, Sancho Ferrando E, Grieco DL, Antonelli M, De Pascale G. Antimicrobial De-Escalation in Critically Ill Patients. Antibiotics (Basel) 2024; 13:375. [PMID: 38667051 PMCID: PMC11047373 DOI: 10.3390/antibiotics13040375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
Antimicrobial de-escalation (ADE) is defined as the discontinuation of one or more antimicrobials in empirical therapy, or the replacement of a broad-spectrum antimicrobial with a narrower-spectrum antimicrobial. The aim of this review is to provide an overview of the available literature on the effectiveness and safety of ADE in critically ill patients, with a focus on special conditions such as anti-fungal therapy and high-risk categories. Although it is widely considered a safe strategy for antimicrobial stewardship (AMS), to date, there has been no assessment of the effect of de-escalation on the development of resistance. Conversely, some authors suggest that prolonged antibiotic treatment may be a side effect of de-escalation, especially in high-risk categories such as neutropenic critically ill patients and intra-abdominal infections (IAIs). Moreover, microbiological documentation is crucial for increasing ADE rates in critically ill patients with infections, and efforts should be focused on exploring new diagnostic tools to accelerate pathogen identification. For these reasons, ADE can be safely used in patients with infections, as confirmed by high-quality and reliable microbiological samplings, although further studies are warranted to clarify its applicability in selected populations.
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Affiliation(s)
- Eloisa Sofia Tanzarella
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
| | - Salvatore Lucio Cutuli
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
| | - Gianmarco Lombardi
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
| | - Fabiola Cammarota
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
| | - Alessandro Caroli
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
| | - Emanuele Franchini
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
| | | | - Domenico Luca Grieco
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
| | - Massimo Antonelli
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
| | - Gennaro De Pascale
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.S.T.); (S.L.C.); (G.L.); (F.C.); (A.C.); (E.F.); (D.L.G.); (M.A.)
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Li Q, Zhou X, Yang R, Shen X, Li G, Zhang C, Li P, Li S, Xie J, Yang Y. Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention - a comprehensive review. Front Public Health 2024; 12:1376513. [PMID: 38601497 PMCID: PMC11004409 DOI: 10.3389/fpubh.2024.1376513] [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: 01/25/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
Intensive care units (ICUs) are specialized environments dedicated to the management of critically ill patients, who are particularly susceptible to drug-resistant bacteria. Among these, carbapenem-resistant Gram-negative bacteria (CR-GNB) pose a significant threat endangering the lives of ICU patients. Carbapenemase production is a key resistance mechanism in CR-GNB, with the transfer of resistance genes contributing to the extensive emergence of antimicrobial resistance (AMR). CR-GNB infections are widespread in ICUs, highlighting an urgent need for prevention and control measures to reduce mortality rates associated with CR-GNB transmission or infection. This review provides an overview of key aspects surrounding CR-GNB within ICUs. We examine the mechanisms of bacterial drug resistance, the resistance genes that frequently occur with CR-GNB infections in ICU, and the therapeutic options against carbapenemase genotypes. Additionally, we highlight crucial preventive measures to impede the transmission and spread of CR-GNB within ICUs, along with reviewing the advances made in the field of clinical predictive modeling research, which hold excellent potential for practical application.
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Affiliation(s)
- Qi Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoshi Zhou
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rou Yang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoyan Shen
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Chengdu Qingbaijiang District People's Hospital, Chengdu, China
| | - Guolin Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Changji Zhang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Pengfei Li
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shiran Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingxian Xie
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yong Yang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Lass-Flörl C, Kanj SS, Govender NP, Thompson GR, Ostrosky-Zeichner L, Govrins MA. Invasive candidiasis. Nat Rev Dis Primers 2024; 10:20. [PMID: 38514673 DOI: 10.1038/s41572-024-00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
Invasive candidiasis is an important fungal disease caused by Candida albicans and, increasingly, non-albicans Candida pathogens. Invasive Candida infections originate most frequently from endogenous human reservoirs and are triggered by impaired host defences. Signs and symptoms of invasive candidiasis are non-specific; candidaemia is the most diagnosed manifestation, with disseminated candidiasis affecting single or multiple organs. Diagnosis poses many challenges, and conventional culture techniques are frequently supplemented by non-culture-based assays. The attributable mortality from candidaemia and disseminated infections is ~30%. Fluconazole resistance is a concern for Nakaseomyces glabratus, Candida parapsilosis, and Candida auris and less so in Candida tropicalis infection; acquired echinocandin resistance remains uncommon. The epidemiology of invasive candidiasis varies in different geographical areas and within various patient populations. Risk factors include intensive care unit stay, central venous catheter use, broad-spectrum antibiotics use, abdominal surgery and immune suppression. Early antifungal treatment and central venous catheter removal form the cornerstones to decrease mortality. The landscape of novel therapeutics is growing; however, the application of new drugs requires careful selection of eligible patients as the spectrum of activity is limited to a few fungal species. Unanswered questions and knowledge gaps define future research priorities and a personalized approach to diagnosis and treatment of invasive candidiasis is of paramount importance.
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Affiliation(s)
- Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, ECMM Excellence Centres of Medical Mycology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Souha S Kanj
- Infectious Diseases Division, and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nelesh P Govender
- Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - George R Thompson
- UC Davis Health Medical Center, Division of Infectious Diseases, Sacramento, CA, USA
| | | | - Miriam Alisa Govrins
- Institute of Hygiene and Medical Microbiology, ECMM Excellence Centres of Medical Mycology, Medical University of Innsbruck, Innsbruck, Austria
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Wang J, Song Y, Liu S, Jang X, Zhang L. Persistent bacteremia caused by Ralstonia pickettii and Microbacterium: a case report. BMC Infect Dis 2024; 24:327. [PMID: 38500029 PMCID: PMC10949731 DOI: 10.1186/s12879-024-09228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/15/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Ralstonia pickettii is a low virulent, gram-negative bacillus that is rarely associated with human infections and may cause bacteremia. Microbacterium species are gram-positive coryneforms that are generally considered as a contaminant in Gram staining of blood cultures, especially when the time to positivity is longer than 48 h. Both these bacterial species are emerging opportunistic pathogens that may occasionally cause serious infections and even life-threatening health conditions. CASE PRESENTATION Here, we report the case of a patient with bacteremia caused by both R. pickettii and Microbacterium. We advocate for providers to order rapid antibiotic susceptibility testing, since our patient's suffered two kinds of rare pathogens with the opposite of drug sensitivity results to imipenem. CONCLUSIONS Our case present a patient suffered septic shock caused by R. pickettii and Microbacterium. Improving the antibiotic management based on the result of antimicrobial susceptibility tests is the key of successful treatment.
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Affiliation(s)
- Jinwen Wang
- Department of Laboratory Medicine, Daqing Oilfield General Hospital, Daqing, China
| | - Yu Song
- Department of Laboratory Medicine, Daqing Oilfield General Hospital, Daqing, China
| | - Siqin Liu
- Department of Laboratory Medicine, Daqing Oilfield General Hospital, Daqing, China
| | - Xudong Jang
- Department of Laboratory Medicine, Daqing Oilfield General Hospital, Daqing, China
| | - Lina Zhang
- Department of Laboratory Medicine, Daqing Oilfield General Hospital, Daqing, China.
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Wang X, Li M, Yang Y, Shang X, Wang Y, Li Y. Clinical significance of inflammatory markers for evaluating disease severity of mixed-pathogen bloodstream infections of both Enterococcus spp. and Candida spp. Heliyon 2024; 10:e26873. [PMID: 38434384 PMCID: PMC10907801 DOI: 10.1016/j.heliyon.2024.e26873] [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: 04/08/2023] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Objective In recent decades, there has been a notable increase in the morbidity and mortality rates linked to bacteremia and candidemia. This study aimed to investigate the clinical significance of inflammatory markers in assessing the disease severity in critically ill patients suffering from mixed-bloodstream infections (BSIs) due to Enterococcus spp. and Candida spp. Methods In this retrospective research, patients diagnosed with BSIs who were admitted to the intensive care unit (ICU) during the period of January 2019 to December 2022 were analyzed. The patients were divided into two groups: a mixed-pathogen BSI group with both Enterococcus spp. and Candida spp., and a single-pathogen BSI group with only Enterococcus spp. The study examined the differences in inflammatory marker levels and disease severity, including Acute Physiology and Chronic Health Evaluation (APACHE) II scores, duration of ICU stay, and 30-day mortality, between the two groups. Furthermore, we sought to scrutinize the potential associations among these aforementioned parameters. Results The neutrophil-to-lymphocyte ratios (NLRs) and levels of plasma C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) in the mixed-pathogen BSI group were higher than those in the single-pathogen BSI group. Spearman's rank correlation analysis showed that NLRs and plasma CRP and IL-6 levels were positively correlated with disease severity in the mixed-pathogen BSI group. Further, the levels of plasma IL-8 and TNF-α were also positively correlated with ICU stay duration and 30-day mortality. In multivariate analysis, plasma CRP and IL-6 levels were independently associated with 30-day mortality. Conclusion Mixed-pathogen BSIs caused by Enterococcus spp. and Candida spp. may give rise to increased NLRs and plasma CRP, IL-6, IL-8, and TNF-α levels in comparison to BSI caused by Enterococcus spp. only, thus leading to elevated disease severity in critically ill patients.
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Affiliation(s)
- Xin Wang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Ming Li
- Department of Clinical Laboratory, The First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Yang Yang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Xueyi Shang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Yonggang Wang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Yan Li
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
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Yuan L, Chen Q, Zhu XY, Lai LM, Zhao R, Liu Y. Evaluation of clinical characteristics and risk factors associated with Chlamydia psittaci infection based on metagenomic next-generation sequencing. BMC Microbiol 2024; 24:86. [PMID: 38481150 PMCID: PMC10935969 DOI: 10.1186/s12866-024-03236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Psittacosis is a zoonosis caused by Chlamydia psittaci, the clinical manifestations of Psittacosis range from mild illness to fulminant severe pneumonia with multiple organ failure. This study aimed to evaluate the clinical characteristics of Chlamydia psittaci infection diagnosed based on metagenomic next-generation sequencing(mNGS), as well as the risk factors affecting the progress of Chlamydia psittaci infection, in order to improve the effect of therapeutics. METHODS We retrospectively analyzed the clinical data of patients infected with chlamydia psittaci in the First Affiliated Hospital of Nanchang University from January 2021 to December 2021. The patient's past medical history, clinical manifestations, laboratory examinations, chest CT results, treatment status, and prognosis data were collected. we also investigated both the pathogenic profile characteristics and the lower respiratory tract microbiota of patients with Chlamydia psittaci pneumonia using mNGS. RESULTS All cases of Chlamydia psittaci in our research have been confirmed by mNGS. Among 46 cases of Chlamydia psittaci pneumonia, Poultry exposure was reported in 35 cases. In severe cases of Chlamydia psittaci pneumonia, Neutrophils, Procalcitonin (PCT), Lactate Dehydrogenase (LDH), Hydroxybutyrate Dehydrogenase (HBDH), Creatine Kinase Isoenzymes-B (CK-MB) and D-Dimer levels were remarkably higher than that of non-severe cases, except for lymphocytes (all P < 0.05). Chest CT scans showed Bilateral (77.8%), multiple lobar lungs (85.2%), pleural effusions (44.4%) involvement in those suffering from severe Chlamydia psittaci pneumonia, whereas its incidence was 0%, 21.1% and 10.5% in non-severe patients, respectively (P < 0.05). Multivariate analysis revealed that higher lymphocyte concentrations (OR 0.836, 95% CI 0.714-0.962, P = 0.041) were the only protective factor for survival. mNGS results indicated that 41.3% of patients (19/46) had suspected coinfections with a coinfection rate of 84.2% (16/19) in the severe group, much higher than that in the non severe group (p < 0.05). No significantly different profiles of lower respiratory tract microbiota diversity were found between non severe group and severe group. CONCLUSION A history of poultry exposure in patients can serve as an important basis for diagnosing Chlamydia psittaci pneumonia, and patients with severe Chlamydia psittaci pneumonia are more likely to develop elevated inflammatory biomarkers as well as elevated cardiac markers. Higher lymphocyte concentrations are protective factors associated with severe C. psittaci pneumonia. The higher proportion of patients with coinfections in our study supports the use of mNGS for comprehensive early detection of respiratory infections in patients with C. psittaci pneumonia.
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Affiliation(s)
- Lei Yuan
- Department of Clinical laboratory, The First Affiliated Hospital of Nanchang University of Nanchang University, Nanchang University, No.17, YongWaiZhengStreet, Nanchang, 330006, China
| | - Qiang Chen
- Department of Clinical laboratory, The First Affiliated Hospital of Nanchang University of Nanchang University, Nanchang University, No.17, YongWaiZhengStreet, Nanchang, 330006, China
| | - Xin Yu Zhu
- Department of Clinical laboratory, The First Affiliated Hospital of Nanchang University of Nanchang University, Nanchang University, No.17, YongWaiZhengStreet, Nanchang, 330006, China
| | - Lan Min Lai
- Department of Clinical laboratory, The First Affiliated Hospital of Nanchang University of Nanchang University, Nanchang University, No.17, YongWaiZhengStreet, Nanchang, 330006, China
| | - Rui Zhao
- Department of Clinical laboratory, The First Affiliated Hospital of Nanchang University of Nanchang University, Nanchang University, No.17, YongWaiZhengStreet, Nanchang, 330006, China.
| | - Yang Liu
- Department of Clinical laboratory, The First Affiliated Hospital of Nanchang University of Nanchang University, Nanchang University, No.17, YongWaiZhengStreet, Nanchang, 330006, China.
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Li X, Wang S, Ma J, Bai SG, Fu SZ. Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock. World J Crit Care Med 2024; 13:88540. [PMID: 38633475 PMCID: PMC11019628 DOI: 10.5492/wjccm.v13.i1.88540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock. AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit. METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited. Patient population characteristics and laboratory data were collected for analysis. RESULTS The study group consisted of 85 (39%) inpatients with bloodstream infection, and the control group consisted of 133 (61%) with negative results or contamination. The percentage decline in platelet counts (PPCs) in patients positive for pathogens [57.1 (41.3-74.6)] was distinctly higher than that in the control group [18.2 (5.1-43.1)] (P < 0.001), whereas the PPCs were not significantly different among those with gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection. Using receiver operating characteristic curves, the area under the curve of the platelet drop rate was 0.839 (95%CI: 0.783-0.895). CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock. However, it cannot identify gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection.
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Affiliation(s)
- Xia Li
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Sheng Wang
- Department of Physiology, Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jun Ma
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Su-Ge Bai
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Su-Zhen Fu
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
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Tsai YW, Zhang B, Chou HY, Chen HJ, Hsu YC, Shiue YL. Clinical impacts of the rapid diagnostic method on positive blood cultures. Lab Med 2024; 55:179-184. [PMID: 37352545 DOI: 10.1093/labmed/lmad057] [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: 06/25/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the impact of short-term incubation (STI) protocol on clinical outcomes of bloodstream infection (BSI) patients. METHODS A total of 1363 positive blood culture records from January 2019 to December 2021 were included. The main clinical outcomes included pathogen identification turnaround time (TAT), antimicrobial susceptibility testing (AST) TAT, and length of total hospital stay. RESULTS The TAT of pathogen identification and AST significantly decreased after implementing the STI protocol (2.2 vs 1.4 days and 3.4 vs 2.5 days, respectively, with P < .001 for both). Moreover, for patients with Gram-negative bacteria (GNB)-infected BSIs, the length of total hospital stay decreased from 31.9 days to 27.1 days, indicating that these patients could be discharged 5 days earlier after implementing the STI protocol (P < .01). CONCLUSION The protocol led to a significant reduction in TAT and improved clinical outcomes, particularly for GNB organisms. The findings suggest that the STI protocol can improve patient outcomes and hospital resource utilization in the management of BSIs.
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Affiliation(s)
- Ya-Wen Tsai
- Center for Integrative Medicine, Tainan City, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, US
| | - Hsiu-Yin Chou
- Center for Integrative Medicine, Tainan City, Taiwan
| | - Hung-Jui Chen
- Division of Infectious Diseases, Department of Internal Medicine, Tainan City, Taiwan
| | - Yu-Chi Hsu
- Information Systems Office, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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Rinaldi M, Gatti M, Tonetti T, Nocera D, Ambretti S, Berlingeri A, Nigrisoli G, Pierucci E, Siniscalchi A, Pea F, Viale P, Giannella M. Impact of a multidisciplinary management team on clinical outcome in ICU patients affected by Gram-negative bloodstream infections: a pre-post quasi-experimental study. Ann Intensive Care 2024; 14:36. [PMID: 38448761 PMCID: PMC10917714 DOI: 10.1186/s13613-024-01271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Bloodstream infections (BSIs) by Gram-negative pathogens play a major role in intensive care patients, both in terms of prevalence and severity, especially if multi-drug resistant pathogens are involved. Early appropriate antibiotic therapy is therefore a cornerstone in the management of these patients, and growing evidence shows that implementation of a multidisciplinary team may improve patients' outcomes. Our aim was to evaluate the clinical and microbiological impact of the application of a multidisciplinary team on critically ill patients. METHODS Pre-post study enrolling critically ill patients with Gram negative bloodstream infection in intensive care unit. In the pre-intervention phase (from January until December 2018) patients were managed with infectious disease consultation on demand, in the post-intervention phase (from January until December 2022) patients were managed with a daily evaluation by a multidisciplinary team composed of intensivist, infectious disease physician, clinical pharmacologist and microbiologist. RESULTS Overall, 135 patients were enrolled during the study period, of them 67 (49.6%) in the pre-intervention phase and 68 (50.4%) in the post-intervention phase. Median age was 67 (58-75) years, sex male was 31.9%. Septic shock, the need for continuous renal replacement therapy and mechanical ventilation at BSI onset were similar in both groups, no difference of multidrug-resistant organisms (MDRO) prevalence was observed. In the post-phase, empirical administration of carbapenems decreased significantly (40.3% vs. 62.7%, p = 0.02) with an increase of appropriate empirical therapy (86.9% vs. 55.2%, p < 0.001) and a decrease of overall antibiotic treatment (12 vs. 16 days, p < 0.001). Despite no differences in delta SOFA and all-cause 30-day mortality, a significant decrease in microbiological failure (10.3% vs. 29.9%, p = 0.005) and a new-onset 30-day MDRO colonization (8.3% vs. 36.6%, p < 0.001) in the post-phase was reported. At multivariable analysis adjusted for main covariates, the institution of a multidisciplinary management team (MMT) was found to be protective both for new MDRO colonization [OR 0.17, 95%CI(0.05-0.67)] and microbiological failure [OR 0.37, 95%CI (0.14-0.98)]. CONCLUSIONS The institution of a MMT allowed for an optimization of antimicrobial treatments, reflecting to a significant decrease in new MDRO colonization and microbiological failure among critically ill patients.
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Affiliation(s)
- Matteo Rinaldi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tommaso Tonetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy.
- Anesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Domenico Nocera
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
| | - Simone Ambretti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy
| | - Andrea Berlingeri
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy
| | - Giacomo Nigrisoli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
| | - Elisabetta Pierucci
- Anesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti, 9, Bologna, 40138, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Lee SY, Park MH, Oh DK, Lim CM. Polymicrobial bloodstream infections per se do not increase mortality compared to monomicrobial bloodstream infections in sepsis patients: a Korean nationwide sepsis cohort study. BMC Infect Dis 2024; 24:285. [PMID: 38443789 PMCID: PMC10913581 DOI: 10.1186/s12879-024-09130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND There is limited information about the outcomes of polymicrobial bloodstream infections in patients with sepsis. We aimed to investigate outcomes of polymicrobial bloodstream infections compared to monomicrobial bloodstream infections. METHODS This study used data from the Korean Sepsis Alliance Registry, a nationwide database of prospective observational sepsis cohort. Adult sepsis patients with bloodstream infections from September 2019 to December 2021 at 20 tertiary or university-affiliated hospitals in South Korea were analyzed. RESULTS Among the 3,823 patients with bloodstream infections, 429 of them (11.2%) had polymicrobial bloodstream infections. The crude hospital mortality of patients with sepsis with polymicrobial bloodstream infection and monomicrobial bloodstream infection was 35.7% and 30.1%, respectively (p = 0.021). However, polymicrobial bloodstream infections were not associated with hospital mortality in the proportional hazard analysis (HR 1.15 [0.97-1.36], p = 0.11). The inappropriate use of antibiotics was associated with increased mortality (HR 1.37 [1.19-1.57], p < 0.001), and source control was associated with decreased mortality (HR 0.51 [0.42-0.62], p < 0.001). CONCLUSIONS Polymicrobial bloodstream infections per se were not associated with hospital mortality in patients with sepsis as compared to monomicrobial bloodstream infections. The appropriate use of antibiotics and source control were associated with decreased mortality in bloodstream infections regardless of the number of microbial pathogens.
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Grants
- 2019E280500, 2020E280700, 2021-10-026 Korea Disease Control and Prevention Agency
- 2019E280500, 2020E280700, 2021-10-026 Korea Disease Control and Prevention Agency
- 2019E280500, 2020E280700, 2021-10-026 Korea Disease Control and Prevention Agency
- 2019E280500, 2020E280700, 2021-10-026 Korea Disease Control and Prevention Agency
- 2019E280500, 2020E280700, 2021-10-026 Korea Disease Control and Prevention Agency
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Affiliation(s)
- Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Mi Hyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
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50
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Kumar A, Raj N, Singh S, Das A, Singh V, Sen M, Agarwal J. A Retrospective Observational Study of the Microbial Etiology and Antimicrobial Susceptibility Patterns of Blood Cultures From ICU Patients at a Healthcare Facility in North India. Cureus 2024; 16:e57356. [PMID: 38694412 PMCID: PMC11061268 DOI: 10.7759/cureus.57356] [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: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Bloodstream infections (BSI) are a leading source of fatalities and morbidity in hospitals. However, the clinical spectrum and antimicrobial resistance differ globally. Identifying the pathogenic spectrum and variations in antibiotic resistance is crucial for controlling BSI and preventing inappropriate antibiotic use. Material and methods This retrospective observational study was conducted at the Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP, India, for one year between June 2022 and June 2023. A total of 669 adult patients' blood cultures were obtained from ICUs. Blood culture was done using a BacT/Alert 3D (BioMérieux SA, Marcy-l'Étoile, France) automated system. Identification of the bacterial as well as fungal isolates was done using matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and the antimicrobial susceptibility profile was analyzed using the VITEK 2 Compact system (BioMérieux SA). Results Of the 669 blood culture samples, 213 (31.8%) showed bacterial or fungal growth. Of these 213 isolates, the most common isolate was coagulase-negative Staphylococci (21.6%), followed by Klebsiella pneumoniae (19.3%) and Acinetobacter spp. (17.8%). The majority of gram-negative bacteria were resistant to most drugs, and vancomycin and linezolid were both effective against the majority of gram-positive bacteria. Conclusion The current study found that septicemia was more frequently caused by gram-negative bacteria than by gram-positive bacteria. Blood cultures are always necessary in cases of suspected septicemia, and once the antimicrobial susceptibility profile of the pathogen causing septicemia has been determined, suitable antimicrobials should be prescribed and used to lower the antimicrobial resistance burden.
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Affiliation(s)
- Amit Kumar
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Nikhil Raj
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Sangeeta Singh
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Anupam Das
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Vikramjeet Singh
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Manodeep Sen
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Jyotsna Agarwal
- Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
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