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Thomas JK, Clark J, Arora V, Burgess DS, Burgess DR, Mynatt RP, VanHoose JD, Wallace KL, Cotner SE. Performance of ePlex® blood culture identification panels in clinical isolates and characterization of antimicrobial stewardship opportunities. Diagn Microbiol Infect Dis 2024; 109:116269. [PMID: 38692201 DOI: 10.1016/j.diagmicrobio.2024.116269] [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: 08/03/2023] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 05/03/2024]
Abstract
We assessed the performance of GenMark's ePlex® Blood Culture Identification (BCID) Panels for overall agreement of organism identification and resistance mechanism detection with standard microbiologic methods. This study included patients with a positive blood culture from May 2020 to January 2021. The primary outcomes were to assess concordance of ePlex® organism identification with standard identification methods and concordance of ePlex® genotypic resistance mechanism detection with standard phenotypic susceptibility testing. Secondary outcomes included panel specific performance and characterization of antimicrobial stewardship opportunities. The overall identification concordance rate in 1276 positive blood cultures was 98.1%. The overall concordance for the presence of resistance markers was 98.2% and concordance for the absence of resistance markers was 100%. A majority of ePlex® results (69.5%) represented opportunities for potential antimicrobial stewardship intervention. High concordance rates between the ePlex® BCID panels and standard identification and susceptibility methods enable utilization of results to guide rapid antimicrobial optimization.
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Affiliation(s)
- Jenni K Thomas
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA
| | - Justin Clark
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Vaneet Arora
- University of Kentucky College of Medicine, Lexington, KY, USA; Department of Pathology and Laboratory Medicine, University of Kentucky HealthCare, Lexington, KY, USA
| | - David S Burgess
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Donna R Burgess
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA; University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Ryan P Mynatt
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA
| | - Jeremy D VanHoose
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA
| | - Katie L Wallace
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA; University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Sarah E Cotner
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA; University of Kentucky College of Pharmacy, Lexington, KY, USA.
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Cui Y, Yi C, Zhang C, Yang C, Wang X, Chen W, Peng Y, Dai J. Risk factors for bloodstream infection among patients admitted to an intensive care unit of a tertiary hospital of Shanghai, China. Sci Rep 2024; 14:12765. [PMID: 38834645 DOI: 10.1038/s41598-024-63594-8] [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: 02/02/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
Blood flow infections (BSIs) is common occurrences in intensive care units (ICUs) and are associated with poor prognosis. The study aims to identify risk factors and assess mortality among BSI patients admitted to the ICU at Shanghai Ruijin hospital north from January 2022 to June 2023. Additionally, it seeks to present the latest microbiological isolates and their antimicrobial susceptibility. Independent risk factors for BSI and mortality were determined using the multivariable logistic regression model. The study found that the latest incidence rate of BSI was 10.11%, the mortality rate was 35.21% and the mean age of patients with BSI was 74 years old. Klebsiella pneumoniae was the predominant bacterial isolate. Logistic multiple regression revealed that tracheotomy, tigecycline, gastrointestinal bleeding, shock, length of hospital stay, age and laboratory indicators (such as procalcitonine and hemoglobin) were independent risk factors for BSI. Given the elevated risk associated with use of tracheotomy and tigecycline, it underscores the importance of the importance of cautious application of tracheostomy and empirical antibiotic management strategies. Meanwhile, the independent risk factors of mortality included cardiovascular disease, length of hospital stay, mean platelet volume (MPV), uric acid levels and ventilator. BSI patients exhibited a significant decrease in platelet count, and MPV emerged as an independent factor of mortality among them. Therefore, continuous monitoring of platelet-related parameters may aid in promptly identifying high-risk patients and assessing prognosis. Moreover, monitoring changes in uric acid levels may serve as an additional tool for prognostic evaluation in BSI patients.
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Affiliation(s)
- Yingchao Cui
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China
| | - Changlin Yi
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China
| | - Chaomin Zhang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China
| | - Chihui Yang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China
| | - Xinyi Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China
| | - Wenkai Chen
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China
| | - Yibing Peng
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China.
| | - Jing Dai
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Second Ruijin ER Road, Shanghai, 200025, China.
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Alonso-Menchén D, Sánchez-Carrillo C, Alcalá L, Soriano-Martín A, Cercenado E, Burillo A, Serrano-Lobo J, Pérez-Latorre L, Muñoz P, Bouza E. Bloodstream infections: trends and evolution of incidence and etiology in a 12-year period (2010-2021). Infect Dis (Lond) 2024; 56:441-450. [PMID: 38407125 DOI: 10.1080/23744235.2024.2320333] [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: 10/26/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION The epidemiological evolution of bloodstream infections (BSIs) in the last decade is not clearly defined. Our aim was to analyze the changes in the workload in our institution and to describe the evolution of the incidence and etiology of BSIs in a 12-year period, including the COVID-19 pandemic. METHODS All blood cultures received in the laboratory of a tertiary general hospital between 2010 and 2021 were analyzed. Bloodstream infection episodes refer to each episode of bacteremia or fungemia in each patient. Incidence rates per 1000 admissions and per 100,000 population were calculated. RESULTS No significant changes in the incidence of BSI episodes/1000 admissions were observed (mean, 31.1), while estimated population-based incidences showed declining trends (mean, 182.8/100,000 inhabitants). There was a slight increase in BSI episodes per 1000 admissions caused by Gram-negatives (mean, 16.6/1000 admissions) and E. coli was the most frequent pathogen (mean, 8.5/1000 admissions). There was no significant rise in episodes caused by ESBL- and carbapenemase-producing E. coli or K. pneumoniae, with a decline in those caused by methicillin-resistant S. aureus. A spike in BSI episodes, fungal BSIs and catheter-related infections was detected in 2020, during the COVID-19 outbreak. CONCLUSIONS No clear increase in the incidence of BSI episodes was detected in our center over this period. Gram-negatives are the most frequent etiology, with no clear rise in antimicrobial resistance phenotypes. The COVID-19 pandemic accounted for a small increase in BSI episodes in 2020, probably related to the increase of catheter-related infections.
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Affiliation(s)
- David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
| | - Luis Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
| | - Ana Soriano-Martín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Emilia Cercenado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Julia Serrano-Lobo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Leire Pérez-Latorre
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Infecciosas-CIBERINFEC, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CIBERES CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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MacPhail A, Dendle C, Slavin M, McQuilten Z. Hospital-acquired bloodstream infections in patients with cancer: current knowledge and future directions. J Hosp Infect 2024; 148:39-50. [PMID: 38490489 DOI: 10.1016/j.jhin.2024.03.002] [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: 12/19/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Patients with cancer experience higher rates of preventable harm from hospital-acquired bloodstream infections (haBSIs) and central-line-associated bloodstream infections (CLABSIs) compared with the general hospital population. The prevention of haBSIs and CLABSIs in patients with cancer is an urgent priority, and requires standardized surveillance and reporting efforts. The application of haBSI and CLABSI definitions, classification systems and surveillance strategies for patients with cancer is complex, and there is wide variation in clinical practice. Existing systems were not designed explicitly for patients with cancer, and have different strengths and weaknesses in the cancer setting. For these reasons, epidemiological estimates of haBSIs and CLABSIs in patients with cancer also require careful interpretation. This complexity can be a barrier to identifying appropriate targets for intervention and reducing preventable harm. This review provides an overview of key concepts and challenges in haBSI surveillance and prevention specific to patients with cancer. In addition, this review summarizes the strengths and weaknesses of commonly used surveillance definitions and denominators in the setting of cancer care; existing surveillance practice; epidemiology of haBSIs and CLABSIs; prevention strategies; and current knowledge gaps. A global collaborative effort to harmonize the surveillance of hospital-acquired infections in patients with cancer would be invaluable to improve the accuracy and utility of existing data, advance efforts to prevent hospital-acquired infections, and improve patient safety.
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Affiliation(s)
- A MacPhail
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Infectious Diseases, Monash Health, Melbourne, Australia
| | - C Dendle
- Department of Infectious Diseases, Monash Health, Melbourne, Australia; School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - M Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Z McQuilten
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Haematology, Monash Health, Clayton, Australia.
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Lee CC, Chen PL, Ho CY, Hong MY, Hung YP, Ko WC. Prompt antimicrobial therapy and source control on survival and defervescence of adults with bacteraemia in the emergency department: the faster, the better. Crit Care 2024; 28:176. [PMID: 38790061 PMCID: PMC11127347 DOI: 10.1186/s13054-024-04963-7] [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: 03/06/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Bacteraemia is a critical condition that generally leads to substantial morbidity and mortality. It is unclear whether delayed antimicrobial therapy (and/or source control) has a prognostic or defervescence effect on patients with source-control-required (ScR) or unrequired (ScU) bacteraemia. METHODS The multicenter cohort included treatment-naïve adults with bacteraemia in the emergency department. Clinical information was retrospectively obtained and etiologic pathogens were prospectively restored to accurately determine the time-to-appropriate antibiotic (TtAa). The association between TtAa or time-to-source control (TtSc, for ScR bacteraemia) and 30-day crude mortality or delayed defervescence were respectively studied by adjusting independent determinants of mortality or delayed defervescence, recognised by a logistic regression model. RESULTS Of the total 5477 patients, each hour of TtAa delay was associated with an average increase of 0.2% (adjusted odds ratio [AOR], 1.002; P < 0.001) and 0.3% (AOR 1.003; P < 0.001) in mortality rates for patients having ScU (3953 patients) and ScR (1524) bacteraemia, respectively. Notably, these AORs were augmented to 0.4% and 0.5% for critically ill individuals. For patients experiencing ScR bacteraemia, each hour of TtSc delay was significantly associated with an average increase of 0.31% and 0.33% in mortality rates for overall and critically ill individuals, respectively. For febrile patients, each additional hour of TtAa was significantly associated with an average 0.2% and 0.3% increase in the proportion of delayed defervescence for ScU (3085 patients) and ScR (1266) bacteraemia, respectively, and 0.5% and 0.9% for critically ill individuals. For 1266 febrile patients with ScR bacteraemia, each hour of TtSc delay respectively was significantly associated with an average increase of 0.3% and 0.4% in mortality rates for the overall population and those with critical illness. CONCLUSIONS Regardless of the need for source control in cases of bacteraemia, there seems to be a significant association between the prompt administration of appropriate antimicrobials and both a favourable prognosis and rapid defervescence, particularly among critically ill patients. For ScR bacteraemia, delayed source control has been identified as a determinant of unfavourable prognosis and delayed defervescence. Moreover, this association with patient survival and the speed of defervescence appears to be augmented among critically ill patients.
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Affiliation(s)
- Ching-Chi Lee
- Clinical Medical Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
- Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
| | - Po-Lin Chen
- Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan
| | - Ching-Yu Ho
- Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, No.57, Sec. 1, Dongmen Road, East Dist., Tainan, 70142, Taiwan
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Ming-Yuan Hong
- Departments of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan
| | - Yuan-Pin Hung
- Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan
- Department of Medicine, Medical College, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, No. 125, Jhongshan Rd., West Central Dist., Tainan City, Taiwan
| | - Wen-Chien Ko
- Division of Infectious Disease, Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
- Department of Medicine, Medical College, National Cheng Kung University, No. 138, Sheng Li Road, 70403, Tainan, Taiwan.
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Leekha S, Robinson GL, Jacob JT, Fridkin S, Shane A, Sick-Samuels A, Milstone AM, Nair R, Perencevich E, Puig-Asensio M, Kobayashi T, Mayer J, Lewis J, Bleasdale S, Wenzler E, Mena Lora AJ, Baghdadi J, Schrank GM, Wilber E, Aldredge AA, Sharp J, Dyer KE, Kendrick L, Ambalam V, Borgetti S, Carmack A, Gushiken A, Patel A, Reddy S, Brown CH, Dantes RB, Harris AD. Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study. BMJ Qual Saf 2024:bmjqs-2023-016831. [PMID: 38782579 DOI: 10.1136/bmjqs-2023-016831] [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: 10/19/2023] [Accepted: 03/01/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Hospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability. METHODS We conducted a cross-sectional study of HOB events at 10 academic and three community hospitals using structured chart review. HOB was defined as a blood culture on or after hospital day 4 with growth of one or more bacterial or fungal organisms. HOB events were stratified by commensal and non-commensal organisms. Medical resident physicians, infectious disease fellows or infection preventionists reviewed charts to determine HOB source, and infectious disease physicians with training in infection prevention/hospital epidemiology rated preventability from 1 to 6 (1=definitely preventable to 6=definitely not preventable) using a structured guide. Ratings of 1-3 were collectively considered 'potentially preventable' and 4-6 'potentially not preventable'. RESULTS Among 1789 HOB events with non-commensal organisms, gastrointestinal (including neutropenic translocation) (35%) and endovascular (32%) were the most common sources. Overall, 636/1789 (36%) non-commensal and 238/320 (74%) commensal HOB events were rated potentially preventable. In logistic regression analysis among non-commensal HOB events, events attributed to intravascular catheter-related infection, indwelling urinary catheter-related infection and surgical site infection had higher odds of being rated preventable while events with neutropenia, immunosuppression, gastrointestinal sources, polymicrobial cultures and previous positive blood culture in the same admission had lower odds of being rated preventable, compared with events without those attributes. Of 636 potentially preventable non-commensal HOB events, 47% were endovascular in origin, followed by gastrointestinal, respiratory and urinary sources; approximately 40% of those events would not be captured through existing healthcare-associated infection surveillance. DISCUSSION Factors identified as associated with higher or lower preventability should be used to guide inclusion, exclusion and risk adjustment for an HOB-related quality metric.
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Affiliation(s)
- Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gwen L Robinson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jesse T Jacob
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Scott Fridkin
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andi Shane
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Anna Sick-Samuels
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Aaron M Milstone
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rajeshwari Nair
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Eli Perencevich
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jeanmarie Mayer
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Julia Lewis
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Susan Bleasdale
- Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Eric Wenzler
- Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Alfredo J Mena Lora
- Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Jonathan Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gregory M Schrank
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Eli Wilber
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amalia A Aldredge
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joseph Sharp
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelly E Dyer
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lea Kendrick
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Viraj Ambalam
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Scott Borgetti
- Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Anna Carmack
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alexis Gushiken
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ashka Patel
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sujan Reddy
- Divison of Healthcare Quality Promotion, Nationation Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Raymund B Dantes
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Divison of Healthcare Quality Promotion, Nationation Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Howard-Anderson J, Morgan DJ. Moving Beyond Central Line-Associated Bloodstream Infections. Ann Intern Med 2024. [PMID: 38768455 DOI: 10.7326/m24-0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Jessica Howard-Anderson
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia (J.H.-A.)
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, and VA Maryland Healthcare System, Baltimore, Maryland (D.J.M.)
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Hsueh SC, Chen PL, Ho CY, Hong MY, Lee CC, Ko WC. Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia. Antibiotics (Basel) 2024; 13:465. [PMID: 38786193 PMCID: PMC11117469 DOI: 10.3390/antibiotics13050465] [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: 04/23/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Although prompt administration of an appropriate antimicrobial therapy (AAT) is crucial for reducing mortality in the general population with community-onset bacteremia, the prognostic effects of delayed AAT in older individuals with febrile and afebrile bacteremia remain unclear. A stepwise and backward logistic regression analysis was used to identify independent predictors of 30-day mortality. In a 7-year multicenter cohort study involving 3424 older patients (≥65 years) with community-onset bacteremia, febrile bacteremia accounted for 27.1% (912 patients). A crucial association of afebrile bacteremia and 30-day mortality (adjusted hazard ratio [AHR], 1.69; p < 0.001) was revealed using Cox regression and Kaplan-Meier curves after adjusting for the independent predictors of mortality. Moreover, each hour of delayed AAT was associated with an average increase of 0.3% (adjusted odds ratio [AOR], 1.003; p < 0.001) and 0.2% (AOR, 1.002; p < 0.001) in the 30-day crude mortality rates among patients with afebrile and febrile bacteremia, respectively, after adjusting for the independent predictors of mortality. Similarly, further analysis based on Cox regression and Kaplan-Meier curves revealed that inappropriate empirical therapy (i.e., delayed AAT administration > 24 h) had a significant prognostic impact, with AHRs of 1.83 (p < 0.001) and 1.76 (p < 0.001) in afebrile and febrile patients, respectively, after adjusting for the independent predictors of mortality. In conclusion, among older individuals with community-onset bacteremia, the dissimilarity of the prognostic impacts of delayed AAT between afebrile and febrile presentation was evident.
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Affiliation(s)
- Shu-Chun Hsueh
- Department of Nursing, Meiho University, Pingtung 912009, Taiwan;
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-L.C.); (M.-Y.H.)
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ching-Yu Ho
- Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, Tainan 70142, Taiwan;
- Department of Nursing, National Tainan Junior College of Nursing, Tainan 700007, Taiwan
| | - Ming-Yuan Hong
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-L.C.); (M.-Y.H.)
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ching-Chi Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-L.C.); (M.-Y.H.)
- Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-L.C.); (M.-Y.H.)
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
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Giménez-Pérez M, Hernández S, Padullés A, Boix-Palop L, Grau S, Badia JM, Ferrer R, Calbo E, Limón E, Pujol M, Horcajada JP. Impact of an antimicrobial stewardship program indicator on the appropriateness of the empiric antibiotic treatment of urinary source Escherichia coli bacteremia. Int J Antimicrob Agents 2024:107202. [PMID: 38768736 DOI: 10.1016/j.ijantimicag.2024.107202] [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: 12/11/2023] [Revised: 04/17/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
A prospective multicenter study was carried out between 2017 and 2021 to assess (1) the appropriateness of the empirical treatment to the local guidelines of urinary source E. coli bacteremia, (2) the appropriateness of empirical treatment to antibiotic sensitivity results, and (3) the degree of error in the local guidelines regarding the antibiotic sensitivity reported in acute care hospitals enrolled in the VINCat program. During the study period, 79.0% of the empirical treatments analyzed complied with the guidelines and 88.1% were appropriate in view of the in vitro activity of the isolated strain. The rate of appropriateness rose from 73.8% in 2017 to 81.0% in 2021 (p<0.001). The degree of error in the recommendations regarding the in vitro activity of the isolated strains was 5.9% and remained stable during the study period. Antibiotic families correctly prescribed according to the guidelines were third-generation cephalosporins (54.9%), carbapenems (16.8%) and combinations of penicillins and beta-lactamase inhibitors (16.4%). Of the 8009 E. coli strains, 19.0% were ESBL producers, 36.8% were resistant to quinolones, and 0.5% were resistant to carbapenems. The broad implementation of an antimicrobial stewardship program with quality indicators of antibiotic use improved compliance to local guidelines in the empiric treatment of urinary tract E. coli bacteremia. The degree of error in local guidelines was low but higher in more complex hospitals and in health-care associated infections. Guidelines need to be constantly updated with the use of epidemiological data, rapid diagnostic tests and the analysis of patient risk factors specific to each geographical area.
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Affiliation(s)
- Montserrat Giménez-Pérez
- Microbiology Department, Laboratori clinic Metropolitana Nord, CIBERES, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
| | - Sergi Hernández
- VINCat Programme Surveillance of Healthcare Related Infections in Catalonia, Departament de Salut, Barcelona, Spain
| | - Ariadna Padullés
- Pharmacy Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Service, Hospital Universitari Mútua de Terrassa, Barcelona, Spain. Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Santiago Grau
- Pharmacy Department, Infectious Diseases Service, Infectious Pathology and Antimicriobials Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Hospital del Mar, Barcelona, Spain
| | - Josep M Badia
- Department of Surgery, Hospital General Granollers; Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute for Research, Barcelona, Spain
| | - Esther Calbo
- Infectious Diseases Service, Hospital Universitari Mútua de Terrassa, Barcelona, Spain. Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Enric Limón
- VINCat Programme Surveillance of Healthcare Related Infections in Catalonia, Departament de Salut, Barcelona, Spain. Department of Public Health, Mental Health and Mother-Infant Nursing, Faculty of Nursing, University of Barcelona, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL. L'Hospitalet de Llobregat, Spain. VINCat Programme Surveillance of Healthcare Related Infections in Catalonia, Departament de Salut, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Juan P Horcajada
- Infectious Diseases Service, Hospital del Mar; Hospital del Mar Research Institute (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
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10
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Guedes M, Gathara D, López-Hernández I, Pérez-Crespo PMM, Pérez-Rodríguez MT, Sousa A, Plata A, Reguera-Iglesias JM, Boix-Palop L, Dietl B, Blanco JS, Castillo CA, Galán-Sánchez F, Kindelán CN, Jover-Saenz A, Aguirre JG, Alemán AA, Ciordia TM, Del Arco Jiménez A, Fernandez-Suarez J, Lopez-Cortes LE, Rodríguez-Baño J. Differences in clinical outcomes of bloodstream infections caused by Klebsiella aerogenes, Klebsiella pneumoniae and Enterobacter cloacae: a multicentre cohort study. Ann Clin Microbiol Antimicrob 2024; 23:42. [PMID: 38711045 DOI: 10.1186/s12941-024-00700-8] [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: 03/03/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Klebsiella aerogenes has been reclassified from Enterobacter to Klebsiella genus due to its phenotypic and genotypic similarities with Klebsiella pneumoniae. It is unclear if clinical outcomes are also more similar. This study aims to assess clinical outcomes of bloodstreams infections (BSI) caused by K. aerogenes, K. pneumoniae and Enterobacter cloacae, through secondary data analysis, nested in PRO-BAC cohort study. METHODS Hospitalized patients between October 2016 and March 2017 with monomicrobial BSI due to K. aerogenes, K. pneumoniae or E. cloacae were included. Primary outcome was a composite clinical outcome including all-cause mortality or recurrence until 30 days follow-up. Secondary outcomes were fever ≥ 72 h, persistent bacteraemia, and secondary device infection. Multilevel mixed-effect Poisson regression was used to estimate the association between microorganisms and outcome. RESULTS Overall, 29 K. aerogenes, 77 E. cloacae and 337 K. pneumoniae BSI episodes were included. Mortality or recurrence was less frequent in K. aerogenes (6.9%) than in E. cloacae (20.8%) or K. pneumoniae (19.0%), but statistical difference was not observed (rate ratio (RR) 0.35, 95% CI 0.08 to 1.55; RR 0.42, 95% CI 0.10 to 1.71, respectively). Fever ≥ 72 h and device infection were more common in K. aerogenes group. In the multivariate analysis, adjusted for confounders (age, sex, BSI source, hospital ward, Charlson score and active antibiotic therapy), the estimates and direction of effect were similar to crude results. CONCLUSIONS Results suggest that BSI caused by K. aerogenes may have a better prognosis than E. cloacae or K. pneumoniae BSI.
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Affiliation(s)
- Mariana Guedes
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain.
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - David Gathara
- London School of Hygiene and Tropical Medicine, MARCH Centre, London, UK
| | - Inmaculada López-Hernández
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - María Teresa Pérez-Rodríguez
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Complexo Hospitalario Universitario de Vigo/Galicia Sur Health Research Institute, Vigo, Spain
| | - Adrian Sousa
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Complexo Hospitalario Universitario de Vigo/Galicia Sur Health Research Institute, Vigo, Spain
| | - Antonio Plata
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA Málaga, Málaga, Spain
| | - Jose María Reguera-Iglesias
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA Málaga, Málaga, Spain
| | - Lucía Boix-Palop
- Servicio de Enfermedades Infecciosas, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Beatriz Dietl
- Servicio de Enfermedades Infecciosas, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Juan Sevilla Blanco
- Unidad de Enfermedades Infecciosas y Microbiologia Clinica, Hospital Universitario Jerez De La Frontera, Jerez De La Frontera, Cádiz, Spain
| | - Carlos Armiñanzas Castillo
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Fátima Galán-Sánchez
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Clara Natera Kindelán
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofia, Cordoba, Spain
| | - Alfredo Jover-Saenz
- Unidad de Infección Nosocomial, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - Ana Alemán Alemán
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario de Burgos, Burgos, Spain
| | - Teresa Marrodán Ciordia
- Departamento de Microbiología Clínica, Complejo Asistencial Universitario de León (CAULE), León, Spain
| | - Alfonso Del Arco Jiménez
- Grupo Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Spain
| | - Jonathan Fernandez-Suarez
- Unidad de Microbiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Eduardo Lopez-Cortes
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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11
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Theophanous R, Ramos J, Calland AR, Krcmar R, Shah P, da Matta LT, Shaheen S, Wrenn RH, Seidelman J. Blood culture algorithm implementation in emergency department patients as a diagnostic stewardship intervention. Am J Infect Control 2024:S0196-6553(24)00472-3. [PMID: 38719159 DOI: 10.1016/j.ajic.2024.04.198] [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: 03/06/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Blood cultures (BCx) are important for selecting appropriate antibiotic treatment. Ordering BCx for conditions with a low probability of bacteremia has limited utility, thus improved guidance for ordering BCx is needed. Inpatient studies have implemented BCx algorithms, but no studies examine the intervention in an Emergency Department (ED) setting. METHODS We performed a quasi-experimental pre and postintervention study from January 12, 2020, to October 31, 2023, at a single academic adult ED and implemented a BCx algorithm. The primary outcome was the blood culture event rates (BCE per 100 ED admissions) pre and postintervention. Secondary outcomes included adverse event rates (30-day ED and hospital readmission and antibiotic days of therapy). Seven ED physicians and APP reviewed BCx for appropriateness, with monthly feedback provided to ED leadership and physicians. RESULTS After the BCx algorithm implementation, the BCE rate decreased from 12.17 BCE/100 ED admissions to 10.50 BCE/100 ED admissions. Of the 3,478 reviewed BCE, we adjudicated 2,153 BCE (62%) as appropriate, 653 (19%) as inappropriate, and 672 (19%) as uncertain. Adverse safety events were not statistically different pre and postintervention. CONCLUSIONS Implementation of an ED BCx algorithm demonstrated a reduction in BCE, without increased adverse safety events. Future studies should compare outcomes of BCx algorithm implementation in a community hospital ED without intensive chart review.
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Affiliation(s)
- Rebecca Theophanous
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - John Ramos
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Alyssa R Calland
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Rachel Krcmar
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Priya Shah
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Lucas T da Matta
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Stephen Shaheen
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC
| | - Rebekah H Wrenn
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC
| | - Jessica Seidelman
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC.
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12
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Kim KJ, Yun SG, Cho Y, Lee CK, Nam MH. Rapid Direct Identification of Microbial Pathogens and Antimicrobial Resistance Genes in Positive Blood Cultures Using a Fully Automated Multiplex PCR Assay. J Korean Med Sci 2024; 39:e157. [PMID: 38711319 DOI: 10.3346/jkms.2024.39.e157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
This study assessed the performance of the BioFire Blood Culture Identification 2 (BCID2) panel in identifying microorganisms and antimicrobial resistance (AMR) profiles in positive blood cultures (BCs) and its influence on turnaround time (TAT) compared with conventional culture methods. We obtained 117 positive BCs, of these, 102 (87.2%) were correctly identified using BCID2. The discordance was due to off-panel pathogens detected by culture (n = 13), and additional pathogens identified by BCID2 (n = 2). On-panel pathogen concordance between the conventional culture and BCID2 methods was 98.1% (102/104). The conventional method detected 19 carbapenemase-producing organisms, 14 extended-spectrum beta-lactamase-producing Enterobacterales, 18 methicillin-resistant Staphylococcus spp., and four vancomycin-resistant Enterococcus faecium. BCID2 correctly predicted 53 (96.4%) of 55 phenotypic resistance patterns by detecting AMR genes. The TAT for BCID2 was significantly lower than that for the conventional method. BCID2 rapidly identifies pathogens and AMR genes in positive BCs.
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Affiliation(s)
- Keun Ju Kim
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seung Gyu Yun
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yunjung Cho
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Kyu Lee
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Myung-Hyun Nam
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea.
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13
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Riestra SDLR, Pérez-Crespo PMM, Rodríguez MTP, Sousa A, Goikoetxea J, Iglesias JMR, Armiñanzas C, López-Hernández I, López-Cortés LE, Rodríguez-Baño J. Mortality impact of further delays in active targeted antibiotic therapy in bacteraemic patients that did not receive initial active empiric treatment: results from the prospective, multicentre cohort PROBAC. Int J Infect Dis 2024:107072. [PMID: 38701915 DOI: 10.1016/j.ijid.2024.107072] [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: 01/18/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES The early initiation of the empirical antibiotic treatment and its impact on mortality in patients with bacteraemia has been extensively studied. However, information on the impact of precocity of the targeted antibiotic treatment is scarce. We aimed to study the impact of further delay in active antibiotic therapy on 30-day mortality among patients with bloodstream infection (BSI) who had not received appropriate empirical therapy. DESIGN We worked with PROBAC cohort (prospective and compound by patients from 26 different Spanish hospitals). We selected a total of 1703 patients, who survived to day 2 without having received any active antibiotic therapy against the causative pathogen. RESULTS The 30-day mortality was 14% (238 patients). The adjusted odds of mortality increased for every day of delay, from 1.53 (95% CI 1.13-2.08) for day 3 or after to 11.38 (95% CI 7.95-16.38) for day 6 or after. CONCLUSIONS We concluded that among patients who had not received active treatment within the first two days of blood culture collection, additional delays in active targeted therapy were associated with increased mortality. These results emphasize the importance of active interventions in the management of patients with bloodstream infections.
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Affiliation(s)
- Sandra De la Rosa Riestra
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS); Hospital Universitario Virgen Macarena; Departamento de Medicina, Universidad de Sevilla; CSIC, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | | | | | | | | | | | | | - Inmaculada López-Hernández
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS); Hospital Universitario Virgen Macarena; Departamento de Medicina, Universidad de Sevilla; CSIC, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis E López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS); Hospital Universitario Virgen Macarena; Departamento de Medicina, Universidad de Sevilla; CSIC, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS); Hospital Universitario Virgen Macarena; Departamento de Medicina, Universidad de Sevilla; CSIC, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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14
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Nahra R, Darvish S, Gandhi S, Gould S, Floyd D, Devine K, Fraimow H, Dibato JE, Rachoin JS. Impact of Povidone Application to Nares in Addition to Chlorhexidine Bath in Critically Ill Patients on Nosocomial Bacteremia and Central Line Blood Stream Infection. J Clin Med 2024; 13:2647. [PMID: 38731176 PMCID: PMC11084507 DOI: 10.3390/jcm13092647] [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: 03/11/2024] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention.
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Affiliation(s)
- Raquel Nahra
- Division of Infectious Diseases, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA;
- Division of Critical Care Medicine, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
- Department of Infection Prevention, Cooper University Healthcare, Camden, NJ 08103, USA;
| | - Shahrzad Darvish
- Department of Infection Prevention, Cooper University Healthcare, Camden, NJ 08103, USA;
| | - Snehal Gandhi
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
- Division of Hospital Medicine, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA
| | | | - Diane Floyd
- Department of Nursing, Cooper University Healthcare, Camden, NJ 08103, USA
| | - Kathy Devine
- Department of Nursing, Cooper University Healthcare, Camden, NJ 08103, USA
| | - Henry Fraimow
- Division of Infectious Diseases, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA;
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
| | - John E. Dibato
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
- Cooper University Healthcare, Camden, NJ 08103, USA
| | - Jean-Sebastien Rachoin
- Division of Critical Care Medicine, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
- Division of Hospital Medicine, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA
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15
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Słabisz N, Leśnik P, Żybura-Wszoła K, Dudek-Wicher R, Nawrot U, Majda J. Assessing the Interpretation of Molecular Test Results in the Diagnosis of Bloodstream Infections. Diagnostics (Basel) 2024; 14:915. [PMID: 38732329 PMCID: PMC11083173 DOI: 10.3390/diagnostics14090915] [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: 03/12/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
A retrospective study at the 4th Military Clinical Hospital in Wroclaw, Poland, assessed PCR testing alongside blood cultures to guide antimicrobial therapy decisions in hospitalized patients, to determine how much time the results of the molecular tests preceded conventional methods. Among 118 patients, Staphylococcus aureus (37%) and Escherichia coli (21%) were the most common bloodstream infection agents. Blood cultures utilized the BacT/ALERT 3D system, and molecular diagnostics were conducted using the FilmArray platform with the BIOFIRE BCID2 panel. Methicillin susceptibility was observed in 66% of S. aureus strains, while 26% of Gram-negative bacilli exhibited an ESBL phenotype. Therapeutic decisions based on molecular test results were often incorrect for S. aureus infections, particularly MSSA (64.5%), but generally accurate for Gram-negative bacilli. The median times from positive blood culture to BCID2 and pathogen identification/susceptibility were 10 h and 52 h, respectively. Molecular diagnostics facilitated faster initiation of appropriate antibiotic therapy, highlighting the need to educate medical staff on proper interpretation. Consulting within an antimicrobial stewardship program (ASP) could enhance the benefits of implementing molecular methods in bloodstream infection diagnostics.
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Affiliation(s)
- Natalia Słabisz
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
| | - Patrycja Leśnik
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, 50-386 Wroclaw, Poland;
| | - Katarzyna Żybura-Wszoła
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
| | - Ruth Dudek-Wicher
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (R.D.-W.); (U.N.)
| | - Urszula Nawrot
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (R.D.-W.); (U.N.)
| | - Jacek Majda
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
- Department of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and Technology, 58-376 Wroclaw, Poland
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16
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Yuan F, Li M, Wang X, Fu Y. Risk factors and mortality of carbapenem-resistant Pseudomonas aeruginosa bloodstream infection in hematology department: a ten-year retrospective study. J Glob Antimicrob Resist 2024:S2213-7165(24)00070-5. [PMID: 38615882 DOI: 10.1016/j.jgar.2024.03.018] [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: 12/31/2023] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE This study aims to investigate the risk factors for carbapenem-resistant Pseudomonas aeruginosa bloodstream infection (CRPA-BSI) and identify predictors of outcomes among patients with P. aeruginosa bloodstream infection (PA-BSI). METHODS A retrospective cohort study was conducted on patients with PA-BSI at Henan Cancer Hospital from 2013 to 2022. RESULTS Among the 503 incidences analyzed, 15.1% of them were CRPA strains. Age, ANC<100/mmc, receiving antifungal prophylaxis, exposure to carbapenems within the previous 90 days to onset of BSI, and allogeneic HSCT (allo-HSCT) were associated with the development of CRPA-BSI. CRPA-BSI patients experienced significantly higher 28-day mortality rates compared to those with carbapenem-susceptible P. aeruginosa bloodstream infection (CSPA-BSI). Multivariate logistic regression analysis identified age at BSI, active stage of hematological disease, procalcitonin levels, prior corticosteroid treatment, isolation of CRPA, and septic shock as independent predictors of 28-day mortality. CONCLUSION Risk factors for CRPA-BSI include age, ANC <100/mmc, antifungal prophylaxis, exposure to carbapenems, and allo-HSCT. Additionally, age at BSI, active hematological disease, procalcitonin levels, prior corticosteroid treatment, CRPA isolation, and septic shock contribute to increased mortality rates among patients with PA-BSI.
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Affiliation(s)
- Fangfang Yuan
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University& Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Minghui Li
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University& Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Xiaokun Wang
- Department of Laboratory Science, The Affiliated Cancer Hospital of Zhengzhou University& Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Yuewen Fu
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University& Henan Cancer Hospital, Zhengzhou, People's Republic of China.
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17
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Harboe-Sjåvik H, Endresen KH, Åsheim S, Sundsfjord A. FilmArray (BCID2) provides essential and timely results in bloodstream infections in small acute care hospitals without conventional microbiology services. APMIS 2024; 132:267-276. [PMID: 38214228 DOI: 10.1111/apm.13374] [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: 07/25/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024]
Abstract
We have evaluated the performance of FilmArray BCID2 in reactive blood cultures in a small acute care hospital compared to conventional diagnostics at a regional microbiological laboratory. This is a retrospective observational study of BactAlert reactive blood cultures (n = 160) from Helgeland Hospital, July-December 2021, analysed by BCID2 locally and conventional culture at a regional laboratory. The overall clinical and analytic sensitivity with BCID2 were 87.2% and 97.8%, respectively. The false-negative BCID2 rate was low (n = 4; 2.9%). No false-positive BCID2 results were observed. The BCID2 data were available on average 1.88 days earlier than culture-based results, due to long transport time to the regional laboratory. The BCID2 provided results to support a significantly earlier optimized targeted antibiotic treatment in 27% of the cases according to national guidelines for empirical treatment of BSI. The high clinical and analytical sensitivity, and specificity support the use of BCID2 as a robust supplement to traditional cultivation of positive blood cultures. The significant time gain to microbial identification and detection of resistance determinants suggests a great clinical importance of BCID2 in small acute care hospitals with long transport time to conventional clinical microbiology services.
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Affiliation(s)
- Hege Harboe-Sjåvik
- Department of Health Care Quality and Research, Helgeland Hospital Trust, Mo i Rana, Norway
| | | | - Sandra Åsheim
- Department of Microbiology, Nordland Hospital Trust, Bodø, Norway
| | - Arnfinn Sundsfjord
- Host-Microbe-Interaction Research Group, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
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18
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Abe R, Ram-Mohan N, Yang S. Re-visiting humoral constitutive antibacterial heterogeneity in bloodstream infections. THE LANCET. INFECTIOUS DISEASES 2024; 24:e245-e251. [PMID: 37944543 DOI: 10.1016/s1473-3099(23)00494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 11/12/2023]
Abstract
Although cellular immunity has garnered much attention in the era of single-cell technologies, humoral innate immunity has receded in priority due to its presumed limited roles. Hence, despite the long-recognised bactericidal activity of serum-a functional characteristic of constitutive humoral immunity-much remains unclear regarding mechanisms underlying its inter-individual heterogeneity and clinical implications in bloodstream infections. Recent work suggests that the immediate antimicrobial effect of humoral innate immunity contributes to suppression of the excessive inflammatory responses to infection by reducing the amount of pathogen-associated molecular patterns. In this Personal View, we propose the need to re-explore factors underlying the inter-individual heterogeneity in serum antibacterial competence as a new approach to better understand humoral innate immunity and revisit the clinical use of measuring serum antibacterial activity in the management of bacterial bloodstream infections. Given the current emphasis on subtyping sepsis, a serum bactericidal assay might prove useful in defining a distinct sepsis endotype, to enable more personalised management.
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Affiliation(s)
- Ryuichiro Abe
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nikhil Ram-Mohan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Samuel Yang
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
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19
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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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20
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Mondal U, Warren E, Bookstaver PB, Kohn J, Al-Hasan MN. Incidence and predictors of complications in Gram-negative bloodstream infection. Infection 2024:10.1007/s15010-024-02202-3. [PMID: 38436912 DOI: 10.1007/s15010-024-02202-3] [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: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The incidence of metastatic complications in Gram-negative bloodstream infection (GN-BSI) remains undefined. This retrospective cohort study examines the incidence and predictors of complications within 90 days of GN-BSI. METHODS Patients with GN-BSIs hospitalized at two Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from 1 January 2012 through 30 June 2015 were included. Complications of GN-BSI included endocarditis, septic arthritis, osteomyelitis, spinal infections, deep-seated abscesses, and recurrent GN-BSI. Kaplan-Meier analysis and multivariate Cox proportional hazards regression were used to examine incidence and risk factors of complications, respectively. RESULTS Among 752 patients with GN-BSI, median age was 66 years and 380 (50.5%) were women. The urinary tract was the most common source of GN-BSI (378; 50.3%) and Escherichia coli was the most common bacteria (375; 49.9%). Overall, 13.9% of patients developed complications within 90 days of GN-BSI. The median time to identification of these complications was 5.2 days from initial GN-BSI. Independent risk factors for complications were presence of indwelling prosthetic material (hazards ratio [HR] 1.73, 95% confidence intervals [CI] 1.08-2.78), injection drug use (HR 6.84, 95% CI 1.63-28.74), non-urinary source (HR 1.98, 95% CI 1.18-3.23), BSI due to S. marcescens, P. mirabilis or P. aeruginosa (HR 1.78, 95% CI 1.05-3.03), early clinical failure criteria (HR 1.19 per point, 95% CI 1.03-1.36), and persistent GN-BSI (HR 2.97, 95% CI 1.26-6.99). CONCLUSIONS Complications of GN-BSI are relatively common and may be predicted based on initial clinical response to antimicrobial therapy, follow-up blood culture results, and other host and microbiological factors.
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Affiliation(s)
- Utpal Mondal
- Department of Medicine, Division of Infectious Diseases, Audie L. Murphy VA Medical Center, San Antonio, TX, USA
- Department of Medicine, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Erin Warren
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - P Brandon Bookstaver
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
- Department of Clinical Pharmacy and Outcomes Science, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health-Midlands, Columbia, SC, USA
| | - Majdi N Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health-Midlands, Columbia, SC, USA.
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21
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Qi Z, Dong L, Lin J, Duan M. Development and validation a nomogram prediction model for early diagnosis of bloodstream infections in the intensive care unit. Front Cell Infect Microbiol 2024; 14:1348896. [PMID: 38500500 PMCID: PMC10946253 DOI: 10.3389/fcimb.2024.1348896] [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: 12/03/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose This study aims to develop and validate a nomogram for predicting the risk of bloodstream infections (BSI) in critically ill patients based on their admission status to the Intensive Care Unit (ICU). Patients and methods Patients' data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database (training set), the Beijing Friendship Hospital (BFH) database (validation set) and the eICU Collaborative Research Database (eICU-CRD) (validation set). Univariate logistic regression analyses were used to analyze the influencing factors, and lasso regression was used to select the predictive factors. Model performance was assessed using area under receiver operating characteristic curve (AUROC) and Presented as a Nomogram. Various aspects of the established predictive nomogram were evaluated, including discrimination, calibration, and clinical utility. Results The model dataset consisted of 14930 patients (1444 BSI patients) from the MIMIC-IV database, divided into the training and internal validation datasets in a 7:3 ratio. The eICU dataset included 2100 patients (100 with BSI) as the eICU validation dataset, and the BFH dataset included 419 patients (21 with BSI) as the BFH validation dataset. The nomogram was constructed based on Glasgow Coma Scale (GCS), sepsis related organ failure assessment (SOFA) score, temperature, heart rate, respiratory rate, white blood cell (WBC), red width of distribution (RDW), renal replacement therapy and presence of liver disease on their admission status to the ICU. The AUROCs were 0.83 (CI 95%:0.81-0.84) in the training dataset, 0.88 (CI 95%:0.88-0.96) in the BFH validation dataset, and 0.75 (95%CI 0.70-0.79) in the eICU validation dataset. The clinical effect curve and decision curve showed that most areas of the decision curve of this model were greater than 0, indicating that this model has a certain clinical effectiveness. Conclusion The nomogram developed in this study provides a valuable tool for clinicians and nurses to assess individual risk, enabling them to identify patients at a high risk of bloodstream infections in the ICU.
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Affiliation(s)
| | | | | | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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22
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Liu R, Li X, Liu Y, Du L, Zhu Y, Wu L, Hu B. A high-speed microscopy system based on deep learning to detect yeast-like fungi cells in blood. Bioanalysis 2024; 16:289-303. [PMID: 38334080 DOI: 10.4155/bio-2023-0193] [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] [Indexed: 02/10/2024] Open
Abstract
Background: Blood-invasive fungal infections can cause the death of patients, while diagnosis of fungal infections is challenging. Methods: A high-speed microscopy detection system was constructed that included a microfluidic system, a microscope connected to a high-speed camera and a deep learning analysis section. Results: For training data, the sensitivity and specificity of the convolutional neural network model were 93.5% (92.7-94.2%) and 99.5% (99.1-99.5%), respectively. For validating data, the sensitivity and specificity were 81.3% (80.0-82.5%) and 99.4% (99.2-99.6%), respectively. Cryptococcal cells were found in 22.07% of blood samples. Conclusion: This high-speed microscopy system can analyze fungal pathogens in blood samples rapidly with high sensitivity and specificity and can help dramatically accelerate the diagnosis of fungal infectious diseases.
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Affiliation(s)
- Ruiqi Liu
- Guangxi Key Laboratory of Special Biomedicine, School of Medicine, Guangxi University, Nanning, Guangxi, P.R. China
| | - Xiaojie Li
- Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Yingyi Liu
- Guangxi Key Laboratory of Special Biomedicine, School of Medicine, Guangxi University, Nanning, Guangxi, P.R. China
| | - Lijun Du
- Department of Clinical Laboratory, Huadu District People's Hospital of Guangzhou, Guangdong, China
| | - Yingzhu Zhu
- Guangzhou Waterrock Gene Technology, Guangdong, China
| | - Lichuan Wu
- Guangxi Key Laboratory of Special Biomedicine, School of Medicine, Guangxi University, Nanning, Guangxi, P.R. China
| | - Bo Hu
- Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
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23
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Waterlow NR, Cooper BS, Robotham JV, Knight GM. Antimicrobial resistance prevalence in bloodstream infection in 29 European countries by age and sex: An observational study. PLoS Med 2024; 21:e1004301. [PMID: 38484006 PMCID: PMC10939247 DOI: 10.1371/journal.pmed.1004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/22/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Antibiotic usage, contact with high transmission healthcare settings as well as changes in immune system function all vary by a patient's age and sex. Yet, most analyses of antimicrobial resistance (AMR) ignore demographic indicators and provide only country-level resistance prevalence values. This study aimed to address this knowledge gap by quantifying how resistance prevalence and incidence of bloodstream infection (BSI) varied by age and sex across bacteria and antibiotics in Europe. METHODS AND FINDINGS We used patient-level data collected as part of routine surveillance between 2015 and 2019 on BSIs in 29 European countries from the European Antimicrobial Resistance Surveillance Network (EARS-Net). A total of 6,862,577 susceptibility results from isolates with age, sex, and spatial information from 944,520 individuals were used to characterise resistance prevalence patterns for 38 different bacterial species and antibiotic combinations, and 47% of these susceptibility results were from females, with a similar age distribution in both sexes (mean of 66 years old). A total of 349,448 isolates from 2019 with age and sex metadata were used to calculate incidence. We fit Bayesian multilevel regression models by country, laboratory code, sex, age, and year of sample to quantify resistant prevalence and provide estimates of country-, bacteria-, and drug-family effect variation. We explore our results in greater depths for 2 of the most clinically important bacteria-antibiotic combinations (aminopenicillin resistance in Escherichia coli and methicillin resistance in Staphylococcus aureus) and present a simplifying indicative index of the difference in predicted resistance between old (aged 100) and young (aged 1). At the European level, we find distinct patterns in resistance prevalence by age. Trends often vary more within an antibiotic family, such as fluroquinolones, than within a bacterial species, such as Pseudomonas aeruginosa. Clear resistance increases by age for methicillin-resistant Staphylococcus aureus (MRSA) contrast with a peak in resistance to several antibiotics at approximately 30 years of age for P. aeruginosa. For most bacterial species, there was a u-shaped pattern of infection incidence with age, which was higher in males. An important exception was E. coli, for which there was an elevated incidence in females between the ages of 15 and 40. At the country-level, subnational differences account for a large amount of resistance variation (approximately 38%), and there are a range of functional forms for the associations between age and resistance prevalence. For MRSA, age trends were mostly positive, with 72% (n = 21) of countries seeing an increased resistance between males aged 1 and 100 years and a greater change in resistance in males. This compares to age trends for aminopenicillin resistance in E. coli which were mostly negative (males: 93% (n = 27) of countries see decreased resistance between those aged 1 and 100 years) with a smaller change in resistance in females. A change in resistance prevalence between those aged 1 and 100 years ranged up to 0.51 (median, 95% quantile of model simulated prevalence using posterior parameter ranges 0.48, 0.55 in males) for MRSA in one country but varied between 0.16 (95% quantile 0.12, 0.21 in females) to -0.27 (95% quantile -0.4, -0.15 in males) across individual countries for aminopenicillin resistance in E. coli. Limitations include potential bias due to the nature of routine surveillance and dependency of results on model structure. CONCLUSIONS In this study, we found that the prevalence of resistance in BSIs in Europe varies substantially by bacteria and antibiotic over the age and sex of the patient shedding new light on gaps in our understanding of AMR epidemiology. Future work is needed to determine the drivers of these associations in order to more effectively target transmission and antibiotic stewardship interventions.
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Affiliation(s)
- Naomi R. Waterlow
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, EPH, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ben S. Cooper
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Julie V. Robotham
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in Partnership with the UK Health Security Agency, Oxford, United Kingdom
| | - Gwenan Mary Knight
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, EPH, London School of Hygiene and Tropical Medicine, London, United Kingdom
- AMR Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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24
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Rahman MK, Williams RB, Ajulo S, Levent G, Loneragan GH, Awosile B. Predictive Modeling of Phenotypic Antimicrobial Susceptibility of Selected Beta-Lactam Antimicrobials from Beta-Lactamase Resistance Genes. Antibiotics (Basel) 2024; 13:224. [PMID: 38534659 DOI: 10.3390/antibiotics13030224] [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: 01/30/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
The outcome of bacterial infection management relies on prompt diagnosis and effective treatment, but conventional antimicrobial susceptibility testing can be slow and labor-intensive. Therefore, this study aims to predict phenotypic antimicrobial susceptibility of selected beta-lactam antimicrobials in the bacteria of the family Enterobacteriaceae from different beta-lactamase resistance genotypes. Using human datasets extracted from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program conducted by Pfizer and retail meat datasets from the National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS), we used a robust or weighted least square multivariable linear regression modeling framework to explore the relationship between antimicrobial susceptibility data of beta-lactam antimicrobials and different types of beta-lactamase resistance genes. In humans, in the presence of the blaCTX-M-1, blaCTX-M-2, blaCTX-M-8/25, and blaCTX-M-9 groups, MICs of cephalosporins significantly increased by values between 0.34-3.07 μg/mL, however, the MICs of carbapenem significantly decreased by values between 0.81-0.87 μg/mL. In the presence of carbapenemase genes (blaKPC, blaNDM, blaIMP, and blaVIM), the MICs of cephalosporin antimicrobials significantly increased by values between 1.06-5.77 μg/mL, while the MICs of carbapenem antimicrobials significantly increased by values between 5.39-67.38 μg/mL. In retail meat, MIC of ceftriaxone increased significantly in the presence of blaCMY-2, blaCTX-M-1, blaCTX-M-55, blaCTX-M-65, and blaSHV-2 by 55.16 μg/mL, 222.70 μg/mL, 250.81 μg/mL, 204.89 μg/mL, and 31.51 μg/mL respectively. MIC of cefoxitin increased significantly in the presence of blaCTX-M-65 and blaTEM-1 by 1.57 μg/mL and 1.04 μg/mL respectively. In the presence of blaCMY-2, MIC of cefoxitin increased by an average of 8.66 μg/mL over 17 years. Compared to E. coli isolates, MIC of cefoxitin in Salmonella enterica isolates decreased significantly by 0.67 μg/mL. On the other hand, MIC of ceftiofur increased in the presence of blaCTX-M-1, blaCTX-M-65, blaSHV-2, and blaTEM-1 by 8.82 μg/mL, 9.11 μg/mL, 8.18 μg/mL, and 1.04 μg/mL respectively. In the presence of blaCMY-2, MIC of ceftiofur increased by an average of 10.20 μg/mL over 14 years. The ability to predict antimicrobial susceptibility of beta-lactam antimicrobials directly from beta-lactamase resistance genes may help reduce the reliance on routine phenotypic testing with higher turnaround times in diagnostic, therapeutic, and surveillance of antimicrobial-resistant bacteria of the family Enterobacteriaceae.
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Affiliation(s)
- Md Kaisar Rahman
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79106, USA
| | - Ryan B Williams
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79106, USA
| | - Samuel Ajulo
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79106, USA
| | - Gizem Levent
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79106, USA
| | - Guy H Loneragan
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79106, USA
| | - Babafela Awosile
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79106, USA
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25
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Tingsgård S, Bastrup Israelsen S, Østergaard C, Benfield T. Emulating a Target Trial of Shorter Compared to Longer Course of Antibiotic Therapy for Gram-Negative Bacteremia. Clin Infect Dis 2024; 78:292-300. [PMID: 37949816 DOI: 10.1093/cid/ciad670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/21/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Despite the availability of antimicrobial therapies, gram-negative bacteremia remains a significant cause of morbidity and mortality on a global level. Recent randomized controlled trials support shorter antibiotic treatment duration for individuals with uncomplicated gram-negative bacteremia. The target trial framework using the cloning approach utilizes real-world data but eliminates the issue of immortal time bias seen in observational studies by emulating the analysis of randomized trials with full adherence. METHOD A hypothetical target trial allocating individuals with gram-negative bacteremia to either short antibiotic treatment duration (5-7 days) or longer antibiotic treatment duration (8-14 days) was specified and emulated using the cloning, censoring, and weighting approach. The primary outcome was 90-day all-cause mortality. Secondary outcome was a composite endpoint of clinical and microbiological relapse. The emulated trial included individuals from four hospitals in Copenhagen from 2018 through 2021. RESULTS In sum, 1040 individuals were included. The median age of the cohort was 76 years, the majority were male (54%), had community-acquired gram-negative bacteremia (86%), urinary tract infection as the source of the infection (78%), and Escherichia coli as the pathogen of the infection (73%). The adjusted 90-day risk difference in all-cause mortality was 1.3% (95% confidence interval [CI]: -.7, 3.3), and the risk ratio was 1.12 (95% CI: .89, 1.37). The adjusted 90-day risk difference in relapse was 0.7% (95% CI: -2.3, 3.8), and the risk ratio was 1.07 (95% CI: .71, 1.45). CONCLUSIONS We found comparative outcomes for shorter treatment duration compared to longer treatment duration in patients with gram-negative bacteremia.
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Affiliation(s)
- Sandra Tingsgård
- Department of Infectious Diseases, Center of Research and Disruption of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Simone Bastrup Israelsen
- Department of Infectious Diseases, Center of Research and Disruption of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Center of Research and Disruption of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
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26
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Itoh N, Akazawa N, Kawabata T, Yamaguchi M, Kodama EN, Ohmagari N. Improving diagnostic accuracy of blood culture-positive cases in a cancer center via an antimicrobial stewardship program and infectious disease consultations. Sci Rep 2024; 14:2869. [PMID: 38311620 PMCID: PMC10838907 DOI: 10.1038/s41598-024-53543-w] [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: 02/01/2024] [Indexed: 02/06/2024] Open
Abstract
The direct impact of antimicrobial stewardship programs (ASP) and infectious disease (ID) consultations on patients' clinical diagnoses remains unknown. We assessed their influence on improving the diagnostic accuracy of blood culture-positive inpatients at a Japanese cancer center. Our single-center, retrospective observational study was conducted from April 1, 2018 to March 31, 2022 to evaluate two phases: pre-intervention (notification of antimicrobials by the infection control team) and post-intervention (ASP implementation and ID consultation service establishment). There were 42,514 inpatients: 22,096 during the pre-intervention and 20,418 during the intervention periods. A total of 939 blood culture-positive episodes (pre-intervention, n = 434; post-intervention, n = 505) were analyzed. During the pre-intervention period, 28.1% of the patients had an unknown diagnosis, which decreased significantly to 1.2% post-intervention. Furthermore, hepatobiliary tract and other infections increased significantly post-intervention, and the mortality rate due to Staphylococcus aureus infection decreased from 28.6% pre-intervention to 10.4% post-intervention. The trend and level of the total number of culture specimens submitted per 1000 patient days for all culture specimens increased significantly post-intervention. Notably, the two-set rate of monthly blood cultures increased significantly. In conclusion, improving the overall diagnostic process with ASP and ID consultations at cancer centers could lead to the optimization of patient care.
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Affiliation(s)
- Naoya Itoh
- Division of Infectious Diseases, Aichi Cancer Center Hospital, Nagoya, Japan.
- Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan.
| | - Nana Akazawa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takanori Kawabata
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Yamaguchi
- Division of Infectious Diseases, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eiichi N Kodama
- Division of Infectious Diseases, International Research Institute of Disaster Science, and Graduate School of Medicine, Tohoku University and Tohoku Medical Megabank Organization, Sendai, Japan
| | - Norio Ohmagari
- Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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27
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Choi MH, Kim D, Kim J, Song YG, Jeong SH. Shift in risk factors for mortality by period of the bloodstream infection timeline. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:97-106. [PMID: 38092626 DOI: 10.1016/j.jmii.2023.11.008] [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: 03/10/2023] [Revised: 08/30/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND This study was designed to determine changes in risk factors on the prognosis of patients during each period of the bloodstream infection (BSI) timeline. METHODS Through an integrated study of multivariable regressions with machine learning techniques, the risk factors for mortality during each period of BSI were analyzed. RESULTS A total of 302,303 inpatients who underwent blood cultures during 2011-2021 were enrolled. More than 8 % of BSI cases progressed to subsequent BSI, and risk factors were identified as gut colonization with vancomycin-resistant enterococci (aOR 1.82; 95 % CI 1.47-2.24), intensive care unit admission (aOR 3.37; 95 % CI 3.35-4.28), and current cancer chemotherapy (aOR 1.54; 95 % CI 1.36-1.74). The mean SOFA score of the deceased patients during the first 7 days was 10.6 (SD 4.3), which was significantly higher than those on days 8-30 (7.0 ± 4.2) and after Day 30 (4.0 ± 3.5). BSIs caused by Acinetobacter baumannii and Candida albicans were more likely to result in deaths of patients for all time periods (all, P < 0.001). BSIs caused by Enterococcus faecalis and Enterococcus faecium were associated with a poor outcome in the period after Day 30 (both, P < 0.001). Nonsusceptible phenotypes to β-lactam/β-lactamase inhibitors of Escherichia coli and Klebsiella pneumoniae influenced the prognoses of patients with BSI in terms of high mortality rates during both days 8-30 and after Day 30. CONCLUSION Influence of microbiological factors on mortality, including BSI-causative microorganisms and their major antimicrobial resistance, was emphasized in both periods of days 8-30 and after Day 30.
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Affiliation(s)
- Min Hyuk Choi
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Dokyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Jihyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea.
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Ranganath N, Yetmar ZA, Saleh OA, Tande AJ, Shah AS. Risk factors for positive follow-up blood cultures in Gram-negative bacteremia among immunocompromised patients with neutropenia. Transpl Infect Dis 2024; 26:e14203. [PMID: 38010744 PMCID: PMC10922757 DOI: 10.1111/tid.14203] [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] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Gram-negative bacillary bloodstream infection (GN-BSI) is a frequent clinical challenge among immunocompromised hosts and is associated with a high mortality. The utility of follow-up blood cultures (FUBCs) for GN-BSI in this population, particularly in the setting of neutropenia, is poorly defined. METHODS We conducted a single-center, retrospective cohort study between the period of July 2018 and April 2022 to investigate the utility of FUBCs and delineate risk factors for positive cultures among neutropenic patients with monomicrobial GN-BSI. Univariate logistic regression was performed to assess risk factors associated with positive FUBCs. RESULTS Of 206 patients, 98% had FUBCs performed, and 9% were positive. Risk factors for positive FUBCs included multidrug-resistant GN infection (OR 3.26; 95% confidence interval [CI] 1.22-8.72) and vascular catheter source (OR 4.82; CI 1.76-13.17). Among patients lacking these risk factors, the prevalence of positive FUBCs was low (2.8%) and the negative predictive value was 92%. Those with positive and negative FUBCs had similar rates of all-cause mortality (16.7% vs. 16.6%; p = .942) and microbiologic relapse (11.1% vs. 6.0%; p = .401) within 90-days of treatment completion. However, positive FUBCs were associated with prolonged hospitalization and longer duration of antimicrobial therapy. CONCLUSION Positive FUBCs were infrequent in neutropenic patients with GN-BSI, and their occurrence did not significantly impact mortality or microbiologic relapse. Risk factors for positive FUBCs included multidrug resistant Gram-negative infection and vascular catheter source. Prospective studies will be necessary to elucidate the benefits and risks of FUBCs when managing GN-BSI in patients with underlying immune compromise.
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Affiliation(s)
- Nischal Ranganath
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN USA
| | - Zachary A. Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN USA
| | - Omar Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN USA
| | - Aaron J. Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN USA
| | - Aditya S. Shah
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN USA
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Andrews SR, Timbrook TT, Fisher MA, Tritle BJ. Comparative analysis of a rapid diagnostic test and scoring tools for ESBL detection in Enterobacterales bloodstream infections for optimizing antimicrobial therapy. Microbiol Spectr 2024; 12:e0313123. [PMID: 38088547 PMCID: PMC10783129 DOI: 10.1128/spectrum.03131-23] [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: 09/10/2023] [Accepted: 11/10/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE Our study addresses a significant issue in the medical and scientific community-the delayed administration of appropriate antimicrobial treatments due to the time-consuming process of phenotypic susceptibility data collection in gram-negative bloodstream infections. Our research indicates that a multiplex PCR rapid diagnostic test (RDT) significantly outperformed two clinical scoring tools in predicting ceftriaxone susceptibility. Multiplex PCR also led to reduced instances of undertreatment with ceftriaxone and minimized overtreatment with carbapenems. Furthermore, multiplex PCR demonstrated high sensitivity and specificity in predicting ceftriaxone susceptibility. The results of our study underscore the potential RDTs to reduce the time to appropriate antimicrobial therapy, leading to improved patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Sam R. Andrews
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
| | - Tristan T. Timbrook
- BioMérieux, Salt Lake City, Utah, USA
- College of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
| | - Mark A. Fisher
- Department of Pathology, University of Utah Health, Salt Lake City, Utah, USA
- Associated Regional and University Pathologists Laboratories, University of Utah Health, Salt Lake City, Utah, USA
| | - Brandon J. Tritle
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
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30
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Liu W, Liao K, Wu J, Liu S, Zheng X, Wen W, Fu L, Fan X, Yang X, Hu X, Jiang Y, Wu K, Guo Z, Li Y, Liu W, Cai M, Guo Z, Guo X, Lu J, Chen E, Zhou H, Chen D. Blood culture quality and turnaround time of clinical microbiology laboratories in Chinese Teaching Hospitals: A multicenter study. J Clin Lab Anal 2024; 38:e25008. [PMID: 38235610 PMCID: PMC10829685 DOI: 10.1002/jcla.25008] [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] [Revised: 12/10/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
PURPOSE Blood culture (BC) remains the gold standard for the diagnosis of bloodstream infections. Improving the quality of clinical BC samples, optimizing BC performance, and accelerating antimicrobial susceptibility test (AST) results are essential for the early detection of bloodstream infections and specific treatments. METHODS We conducted a retrospective multicenter study using 450,845 BC specimens from clinical laboratories obtained from 19 teaching hospitals between 1 January 2021 and 31 December 2021. We evaluated key performance indicators (KPIs), turnaround times (TATs), and frequency distributions of processing in BC specimens. We also evaluated the AST results of clinically significant isolates for four different laboratory workflow styles. RESULTS Across the 10 common bacterial isolates (n = 16,865) and yeast isolates (n = 1011), the overall median (interquartile range) TATs of AST results were 2.67 (2.05-3.31) and 3.73 (2.98-4.64) days, respectively. The specimen collections mainly occurred between 06:00 and 24:00, and specimen reception and loadings mainly between 08:00 and 24:00. Based on the laboratory workflows of the BCs, 16 of the 19 hospitals were divided into four groups. Time to results (TTRs) from specimen collection to the AST reports were 2.35 (1.95-3.06), 2.61 (1.98-3.32), 2.99 (2.60-3.87), and 3.25 (2.80-3.98) days for groups I, II, III, and IV, respectively. CONCLUSION This study shows the related BC KPIs and workflows in different Chinese hospitals, suggesting that laboratory workflow optimization can play important roles in shortening time to AST reports and initiation of appropriate timely treatment.
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Affiliation(s)
- Wanting Liu
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Kang Liao
- Department of Laboratory MedicineThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Jinsong Wu
- Department of Laboratory MedicineShenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
| | - Suling Liu
- Department of Clinical Laboratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouGuangdongChina
| | - Xin Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
| | - Weihong Wen
- Department of Laboratory MedicineThe Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's HospitalQingyuanGuangdongChina
| | - Liang Fu
- Department of Laboratory MedicineThe Fifth Affiliated Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - Xiaoyi Fan
- The Clinical Microbiological LaboratoryThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdongChina
| | - Xiao Yang
- Department of Laboratory MedicineGuangzhou First People's HospitalGuangzhouGuangdongChina
| | - Xiumei Hu
- Department of Laboratory MedicineNanfang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - Yueting Jiang
- Department of Laboratory MedicineThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Kuihai Wu
- Department of Laboratory MedicineThe First People's Hospital of FoshanFoshanGuangdongChina
| | - Zhusheng Guo
- Clinical Microbiology LaboratoryDepartment of Dongguan Tungwah HospitalDongguanGuangdongChina
| | - Yang Li
- Department of Laboratory MedicineZhongshan City People's HospitalZhongshanGuangdongChina
| | - Weiyang Liu
- Clinical LaboratoryThe Third People's Hospital of HuizhouHuizhouGuangdongChina
| | - Mufa Cai
- The Center for Laboratory MedicineAffiliated Hospital of Guangdong Medical UniversityZhanjiangGuangdongChina
| | - Zhaowang Guo
- Clinical LaboratoryThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiGuangdongChina
| | - Xuguang Guo
- Department of Clinical Laboratory MedicineThe Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Jinghui Lu
- Laboratory Medicine DepartmentThe First Affiliated Hospital (School of Clinical Medicine), Guangdong Pharmaceutical UniversityGuangzhouGuangdongChina
| | - Enzhong Chen
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Hongwei Zhou
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Dingqiang Chen
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
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Liu Y, Xu Y, Xu X, Chen X, Chen H, Zhang J, Ma J, Zhang W, Zhang R, Chen J. Metagenomic identification of pathogens and antimicrobial-resistant genes in bacterial positive blood cultures by nanopore sequencing. Front Cell Infect Microbiol 2023; 13:1283094. [PMID: 38192400 PMCID: PMC10773726 DOI: 10.3389/fcimb.2023.1283094] [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: 08/25/2023] [Accepted: 10/30/2023] [Indexed: 01/10/2024] Open
Abstract
Nanopore sequencing workflows have attracted increasing attention owing to their fast, real-time, and convenient portability. Positive blood culture samples were collected from patients with bacterial bloodstream infection and tested by nanopore sequencing. This study compared the sequencing results for pathogen taxonomic profiling and antimicrobial resistance genes to those of species identification and phenotypic drug susceptibility using traditional microbiology testing. A total of 37 bacterial positive blood culture results of strain genotyping by nanopore sequencing were consistent with those of mass spectrometry. Among them, one mixed infection of bacteria and fungi was identified using nanopore sequencing and confirmatory quantitative polymerase chain reaction. The amount of sequencing data was 21.89 ± 8.46 MB for species identification, and 1.0 MB microbial strain data enabled accurate determination. Data volumes greater than or equal to 94.6 MB nearly covered all the antimicrobial resistance genes of the bacteria in our study. In addition, the results of the antimicrobial resistance genes were compared with those of phenotypic drug susceptibility testing for Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Therefore, the nanopore sequencing platform for rapid identification of causing pathogens and relevant antimicrobial resistance genes complementary to conventional blood culture outcomes may optimize antimicrobial stewardship management for patients with bacterial bloodstream infection.
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Affiliation(s)
- Yahui Liu
- Department of Laboratory Medicine, Shanghai Xuhui District Central Hospital & Fudan University Affiliated Xuhui Hospital, Shanghai, China
- Department of Laboratory Medicine, Shanghai Post and Telecommunication Hospital, Shanghai, China
| | - Yumei Xu
- Department of Laboratory Medicine, Shanghai Xuhui District Central Hospital & Fudan University Affiliated Xuhui Hospital, Shanghai, China
| | - Xinyu Xu
- Department of Laboratory Medicine, Shanghai Post and Telecommunication Hospital, Shanghai, China
| | - Xianghui Chen
- Shanghai Diabetes Institute, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongli Chen
- Shanghai Diabetes Institute, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingjing Zhang
- Precision Medicine Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayu Ma
- Precision Medicine Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenrui Zhang
- Precision Medicine Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Zhang
- Shanghai Diabetes Institute, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Chen
- Department of Laboratory Medicine, Shanghai Post and Telecommunication Hospital, Shanghai, China
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Gandhi K, Wrzesinski M, Bunnell K, Gibble A. Oral antibiotic step-down therapy for nonstaphylococcal gram-positive bloodstream infections. Diagn Microbiol Infect Dis 2023; 107:116068. [PMID: 37774630 DOI: 10.1016/j.diagmicrobio.2023.116068] [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: 01/29/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 10/01/2023]
Abstract
Bloodstream infections traditionally are treated with intravenous (IV) therapy. This study's purpose is to evaluate if oral step-down therapy is noninferior to IV therapy for gram-positive bloodstream infections (GP-BSIs). This retrospective cohort study included patients who received IV therapy and those who received oral step-down therapy for a nonstaphylococcal GP-BSI from 2017 to 2019. The primary endpoint was a composite outcome of 90-day all-cause mortality and clinical failure. A total of 308 patients were included (n = 94, oral; n = 214, IV). The oral step-down group had a lower incidence of 90-day clinical failure (9% vs 14%; P < 0.001). The IV group had a longer hospital stay (4 vs 6 days, P < 0.001); however, there were no significant differences in secondary outcomes. Bivariate analysis found no predictors of 90-day clinical failure. Oral step-down therapy was found to be noninferior to IV therapy.
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Affiliation(s)
- Kelvin Gandhi
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI, USA.
| | | | - Kristen Bunnell
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI, USA; Department of Clinical Sciences, Medical College of Wisconsin School of Pharmacy, Milwaukee, WI USA
| | - Allison Gibble
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI, USA
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33
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Wang L, Liu N, Zhang L, Cui L, Zhu M, Li Z, Wang P, Wang Z. Performance of next-generation sequencing for diagnosis of blood infections by Klebsiella pneumoniae. Front Cell Infect Microbiol 2023; 13:1278482. [PMID: 38106471 PMCID: PMC10725243 DOI: 10.3389/fcimb.2023.1278482] [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: 08/16/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Objective Klebsiella pneumoniae (Kp) bloodstream infections (BSI) can be a life-threatening opportunistic infection. We aimed to evaluate the diagnostic accuracy of metagenomic next-generation sequencing (mNGS) for Kp BSI. Methods We retrospectively analyzed 72 patients suspected with bloodstream infection and mNGS Kp positive in peripheral blood, who were hospitalized in our hospital from January 2022 to January 2023. Clinical data and laboratory parameters were collected. All patients had blood drawn and other samples for blood mNGS, blood cultures (BC) and other cultures (OC). The accuracy of mNGS results was analyzed according to infection site, clinical indicators, therapeutic effect and routine culture results. The detection of pathogenic microorganisms by blood mNGS and routine culture was compared. Results Among 72 infection patients, 29 cases (40.28%) were BC positive, 43 cases (59.72%) were other culture (OC) positive, 16 cases (22.22%) were both BC and OC positive, 56 cases were positive for both mNGS and routine culture. Among the 56 double-positive cases, mNGS and conventional cultures were completely consistent in 27 cases, partially consistent in 15 cases, and completely inconsistent in 14 cases. Using the clinical diagnosis as the reference standard, There were 51 cases consistent with the results of mNGS with Kp BSI, the clinical consistency was 70.83% (51/72). The coincidence rate of mNGS and clinical diagnosis was higher than that of BC (54.17%, 39/72), indicating a statistically significant difference between the two methods (P<0.01). Conclusions Current evidence indicates that mNGS exhibits excellent accuracy for the diagnosis of Kp BSI. Although it cannot replace blood culture detection technology, it can be used as a supplement to provide stronger diagnostic capabilities for BSI and optimize treatment.
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Affiliation(s)
- Lei Wang
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | | | | | | | | | | | - Zhengbin Wang
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wang Z, Chen R, Xia F, Jiang M, Zhu D, Zhang Y, Dai J, Zhuge X. ProQ binding to small RNA RyfA promotes virulence and biofilm formation in avian pathogenic Escherichia coli. Vet Res 2023; 54:109. [PMID: 37993891 PMCID: PMC10664665 DOI: 10.1186/s13567-023-01241-2] [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: 05/26/2023] [Accepted: 10/10/2023] [Indexed: 11/24/2023] Open
Abstract
Avian pathogenic Escherichia coli (APEC) is a notable subpathotype of the nonhuman extraintestinal pathogenic E. coli (ExPEC). Recognized as an extraintestinal foodborne pathogen, the zoonotic potential of APEC/ExPEC allows for cross-host transmission via APEC-contaminated poultry meat and eggs. ProQ, an RNA binding protein, is evolutionarily conserved in E. coli. However, its regulatory roles in the biofilm formation and virulence of APEC/ExPEC have not been explored. In this study, proQ deletion in the APEC strain FY26 significantly compromised its biofilm-forming ability. Furthermore, animal tests and cellular infection experiments showed that ProQ depletion significantly attenuated APEC virulence, thereby diminishing its capacity for bloodstream infection and effective adherence to and persistence within host cells. Transcriptome analysis revealed a decrease in the transcription level of the small RNA (sRNA) RyfA in the mutant FY26ΔproQ, suggesting a direct interaction between the sRNA RyfA and ProQ. This interaction might indicate that sRNA RyfA is a novel ProQ-associated sRNA. Moreover, the direct binding of ProQ to the sRNA RyfA was crucial for APEC biofilm formation, pathogenicity, adhesion, and intracellular survival. In conclusion, our findings provide detailed insight into the interaction between ProQ and sRNA RyfA and deepen our understanding of the regulatory elements that dictate APEC virulence and biofilm development. Such insights are instrumental in developing strategies to counteract APEC colonization within hosts and impede APEC biofilm establishment on food surfaces.
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Affiliation(s)
- Zhongxing Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Nantong University, Nantong, 226019, Jiangsu, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Rui Chen
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Fufang Xia
- Department of Nutrition and Food Hygiene, School of Public Health, Nantong University, Nantong, 226019, Jiangsu, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Min Jiang
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Dongyu Zhu
- Department of Nutrition and Food Hygiene, School of Public Health, Nantong University, Nantong, 226019, Jiangsu, China
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China
| | - Yuting Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Nantong University, Nantong, 226019, Jiangsu, China
| | - Jianjun Dai
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, China.
| | - Xiangkai Zhuge
- Department of Nutrition and Food Hygiene, School of Public Health, Nantong University, Nantong, 226019, Jiangsu, China.
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Shulder S, Tamma PD, Fiawoo S, Dzintars K, Escobar D, Livorsi DJ, Malani AN, Palacio D, Spivak ES, Zimmerman M, Bork JT. Infectious Diseases Consultation Associated With Reduced Mortality in Gram-Negative Bacteremia. Clin Infect Dis 2023; 77:1234-1237. [PMID: 37402637 DOI: 10.1093/cid/ciad383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
Gram-negative bacteremia (GN-BSI) can cause significant morbidity and mortality, but the benefit of infectious diseases consultation (IDC) is not well defined. A 24-site observational cohort study of unique hospitalized patients with 4861 GN-BSI episodes demonstrated a 40% decreased risk of 30-day mortality in patients with IDC compared to those without IDC.
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Affiliation(s)
- Stephanie Shulder
- Department of Pharmacy, University of Rochester Medical Center, Rochester, New York, USA
| | - Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Suiyini Fiawoo
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathryn Dzintars
- Department of Infectious Diseases, Johns Hopkins University School of Pharmacy, Baltimore, Maryland, USA
| | - Daniel Escobar
- Department of Medicine, Division of Infectious Disease, University of California San Francisco, San Francisco, California, USA
| | - Daniel J Livorsi
- Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Iowa City Veterans Affairs (VA) Health Care System, Iowa City, Iowa, USA
| | - Anurag N Malani
- Trinity Health Michigan, Section of Infectious Diseases, Ann Arbor, Michigan, USA
| | - Danica Palacio
- Trinity Health Michigan, Section of Infectious Diseases, Ann Arbor, Michigan, USA
| | - Emily S Spivak
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matty Zimmerman
- Department of Infectious Diseases, Johns Hopkins University School of Pharmacy, Baltimore, Maryland, USA
| | - Jacqueline T Bork
- Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Grant VC, Zhou AY, Tan KK, Abdul-Mutakabbir JC. Racial disparities among candidemic patients at a Southern California teaching hospital. Infect Control Hosp Epidemiol 2023; 44:1866-1869. [PMID: 37088549 PMCID: PMC10665870 DOI: 10.1017/ice.2023.74] [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: 11/09/2022] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 04/25/2023]
Abstract
Racially and ethnically minoritized (REM) patients are disproportionately affected by infectious diseases, including candidemia. REM patients with candidemia were significantly younger, with trends toward more risk factors for candidemia and longer lengths of stay. Although Candida parapsilosis was more common in REM patients, there were no differences in mortality rates.
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Affiliation(s)
- Victoria C. Grant
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, California, USA
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Anna Y. Zhou
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, California, USA
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Karen K. Tan
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, California, USA
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Jacinda C. Abdul-Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
- Divison of the Black Diaspora and African American Studies, University of California San Diego, La Jolla, California, USA
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Ong SWX, Tong SYC, Daneman N. Are we enrolling the right patients? A scoping review of external validity and generalizability of clinical trials in bloodstream infections. Clin Microbiol Infect 2023; 29:1393-1401. [PMID: 37633330 DOI: 10.1016/j.cmi.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Having a representative population in randomized clinical trials (RCTs) improves external validity and generalizability of trial results. There are limited data examining differences between RCT-enrolled and real-world populations in bloodstream infections (BSI). OBJECTIVES We conducted a scoping review aiming to review studies assessing generalizability of BSI RCT populations, to identify sub-groups that have been systematically under-represented and to explore approaches to improve external validity of future RCTs. SOURCES MEDLINE, Embase, and Cochrane Library databases were searched for terms related to external validity or generalizability, BSI, and clinical trials in papers published up to 1 August 2023. Studies comparing enrolled versus nonenrolled patients, or papers discussing external validity or generalizability in the context of BSI RCTs were included. CONTENT Sixteen papers were included in the final review. Five compared RCT-enrolled and nonenrolled participants from the same source population. There were significant differences between the two groups in all studies, with nonenrolled patients having a greater comorbidity burden and consistently worse outcomes including mortality. We identified several barriers to improving generalizability of RCT populations and outlined potential approaches to reduce these barriers, such as alternative/simplified consent processes, streamlining eligibility criteria and follow-up procedures, quota-based sampling techniques, and ensuring diversity in site and study team selection. IMPLICATIONS Study cohorts in BSI RCTs are not representative of the general BSI patient population. As we increasingly adopt large pragmatic trials in infectious diseases, it is important to recognize the importance of maximizing generalizability to ensure that our research findings are of direct relevance to our patients.
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Affiliation(s)
- Sean W X Ong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Steven Y C Tong
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Nick Daneman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
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Agnetti J, Büchler AC, Osthoff M, Helfenstein F, Weisser M, Siegemund M, Bassetti S, Bingisser R, Schaefer DJ, Clauss M, Hinic V, Tschudin-Sutter S, Bättig V, Khanna N, Egli A. Identification of microorganisms by a rapid PCR panel from positive blood cultures leads to faster optimal antimicrobial therapy - a before-after study. BMC Infect Dis 2023; 23:730. [PMID: 37884860 PMCID: PMC10601314 DOI: 10.1186/s12879-023-08732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) detects microorganisms with high accuracy in positive blood cultures (BC) - a key step in the management of patients with suspected bacteraemia. We aimed to compare the time to optimal antimicrobial therapy (OAT) for the BF-FA-BCIP vs. standard culture-based identification. METHODS In this retrospective single-centre study with a before-after design, 386 positive BC cases with identification by BF-FA-BCIP were compared to 414 controls with culture-based identification. The primary endpoint was the time from BC sampling to OAT. Secondary endpoints were time to effective therapy, length of stay, (re-)admission to ICU, in-hospital and 30-day mortality. Outcomes were assessed using Cox proportional hazard models and logistic regressions. RESULTS Baseline characteristics of included adult inpatients were comparable. Main sources of bacteraemia were urinary tract and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7%, for cases and controls, respectively). Median (95%CI) time to OAT was 25.5 (21.0-31.2) hours with BF-FA-BCIP compared to 45.7 (37.7-51.4) hours with culture-based identification. We observed no significant difference for secondary outcomes. CONCLUSIONS Rapid microorganism identification by BF-FA-BCIP was associated with a median 20-h earlier initiation of OAT in patients with positive BC. No impact on length of stay and mortality was noted. TRIAL REGISTRATION Clinicaltrials.gov, NCT04156633, registered on November 5, 2019.
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Affiliation(s)
- Jessica Agnetti
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Andrea C Büchler
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Internal Medicine, University of Basel and University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Fabrice Helfenstein
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Maja Weisser
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Plastic, Reconstructive, Aesthetic Surgery and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland
- Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Present Address: Institute for Medical Microbiology, University of Zurich, Gloriastrasse 28/30, CH-8006, Zurich, Switzerland
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Veronika Bättig
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Nina Khanna
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland.
- Present Address: Institute for Medical Microbiology, University of Zurich, Gloriastrasse 28/30, CH-8006, Zurich, Switzerland.
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Sy I, Bühler N, Becker SL, Jung P. Evaluation of the Qvella FAST System and the FAST-PBC cartridge for rapid species identification and antimicrobial resistance testing directly from positive blood cultures. J Clin Microbiol 2023; 61:e0056923. [PMID: 37768103 PMCID: PMC10595056 DOI: 10.1128/jcm.00569-23] [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: 05/04/2023] [Accepted: 07/28/2023] [Indexed: 09/29/2023] Open
Abstract
Blood culture diagnostics require rapid and accurate identification (ID) of pathogens and antimicrobial susceptibility testing (AST). Standard procedures, involving conventional cultivation on agar plates, may take up to 48 hours or more until AST completion. Recent approaches aim to shorten the processing time of positive blood cultures (PBC). The FAST System is a new technology, capable of purifying and concentrating bacterial/fungal pathogens from positive blood culture media and producing a bacterial suspension called "liquid colony" (LC), which can be further used in downstream analyses (e.g., ID and AST). Here, we evaluated the performance of the FAST System LC generated from PBC in comparison to our routine workflow including ID by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry using Sepsityper, AST by automatized MicroScan WalkAway plus and directly inoculated disk diffusion (DD), and MICRONAUT-AM for yeast/fungi. A total of 261 samples were analyzed, of which 86.6% (226/261) were eligible for the comparative ID and AST analyses. In comparison to the reference technique (culture-grown colonies), ID concordance of the FAST System LC and Sepsityper was 150/154 (97.4%) and 123/154 (79.9%), respectively, for Gram positive; 67/70 (95.7%) and 64/70 (91.4%), respectively, for Gram negative. For AST, categorical agreement (CA) of the FAST System LC in comparison to the routine workflow for Gram-positive bacteria was 96.1% and 98.7% for MicroScan and DD, respectively. Similar results were obtained for Gram-negative bacteria with 96.6% and 97.5% of CA for MicroScan and DD, respectively. Taken together, the FAST System LC allowed the laboratory to significantly reduce the time to obtain correct ID and AST (automated MicroScan) results 1 day earlier and represents a promising tool to expedite the processing of PBC.
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Affiliation(s)
- Issa Sy
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Nina Bühler
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Sören L. Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Philipp Jung
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
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Dar S, Erickson D, Manca C, Lozy T, Shashkina E, Kordalewska M, Mediavilla JR, Chen L, Rojtman A, Kreiswirth BN. The impact of COVID on bacterial sepsis. Eur J Clin Microbiol Infect Dis 2023; 42:1173-1181. [PMID: 37597051 DOI: 10.1007/s10096-023-04655-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To identify the predictors of morbidity and mortality in matched COVID-19 positive and negative patients who were septic with Gram positive or Gram negative infections. METHODS We conducted a retrospective review, from March to October 2020, of matched septic patients at five Hackensack Meridian Health hospitals who had bacteremia with Staphylococcus aureus, Klebsiella pneumoniae or Escherichia coli with and without COVID-19. We extracted patient demographics, comorbidities and clinical outcomes data using ICD-10 codes. Bacterial isolates were compared by whole genome sequencing analysis. Multivariate logistic regression was used to analyze independent predictors of morbidity and mortality. RESULTS A total of 208 patients were grouped by positive bloodstream infection (BSI) with COVID-19 (n = 104) and without COVID-19 (n = 104). Most patients were over age 50 (90% vs. 89%) and Caucasian (78% vs. 86%). Inpatient mortality was higher in patients with COVID-19 for both GP (35% vs. 8%, p < 0.05) and GN (28% vs. 10%, p < 0.05) BSIs. Patients with Gram positive (GP) BSIs had a significant increase in mortality risk (OR 4.5, CI 1.4-14.5, p < 0.05) in contrast to those with Gram negative (GN) infections (OR 0.4, CI 0.4-4.0, p = 0.4). CONCLUSION Concurrent COVID-19 infection is associated with a significant increase in morbidity and mortality in patients with GP and GN BSIs. Patients with S. aureus BSIs with COVID-19 are more likely to develop shock and respiratory failure and have higher rates and odds of mortality than those without COVID-19. These findings provide an essential insight into the care of these patients, especially those co-infected with Staphylococcus aureus.
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Affiliation(s)
- Sophia Dar
- Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
- Long Island Jewish Medical Center-Northshore University Hospital, Manhasset, NY, 11030, USA
| | - Daniel Erickson
- Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
| | - Claudia Manca
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Tara Lozy
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Elena Shashkina
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Milena Kordalewska
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Jose R Mediavilla
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Liang Chen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Albert Rojtman
- Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Barry N Kreiswirth
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA.
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Mudrik-Zohar H, Chowers M, Temkin E, Shitrit P. Preventing nosocomial bloodstream infections (NBSIs) by implementing hospitalwide, department-level, self-investigations: A NBSIs frontline ownership intervention. Infect Control Hosp Epidemiol 2023; 44:1562-1568. [PMID: 36883328 DOI: 10.1017/ice.2023.15] [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: 03/09/2023]
Abstract
BACKGROUND Nosocomial bloodstream infections (NBSIs) are adverse complications of hospitalization. Most interventions focus on intensive care units. Data on interventions involving patients' personal care providers in hospitalwide settings are limited. OBJECTIVE To evaluate the impact of department-level NBSI investigations on infection incidence. METHODS Beginning in 2016, positive cultures, classified as suspected of being hospital acquired, were prospectively investigated by patients' unit-based personal healthcare providers using a structured electronic questionnaire. After analyzing the conclusions of the investigation, a summary was sent quarterly to the departments and to hospital management. NBSI rates and clinical data during a 5-year period (2014-2018) were calculated and compared before and after the intervention (2014-2015 versus 2016-2018), using interrupted time-series analysis. RESULTS Among 4,135 bloodstream infections (BSIs), 1,237 (30%) were nosocomial. The rate of NBSI decreased from 4.58 per 1,000 admissions days in 2014 and 4.82 in 2015, to 3.81 in 2016, 2.94 in 2017 and 2.86 in 2018. Following a 4-month lag after introducing the intervention, the NBSI rate per 1000 admissions dropped significantly by 1.33 (P = .04; 95% CI, -2.58 to -0.07). The monthly NBSI rate continued to decrease significantly by 0.03 during the intervention period (P = .03; 95% CI, -0.06 to -0.002). CONCLUSIONS Detailed department-level investigations of NBSI events performed by healthcare providers, increased staff awareness and frontline ownership and were associated with a decrease in NBSI rates hospitalwide.
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Affiliation(s)
- Hadar Mudrik-Zohar
- Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Chowers
- Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth Temkin
- National Institute for Infection Control and Antibiotic Resistance, Tel Aviv, Israel
| | - Pnina Shitrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infection Control Unit, Meir Medical Center, Kfar Saba, Israel
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Tsai WC, Liu CF, Ma YS, Chen CJ, Lin HJ, Hsu CC, Chow JC, Chien YW, Huang CC. Real-time artificial intelligence system for bacteremia prediction in adult febrile emergency department patients. Int J Med Inform 2023; 178:105176. [PMID: 37562317 DOI: 10.1016/j.ijmedinf.2023.105176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Artificial intelligence (AI) holds significant potential to be a valuable tool in healthcare. However, its application for predicting bacteremia among adult febrile patients in the emergency department (ED) remains unclear. Therefore, we conducted a study to provide clarity on this issue. METHODS Adult febrile ED patients with blood cultures at Chi Mei Medical Center were divided into derivation (January 2017 to June 2019) and validation groups (July 2019 to December 2020). The derivation group was utilized to develop AI models using twenty-one feature variables and five algorithms to predict bacteremia. The performance of these models was compared with qSOFA score. The AI model with the highest area under the receiver operating characteristics curve (AUC) was chosen to implement the AI prediction system and tested on the validation group. RESULTS The study included 5,647 febrile patients. In the derivation group, there were 3,369 patients with a mean age of 61.4 years, and 50.7% were female, including 508 (13.8%) with bacteremia. The model with the best AUC was built using the random forest algorithm (0.761), followed by logistic regression (0.755). All five models demonstrated better AUC than the qSOFA score (0.560). The random forest model was adopted to build a real-time AI prediction system integrated into the hospital information system, and the AUC achieved 0.709 in the validation group. CONCLUSION The AI model shows promise to predict bacteremia in adult febrile ED patients; however, further external validation in different hospitals and populations is necessary to verify its effectiveness.
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Affiliation(s)
- Wei-Chun Tsai
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Shan Ma
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Jung Chen
- Department of Information Systems, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Julie Chi Chow
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Stewart AG, Laupland KB, Tabah A. Central line associated and primary bloodstream infections. Curr Opin Crit Care 2023; 29:423-429. [PMID: 37641510 DOI: 10.1097/mcc.0000000000001082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Primary and intravascular catheter-associated bloodstream infections (CA-BSIs) represent an important clinical entity in the intensive care unit (ICU) being associated with significant morbidity and mortality. The purpose of this review was to examine the recently published data on epidemiology and management of CA-BSI and other primary BSIs specifically within the context of the ICU. RECENT FINDINGS In critically ill patients, the pooled prevalence of primary and CA-BSI from contemporary studies was 19.7-40.7% and 26.4-37.3% of all BSIs, respectively. Failure to achieve source control (i.e., removal of catheter in CA-BSI) is associated with higher mortality. Higher severity scores and durations of ICU stay and catheter insertion are well established risk factors for CA-BSI. The use of prevention bundles when inserting a central venous line is able to reduce CA-BSI incidence from 4 to 1.6 episodes per 1000 central venous catheter days. Differential time-to-positivity of paired blood cultures may assist in the diagnosis of CA-BSI. SUMMARY Primary BSI is frequently observed in ICU cohorts and has a poor effect on outcome. Surveillance for BSI among patients admitted to ICUs is fundamental to inform healthcare service delivery, design preventive approaches, to track resistance, and detect emerging pathogens.
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Affiliation(s)
- Adam G Stewart
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane
| | - Kevin B Laupland
- Queensland University of Technology, Faculty of Medicine, University of Queensland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland
| | - Alexis Tabah
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane
- Queensland University of Technology, Faculty of Medicine, University of Queensland
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Australia
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Cekin ZK, Oncul A, Bayraktar B. Bloodstream Infections Caused by Multidrug Resistant Bacteria: Clinical and Microbiological Features and Mortality. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:416-425. [PMID: 37900327 PMCID: PMC10600613 DOI: 10.14744/semb.2023.31697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023]
Abstract
Objectives Bloodstream infections (BSI) are associated with high morbidity and mortality. The aim of our study is to determine whether there is a relationship between certain risk factors such as the underlying disease, patient's medical history, or interventional procedures and multidrug resistant (MDR) bacterial infection and to determine the risk factors for mortality. Methods Two hundred and twenty-two outpatients and inpatients who were diagnosed with bacteremia over a 6-month period were included in the study. 232 agents from 222 patients were isolated and tested for antimicrobial susceptibility. The relationship between patients demographic and clinical data and MDR was analyzed. Results The most common microorganisms were Gram-negative bacteria (59.4%), Gram-positive bacteria (36.9%), Candida species (2.2%), and anaerobic bacteria (1.35%). The most common isolates were Escherichia coli 53 (22.8%), Staphylococcus aureus 35 (%15.1), Klebsiella pneumoniae 26 (11.2%), Pseudomonas spp. (n=17, 7.3%), Acinetobacter spp 17 (7.3%), and Enterococcus spp 14 (6%). Microorganisms with the highest antimicrobial resistance observed were 82.3% in Acinetobacter baumannii, 64.5% in coagulase-negative staphylococci, 60.3% in E. coli, 50% in K. pneumoniae, and 27.2% in Enterobacterales spp. Most patients with BSI caused by MDR bacteria were in the intensive care unit (64%). Sepsis diagnosis, urinary catheter use, history of surgery, and use of broad-spectrum antibiotics as well as risk factors for antibiotic-resistant bacteremia, coronary artery disease, inappropriate empirical therapy, healthcare-associated infections, urinary catheterization, and stay in the ICU were determined as risk factors for mortality. Conclusion Our study identified the risk factors of BSI caused by MDR bacteria and helped to reveal the relationship between these factors and mortality.
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Affiliation(s)
- Zuhal Kalayci Cekin
- Clinical Microbiology Laboratory, Bolu Izzet Baysal State Hospital, Bolu, Türkiye
| | - Ahsen Oncul
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Banu Bayraktar
- Department of Clinical Microbiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Broermann LE, Al-Hasan MN, Withers S, Benbow KL, Ramsey T, McTavish M, Winders HR. Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species. Microorganisms 2023; 11:2313. [PMID: 37764157 PMCID: PMC10536542 DOI: 10.3390/microorganisms11092313] [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: 07/12/2023] [Revised: 08/24/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in uncomplicated bloodstream infections (BSIs) due to Streptococcus species compared to standard intravenous therapy. Adult patients with uncomplicated streptococcal BSIs from April 2016 to June 2020 in seven hospitals in South Carolina, USA, were evaluated. Multivariate Cox proportional hazards regression was used to examine the time to treatment failure within 90 days of a BSI after adjustment for the propensity to receive partial oral therapy. Multivariate linear regression was used to examine the hospital length of stay (HLOS). Among the 222 patients included, 99 received standard intravenous antibiotics and 123 received partial oral therapy. Of the standard intravenous therapy group, 46/99 (46.5%) required outpatient parenteral antibiotic therapy (OPAT). There was no difference in the risk of treatment failure between partial oral and standard intravenous therapy (hazards ratio 0.53, 95% CI 0.18, 1.60; p = 0.25). Partial oral therapy was independently associated with a shorter HLOS after adjustments for the propensity to receive partial oral therapy and other potential confounders (-2.23 days, 95% CI -3.53, -0.94; p < 0.001). Transitioning patients to oral antibiotics may be a reasonable strategy in the management of uncomplicated streptococcal BSIs. Partial oral therapy does not seem to have a higher risk of treatment failure and may spare patients from prolonged hospitalizations and OPAT complications.
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Affiliation(s)
- Lynn E. Broermann
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Majdi N. Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health Midlands, Columbia, SC 29203, USA
| | | | - Kristina L. Benbow
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Taylor Ramsey
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Meghan McTavish
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
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Rein S, Sorowka A, Grünewald T, Kremer T. Microbiologic Analysis of Hand Infections: A Prospective Study. Surg Infect (Larchmt) 2023; 24:625-631. [PMID: 37646765 DOI: 10.1089/sur.2023.052] [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: 09/01/2023] Open
Abstract
Background: Hand infections are a common problem in emergency departments. Staphylococcus aureus is the main pathogen of both hand and blood stream infections. Therefore, the aim of the present study was to evaluate the frequency and impact of bacteremia in patients with hand infections to improve the microbiologic diagnostics. Patients and Methods: A prospective study of 90 patients with acute hand infections without antimicrobial pre-treatment was performed. Blood cultures were taken pre-operatively. If positive, transesophageal echocardiography was performed to rule out infectious endocarditis. Tissue samples were microbiologically processed using standardized culture media. If negative, a broad-spectrum bacterial 16S ribosomal RNA (rRNA) gene polymerase chain reaction (PCR) was applied. The etiology and location of the infection, the length of hospital stay, the number of surgical interventions, and the inflammatory parameters were obtained. Results: Six patients with bacteremia (6.6%) were diagnosed, after animal bites (n = 3) and intra-articular empyema (n = 3). Pathogens included Staphylococcus pettenkoferi, Pasteurella multocida, Staphylococcus epidermidis, Staphylococcus aureus, and Bacteroides pyogenes. No case of infective endocarditis was detected. Patients with bacteremia required more surgical interventions (p = 0.002), had a longer hospital stay (p < 0.001), higher plasma C-reactive protein (CRP; p = 0.016), and a higher age (p = 0.002) compared with those without bacteremia. In 14 cases (15.6%) no pathogen was detected by culture, whereas the subsequent broad-spectrum PCR diagnosed three cases (21.4%). Conclusions: Pre-operative blood cultures in patients with hand infections are important to detect bacteremia as an essential marker of clinical severity. Those blood cultures are indicated after deep animal bites and joint empyema. A precise identification of pathogens is fundamental for an effective treatment of hand infections, for which a 16S rRNA gene PCR can contribute in culture-negative tissue samples.
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Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany
- Martin-Luther-University Halle-Wittenberg, Germany
| | - Anne Sorowka
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany
| | - Thomas Grünewald
- Department of Infectious Diseases and Tropical Medicine, Hospital Chemnitz, Chemnitz, Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany
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47
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Yang M, Tao C. Diagnostic efficiency of the FilmArray blood culture identification (BCID) panel: a systematic review and meta-analysis. J Med Microbiol 2023; 72. [PMID: 37712641 DOI: 10.1099/jmm.0.001608] [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: 09/16/2023] Open
Abstract
Introduction. The FilmArray blood culture identification panel (BCID) panel is a multiplex PCR assay with high sensitivity and specificity to identify the most common pathogens in bloodstream infections (BSIs).Hypothesis. We hypothesize that the BCID panel has good diagnostic performance for BSIs and can be popularized in clinical application.Aim: To provide summarized evidence for the diagnostic accuracy of the BCID panel for the identification of positive blood cultures.Methodology. We searched the MEDLINE, EMBASE and Cochrane databases through March 2021 and assessed the efficacy of the diagnostic test of the BCID panel. We performed a meta-analysis and calculated the summary sensitivity and specificity of the BCID panel. Systematic review protocols were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42021239176).Results. A total of 16 full-text articles were eligible for analysis. The overall sensitivities of the BCID panel on Gram-positive bacteria, Gram-negative bacteria and fungi were 97 % (95 % CI, 0.96-0.98), 100 % (95 % CI, 0.98-01.00) and 99 % (95 % CI, 0.87-1.00), respectively. The pooled diagnostic specificities were 99 % (95 % CI, 0.97-1.00), 100 % (95 % CI, 1.00-1.00) and 100 % (95 % CI, 1.00-1.00) for Gram-positive bacteria, Gram-negative bacteria and fungi, respectively.Conclusions. The BCID panel has high rule-in value for the early detection of BSI patients. The BCID panel can still provide valuable information for ruling out bacteremia or fungemia in populations with low pretest probability.
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Affiliation(s)
- Mei Yang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Chuanmin Tao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
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48
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Speaker SL, Pfoh ER, Pappas MA, Schulte R, Hu B, Gautier TN, Rothberg MB. Relationship Between Oral Temperature and Bacteremia in Hospitalized Patients. J Gen Intern Med 2023; 38:2742-2748. [PMID: 36997793 PMCID: PMC10506973 DOI: 10.1007/s11606-023-08168-6] [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: 11/15/2022] [Accepted: 03/10/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Early recognition and treatment of bacteremia can be lifesaving. Fever is a well-known marker of bacteremia, but the predictive value of temperature has not been fully explored. OBJECTIVE To describe temperature as a predictor of bacteremia and other infections. DESIGN Retrospective review of electronic health record data. SETTING A single healthcare system comprising 13 hospitals in the United States. PATIENTS Adult medical patients admitted in 2017 or 2018 without malignancy or immunosuppression. MAIN MEASURES Maximum temperature, bacteremia, influenza and skin and soft tissue (SSTI) infections based on blood cultures and ICD-10 coding. KEY RESULTS Of 97,174 patients, 1,518 (1.6%) had bacteremia, 1,392 (1.4%) had influenza, and 3,280 (3.3%) had an SSTI. There was no identifiable temperature threshold that provided adequate sensitivity and specificity for bacteremia. Only 45% of patients with bacteremia had a maximum temperature ≥ 100.4˚F (38˚C). Temperature showed a U-shaped relationship with bacteremia with highest risk above 103˚F (39.4˚C). Positive likelihood ratios for influenza and SSTI also increased with temperature but showed a threshold effect at ≥ 101.0 ˚F (38.3˚C). The effect of temperature was similar but blunted for patients aged ≥ 65 years, who frequently lacked fever despite bacteremia. CONCLUSIONS The majority of bacteremic patients had maximum temperatures below 100.4 ˚F (38.0˚C) and positive likelihood ratios for bacteremia increased with high temperatures above the traditional definition of fever. Efforts to predict bacteremia should incorporate temperature as a continuous variable.
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Affiliation(s)
- Sidra L Speaker
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA
| | - Elizabeth R Pfoh
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew A Pappas
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca Schulte
- Department for Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Hu
- Department for Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas N Gautier
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
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49
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Nutman A, Temkin E, Wullfhart L, Schechner V, Schwaber MJ, Carmeli Y. Acinetobacter baumannii Bloodstream Infections: A Nationwide Study in Israel. Microorganisms 2023; 11:2178. [PMID: 37764022 PMCID: PMC10534809 DOI: 10.3390/microorganisms11092178] [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: 07/13/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Acinetobacter baumannii (Ab) bloodstream infections (BSIs) are a major public health concern and associated with high mortality. We describe the nationwide incidence, antimicrobial resistance, and mortality of Ab-BSI in Israel using laboratory-based BSI surveillance data from January 2018 to December 2019. During the study period, there were 971 Ab-BSI events (508 in 2018 and 463 in 2019), with an average annual incidence of 8.08/100,000 population. The median age of patients was 72 (IQR 62-83), and 56.4% were males. Two-thirds of Ab-BSI events were hospital-onset (HO), with median day of onset 16 (IQR 9-30). HO-BSI incidence was 0.62/10,000 patient-days (rate per 10,000 patient-days: 2.78, 1.17, and 0.2 for intensive care, medical, and surgical wards, respectively). Carbapenem susceptibility was 23.4%; 41.4% and 14.9% in community and HO events, respectively. The 14-day, 30-day, and 1-year mortality were 51.2%, 59.3%, and 81.4%, respectively. Carbapenem-resistant Ab-BSI were associated with a significantly higher 14-day, 30-day, and 1-year mortality (p < 0.001 for all). In the multivariable model, age (aHR 1.02) and carbapenem resistance (aHR 3.21) were independent predictors of 30-day mortality. In conclusion, Ab-BSIs pose a significant burden with high mortality, especially associated with antimicrobial resistance. Attention should be focused on prevention and improving treatment.
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Affiliation(s)
- Amir Nutman
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv 6423906, Israel
| | - Liat Wullfhart
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv 6423906, Israel
| | - Vered Schechner
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Mitchell J. Schwaber
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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50
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Boakye-Yiadom E, Najjemba R, Thekkur P, Labi AK, Gil-Cuesta J, Asafo-Adjei K, Mensah P, van Boetzelaer E, Jessani NS, Orish VN. Use and Quality of Blood Cultures for the Diagnosis of Bloodstream Infections: A Cross-Sectional Study in the Ho Teaching Hospital, Ghana, 2019-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6631. [PMID: 37681771 PMCID: PMC10487590 DOI: 10.3390/ijerph20176631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/22/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Blood Culture and Drug Susceptibility Testing (CDST) remains vital for the diagnosis and management of bloodstream infections (BSIs). While the Ghana National Standard Treatment Guidelines require CDST to be performed in each case of suspected or clinically diagnosed BSI, these are poorly adhered to in the Ho Teaching Hospital (HTH). This study used secondary medical and laboratory records to describe blood CDST requests by clinicians and the quality of CDST processes for the diagnosis of BSI among patients admitted to HTH from 2019 to 2021. Of 4278 patients, 33% were infants. Pneumonia and neonatal sepsis cases were 40% and 22%, respectively. Only 8% (351/4278) had blood CDST requested. Of 94% (329/351) blood CDST processed and reported, only 7% (22/329) were culture-positive, with likely contaminants being recovered from 16% (52/329) of the specimens. The duration from admission to request was 2 days (IQR: 0-5), and Further qualitative studies must be conducted to understand the reasons for low blood CDST utilisation among clinicians and the patient outcomes. Targeted interventions are required to enhance the utilisation of blood CDST by clinicians and the quality of laboratory processes.
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Affiliation(s)
- Emily Boakye-Yiadom
- Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho PMB 31, Volta Region, Ghana;
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | | | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France;
| | - Appiah-Korang Labi
- Ghana Country Office, World Health Organization, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana;
| | - Julita Gil-Cuesta
- Luxembourg Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières, Rue Arbre Benit 46, 1050 Brussels, Belgium;
| | - Karikari Asafo-Adjei
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | - Prosper Mensah
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | - Elburg van Boetzelaer
- Luxembourg Operational Research Unit, Médecins Sans Frontières, 68 Rue de Gasperich, L-1617 Luxembourg, Luxembourg;
| | - Nasreen S. Jessani
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Tygerburg 7505, South Africa;
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Verner Ndudri Orish
- Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho PMB 31, Volta Region, Ghana;
- Sickle Cell Disease Unit, Department of Internal Medicine, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana
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