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1.
Infect Dis Clin North Am ; 35(4): 841-856, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34752222

RESUMO

Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Bacteriemia/epidemiologia , Bacteriemia/etiologia , COVID-19/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/normas , Tomada de Decisão Clínica , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Humanos , Pacotes de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , SARS-CoV-2
2.
Arch Argent Pediatr ; 119(6): 408-413, 2021 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34813234

RESUMO

Introduction: Staphylococcus aureus is one of the most prevalent infectious agents in children and may cause a wide variety of clinical presentations. S. aureus bacteremia is frequently associated with complications and metastatic infections. The epidemiological and clinical data about S. aureus bacteremia and its complications in pediatrics are scarce. Objectives: To describe the epidemiology, frequency, distribution, and type of metastatic infections in a series of pediatric patients with S. aureus bacteremia and assess possible risk factors for its development. Population and methods: Cross-sectional study of pediatric patients with S. aureus bacteremia admitted to a children's hospital of La Plata between January 2016 and June 2019. Results: A total of 112 S. aureus bacteremia events were analyzed. The rate of metastatic infection was 34.8%; the lung was the most common infection site. The main risk factors for the development of metastatic infections were bacteremia due to methicillin-resistant S. aureus (odds ratio: 2.95; 95% confidence interval: 1.19- 7.83; p = 0.015) and persistent positive control blood cultures at 48 hours (odds ratio: 3.17; 95% confidence interval: 1.22-8.46; p = 0.012). Conclusion: The rate of metastatic infections among patients with S. aureus bacteremia was 34.8%. Associated risk factors were bacteremia due to methicillin-resistant S. aureus and persistent positive control blood cultures at 48 hours. The most common organs affected included the lungs, the osteoarticular system, and the skin and soft tissue.


Assuntos
Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Pediatria , Argentina/epidemiologia , Bacteriemia/epidemiologia , Criança , Estudos Transversais , Hospitais Pediátricos , Humanos , Staphylococcus aureus
3.
Ann Med ; 53(1): 1779-1786, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34637370

RESUMO

BACKGROUND: An unexpected high prevalence of enterococcal bloodstream infection (BSI) has been observed in critically ill patients with COVID-19 in the intensive care unit (ICU). MATERIALS AND METHODS: The primary objective was to describe the characteristics of ICU-acquired enterococcal BSI in critically ill patients with COVID-19. A secondary objective was to exploratorily assess the predictors of 30-day mortality in critically ill COVID-19 patients with ICU-acquired enterococcal BSI. RESULTS: During the study period, 223 patients with COVID-19 were admitted to COVID-19-dedicated ICUs in our centre. Overall, 51 episodes of enterococcal BSI, occurring in 43 patients, were registered. 29 (56.9%) and 22 (43.1%) BSI were caused by Enterococcus faecalis and Enterococcus faecium, respectively. The cumulative incidence of ICU-acquired enterococcal BSI was of 229 episodes per 1000 ICU admissions (95% mid-p confidence interval [CI] 172-298). Most patients received an empirical therapy with at least one agent showing in vitro activity against the blood isolate (38/43, 88%). The crude 30-day mortality was 42% (18/43) and 57% (4/7) in the entire series and in patients with vancomycin-resistant E. faecium BSI, respectively. The sequential organ failure assessment (SOFA) score showed an independent association with increased mortality (odds ratio 1.32 per one-point increase, with 95% confidence interval 1.04-1.66, p = .021). CONCLUSIONS: The cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19. Our results suggest a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.KEY MESSAGESThe cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19.The crude 30-day mortality of enterococcal BSI in critically ill patients with COVID-19 may be higher than 40%.There could be a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.


Assuntos
Bacteriemia/epidemiologia , COVID-19/epidemiologia , Infecção Hospitalar/epidemiologia , Enterococcus faecalis , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/epidemiologia , Mortalidade , Enterococos Resistentes à Vancomicina , Idoso , Bacteriemia/microbiologia , Estado Terminal , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Retrospectivos , SARS-CoV-2
4.
Emerg Infect Dis ; 27(11): 2825-2835, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34670645

RESUMO

We typed 600 methicillin-resistant Staphylococcus aureus (MRSA) isolates collected in 51 hospitals in the Rio de Janeiro, Brazil, metropolitan area during 2014-2017. We found that multiple new clonal complex (CC) 5 sequence types had replaced previously dominant MRSA lineages in hospitals. Whole-genome analysis of 208 isolates revealed an emerging sublineage of multidrug-resistant MRSA, sequence type 105, staphylococcal cassette chromosome mec II, spa t002, which we designated the Rio de Janeiro (RdJ) clone. Using molecular clock analysis, we hypothesized that this lineage began to expand in the Rio de Janeiro metropolitan area in 2009. Multivariate analysis supported an association between bloodstream infections and the CC5 lineage that includes the RdJ clone. Compared with other closely related isolates, representative isolates of the RdJ clone more effectively evaded immune function related to monocytic cells, as evidenced by decreased phagocytosis rate and increased numbers of viable unphagocytosed (free) bacteria after in vitro exposure to monocytes.


Assuntos
Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Bacteriemia/epidemiologia , Brasil/epidemiologia , Humanos , Staphylococcus aureus Resistente à Meticilina/genética , Monócitos , Infecções Estafilocócicas/epidemiologia
5.
Medicine (Baltimore) ; 100(40): e27386, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622842

RESUMO

ABSTRACT: To investigate the differences in clinical and microbiological features in men hospitalized with community-acquired (CA) and healthcare-associated (HA) nonobstructive acute pyelonephritis (APN), as well as the predictive factors associated with bacteremia.Men discharged from urological centers with nonobstructive APN were identified using an electronic medical records system. We compared the clinical and microbiological data between subjects with CA-APN and HA-APN.Of the 245 men with nonobstructive APN, 175 had CA-APN, and 70 had HA-APN. The HA group was significantly older, had a longer hospital stay, and had more underlying diseases, bacteremia, and intensive care unit admissions than the CA group. The most commonly cultured microorganism was Escherichia coli. The susceptibility of the cultured bacteria to fluoroquinolone was 68.7% in the CA group and 45.3% in the HA group (P = .005). The proportion of extended-spectrum beta-lactamase-producing bacteria was 22.7% for CA and 53.5% for HA (P < .001). The sensitivity to piperacillin/tazobactam was 94.9% for CA and 90.0% for HA, and the sensitivity to amikacin was more than 95% for both groups. The multivariate analysis revealed that an age ≥65 years and chronic liver disease were independent predictive factors for bacteremia.The incidence of antibiotic resistance and bacteremia was higher in the HA group than in the CA group. However, resistance to fluoroquinolone and the presence of extended-spectrum beta-lactamase-producing bacteria were high in both groups. Piperacillin/tazobactam and amikacin may be suitable treatment options in men with nonobstructive APN.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Pielonefrite/etiologia , Adulto , Fatores Etários , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/epidemiologia , Comorbidade , Farmacorresistência Bacteriana , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pielonefrite/tratamento farmacológico , Pielonefrite/epidemiologia , República da Coreia , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 100(43): e27651, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34713857

RESUMO

ABSTRACT: To estimate the prevalence of the most frequent infections related to device utilization and their antimicrobial sensitivity panel, and to investigate the overall incidence of device associated infection rates per 1000 device days, at the pediatric intensive care unit of the Jordan University of Science and Technology.This is a retrospective study from a single pediatric intensive care unit. Data were collected in relation to bloodstream infections associated with central venous catheters, pneumonia associated with ventilator endotracheal tubes, and urinary tract infections associated with Foley catheters, between January 2013 and December 2018, according to the center of disease control and prevention protocols.During the 5-year study, 3195 patients were admitted to the pediatric intensive care unit for a total of 16,487 days. Forty-six patients (1.4%) developed 55 infections, with a median incidence rate of 7.4, 3.7, and 0.7 per 1000 days for central line associated infections, ventilator associated pneumonia, and catheter associated infections, respectively. The commonest isolated microorganisms were gram-negative bacteria in 89.1% of cases, and fungi in 10.9% of cases. Among the resistant bacterial isolates, 59.2% were multidrug resistant, and 32.6% were extended spectrum beta lactamase producers Klebsiella pneumoniae and Eschericia coli. High infection rates were related to Acinetobacter baumannii and K pneumoniae, associated with high resistance to cephalosporins. Susceptibility was highest to tigecycline and imipenem at 42.9% and 32.7% respectively.Microbial isolates are commonly associated with healthcare device insertions in pediatric intensive care unit, invasive bacterial infections associated with critical morbidity and mortality. Further studies on device associated infections are recommended for regional profiling purposes.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Infecções Urinárias/epidemiologia , Bacteriemia/etiologia , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Humanos , Lactente , Jordânia/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Estudos Retrospectivos , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia
7.
Mikrobiyol Bul ; 55(4): 492-506, 2021 Oct.
Artigo em Turco | MEDLINE | ID: mdl-34666651

RESUMO

In Turkey, the seven-valent pneumococcal conjugated vaccine (PCV7) was included in the childhood national immunization programme in April 2008 and was replaced by the 13-valent pneumococcal conjugated vaccine (PCV13) in April 2011. In this retrospective, single-center study, it was aimed to determine the serotype distribution and antimicrobial resistance in Streptococcus pneumoniae isolates of pediatric patients with invasive pneumococcal disease (IPD) after the introduction of PVC7 and PVC13. Fifty pediatric patients diagnosed with meningitis and sepsis/bacteremia between October 2009 and October 2019 were included in the study. The pediatric patient group consisted of previously healthy patients diagnosed with meningitis and sepsis/bacteremia with S.pneumoniae isolated in their blood or cerebrospinal fluids. Patients with pneumonia-associated bacteremia and empyema were not included in the study. Serotyping of the isolates was performed by Quellung reaction using specific antisera (Statens Serum Institute, Denmark) and antibiotic (penicillin and ceftriaxone) susceptibility was determined by antibiotic gradient method based on Clinical Laboratory Standards Institute (CLSI) criteria. Of the children, 29 (58%) were boys and 21 (42%) were girls. The median age of the patients was 19 months (1 month-18 year). When the children under the age of five were evaluated, it was found that 30 (79%) patients were diagnosed with occult bacteremia/sepsis and 8 (21%) with meningitis. The overall annual incidence rate of IPD among the healthy children aged <5 years decreased significantly from 9.35/100000 to 0.83/100000 (p< 0.001). Serotype identification was determined for 44 of 50 pneumococcal isolates . However, since six patients with underlying disease were not included in the evaluation, the remaining 38 isolates were found to be one of the serotypes included in PCV7 and PCV13 at a rate of 28.9% (n= 11) and 44.7% (n= 17), respectively. While the rate of PCV13 serotypes seen in the PCV7 period was 81.8%, this rate decreased to 29.6% within eight years after PCV13 administration. The rate of non-vaccine serotypes was determined as 54.5% in PCV7 period and 70.3% in PCV13 period. The rate of non-vaccine serotypes in patients under 5 years was 60% in the period of PCV7 and 75% in the period of PCV13. The proportion of non-vaccine serotypes has increased over time. However, this difference was not statistically significant (p> 0.05). The most common serotypes detected in isolates were 19F, 23F, 7F, 31 and 24B. According to the minimum inhibitory concentration values of the isolates recovered from patients with meningitis, penicillin and ceftriaxone resistance rates were found as 43.9% and 9.8%, respectively. In conclusion, our study showed that there was a 91.1% decrease in the incidence of IPD in healthy children aged under five years after the implementation of PCV7 and PCV13. It was determined that while the rate of serotypes in vaccine content decreased, there was an increase in non-vaccine serotypes. In addition no significant change was observed in antibiotic resistance rates over the years.


Assuntos
Bacteriemia , Meningite Pneumocócica , Infecções Pneumocócicas , Bacteriemia/epidemiologia , Criança , Resistência Microbiana a Medicamentos , Feminino , Humanos , Lactente , Masculino , Meningite Pneumocócica/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Estudos Retrospectivos , Sorogrupo , Sorotipagem , Streptococcus pneumoniae
8.
Infection ; 49(6): 1289-1297, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34716548

RESUMO

PURPOSE: To evaluate the relationship between mortality or relapse of bloodstream infection (BSI) due to Enterococcus faecalis and infectious diseases specialist consultation (IDC) and other factors potentially associated with outcomes. METHODS: In a tertiary-care center, consecutive adult patients with E. faecalis BSI between January 1, 2016 and January 31, 2019, were prospectively followed. The management of E. faecalis BSI was evaluated in terms of adherence to evidence-based quality-of-care indicators (QCIs). IDC and other factors potentially associated with 90-day-mortality or relapse of E. faecalis BSI were analyzed by multivariate logistic regression. RESULTS: A total of 151 patients with a median age of 68 years were studied. IDC was performed in 38% of patients with E. faecalis BSI. 30 cases of endocarditis (20%) were diagnosed. All-cause in-hospital mortality was 23%, 90-day mortality was 37%, and 90-day relapsing E. faecalis BSI was 8%. IDC was significantly associated with better adherence to 5 QCIs. Factors significantly associated with 90-day mortality or relapsing EfB in multivariate analysis were severe sepsis or septic shock at onset (HR 4.32, CI 2.36e7.88) and deep-seated focus of infection (superficial focus HR 0.33, CI 0.14e0.76). CONCLUSION: Enterococcus faecalis bacteremia is associated with a high mortality. IDC contributed to improved diagnostic and therapeutic management.


Assuntos
Bacteriemia , Doenças Transmissíveis , Infecções por Bactérias Gram-Positivas , Sepse , Adulto , Idoso , Bacteriemia/epidemiologia , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco
9.
PLoS One ; 16(10): e0258114, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618858

RESUMO

BACKGROUND: Enterobacter species are an important cause of healthcare-associated bloodstream infections (BSI) in children. Up to 19% of adult patients with Enterobacter BSI have recurrence of infection resistant to third-generation cephalosporins (3GCs) while on therapy with a 3GC. Data are lacking regarding the incidence of and risk factors for recurrence of infection in children with Enterobacter BSI. METHODS: We conducted a retrospective case-control study of patients aged ≤21 years old admitted to Texas Children's Hospital from January 2012 through December 2018 with Enterobacter BSI. The primary outcome was microbiologic failure from 72 hours to 30 days after the initial BSI (cases). The secondary outcome was isolation of a 3GC non-susceptible Enterobacter sp. from a patient with an initial 3GC-susceptible isolate. RESULTS: Twelve patients (6.7%) had microbiologic failure compared to 167 controls without microbiologic failure. Of the 138 patients (77.1%) with an Enterobacter sp. isolate that was initially susceptible to 3GCs, 3 (2.2%) developed a subsequent infection with a non-susceptible isolate. Predictors of microbiologic failure were having an alternative primary site of infection besides bacteremia without a focus or an urinary tract infection (OR, 9.64; 95% CI, 1.77-52.31; P < 0.01) and inadequate source control (OR, 22.16; 95% CI, 5.26-93.36; P < 0.001). CONCLUSIONS: Source of infection and adequacy of source control are important considerations in preventing microbiologic failure. In-vitro susceptibilities can be used to select an antibiotic regimen for the treatment of Enterobacter BSI in children.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Enterobacter/patogenicidade , Infecções por Enterobacteriaceae/tratamento farmacológico , Sepse/tratamento farmacológico , Adolescente , Adulto , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Enterobacter/genética , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Sepse/epidemiologia , Sepse/microbiologia , Adulto Jovem
10.
Tijdschr Gerontol Geriatr ; 52(3)2021 Aug 11.
Artigo em Holandês | MEDLINE | ID: mdl-34523854

RESUMO

Periprosthetic joint infections at an advanced age can lead to significant diagnostic and therapeutic challenges, mostly related to an atypical form of presentation in this population. We describe in this case the delayed diagnostic process of a disseminated invasive Staphylococcus aureus infection in a frail patient with a total hip prosthesis. The detection of Staphylococcus aureus in a urine sample was a supplementary hint towards the possible existence of a Staphylococcus aureus bacteraemia. The course of this case shows that teleconsultation and ambulatory based diagnostics are not appropriate for frail older patients with (sub)acute bone and joint infections, even in times of pandemic and constrainedly deferred care.


Assuntos
Bacteriemia , COVID-19 , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Humanos , Pandemias , SARS-CoV-2 , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus
12.
BMC Infect Dis ; 21(1): 933, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496787

RESUMO

BACKGROUND: Bloodstream infections (BSIs) are an emerging cause of significant morbidity and mortality in severe Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence, clinical profile and outcome of BSIs in critically ill COVID-19 patients. METHODS: This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All patients (age > 18 years) with reverse-transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 admitted in the intensive care unit (ICU) were included. Hospital electronic records were searched for demographic data, time of bloodstream infection since admission, clinical profile, antimicrobial resistance pattern and clinical outcome of all patients who developed BSIs. RESULTS: Out of 750 patients admitted in COVID ICU, 8.5% developed secondary BSIs. All severe COVID-19 patients who developed BSIs succumbed to illness. A significant proportion of BSIs were Gram-negative pathogens (53/64, 82.8%). Acinetobacter baumannii was the commonest isolate, followed by Klebsiella pneumoniae (32.8% and 21.9%, respectively). Multidrug-resistance organisms (MDRO) were found in 57.8% of the cases. The majority of MDRO belonged to K. pneumoniae and Enterococcus groups. The proportion of Gram-negative bacteria resistant to carbapenems was 47.2% (25/53). On multivariate analysis, raised total leukocyte counts, mechanical ventilation and presence of comorbidities were significantly associated with the incidence of BSIs. CONCLUSION: We found a significant prevalence of Acinetobacter baumannii in COVID-19 associated BSIs. The presence of comorbidities raised leukocyte counts and mechanical ventilation should alarm clinicians for possible BSIs. The timely initiation of empirical antibiotics and rapid de-escalation is vital to improve the outcome. At the same time, strict compliance of infection control practices should be accomplished to reduce the occurrence of MDRO.


Assuntos
Bacteriemia , COVID-19 , Sepse , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Humanos , Estudos Retrospectivos , SARS-CoV-2 , Sepse/tratamento farmacológico
13.
BMC Infect Dis ; 21(1): 1021, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34587893

RESUMO

BACKGROUND: Non-typhoidal Salmonella (NTS) infection is thought to be more severe in cancer patients, but this has not been studied since the development of new cancer therapies, increasing antibiotic resistance and the introduction of new antibiotics. We sought to describe the demographic characteristics, microbiological findings, clinical manifestations, and outcomes of NTS infections in cancer patients at our institution. METHODS: We reviewed microbiology laboratory records and identified patients who had cancer and from whom NTS organisms were recovered between January 1, 2000 and December 31, 2013, at a comprehensive cancer center in Houston, Texas. Descriptive statistics were used to summarize patient characteristics, clinical presentation and outcomes. RESULTS: We identified 110 isolates from 82 patients with 88 episodes of NTS infection (including five relapses [6%] in four patients, and two consecutive episodes in one patient). Fifty-five patients (67%) had hematologic malignancies. Most NTS isolates were susceptible to the commonly prescribed antimicrobials. Sixty-nine percent of patients had sepsis and one-third had severe sepsis or septic shock. Gastroenteritis, bacteremia, or both were present in 69% of patients, and the rest had focal infection. Mortality at 30 days was low (8%). Relapses occurred only in patients receiving ≤ 10 days of antibiotic therapy. CONCLUSIONS: NTS affects predominantly patients with hematologic malignancies, followed by gastrointestinal and genitourinary cancers. Invasive disease, sepsis, and septic shock are common presentations among admitted patients. Antimicrobial prophylaxis may not prevent NTS infection. Thirty-day mortality and attributable mortality rates were low in our series compared to older case series. Early appropriate antibiotic therapy may have had a role in decreasing mortality. Relapses occurred in patients receiving ≤ 10 days of therapy, suggesting the need for longer duration of antibiotic therapy in cancer patients with uncomplicated NTS infections.


Assuntos
Bacteriemia , Infecções por Salmonella , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Humanos , Recidiva Local de Neoplasia/tratamento farmacológico , Salmonella , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/epidemiologia
14.
Public Health ; 198: 292-296, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34507134

RESUMO

OBJECTIVES: To examine the length of stay, hospitalisation costs and case fatality of methicillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA) bacteremia in Japan. STUDY DESIGN: Retrospective cohort study. Patients with a diagnosis of S. aureus bacteremia who were admitted to a tertiary care hospital (the National Centre for Global Health and Medicine [NCGM]) in Tokyo, Japan, between 1st January 2016 and 31st December 2020 were included in the study. METHODS: We combined Japan Nosocomial Infections Surveillance data and Diagnosis Procedure Combination data at NCGM from 2016 to 2020. The data were stratified into MSSA and MRSA groups. Length of stay (LoS), LoS after submission of a blood culture specimen (LoS-after), hospitalisation cost, hospitalisation costs per day and clinical outcome were compared after propensity score matching. RESULTS: Median LoS was 46 (interquartile range [IQR] 28.5-64.5) days in the MSSA group and 66 (IQR 40-91) days in the MRSA group (P = 0.020). Median LoS-after was 38 (IQR 25-62.5) days and 45 (IQR 24-63) days (P = 0.691) in the MSSA and MRSA groups, respectively. Median hospitalisation cost was significantly higher in the MRSA group (26,035 [IQR 18,154-47,362] USD) than in the MSSA group (19,823 [IQR 13,764-32,042] USD) (P = 0.036), but cost per day was not (MRSA: 528.9 [IQR 374.9-647.4] USD; MSSA: 455.6 [IQR 359.2-701.7] USD; P = 0.990). Case fatality rate was higher in the MRSA group than in the MSSA group (22/60 vs 9/60, P = 0.012). CONCLUSIONS: Patients with MRSA bacteremia had longer LoS and higher costs than those with MSSA bacteremia. However, LoS-after and hospitalisation costs per day were not different. The longer LoS of patients in Japan compared with other countries might contribute to the higher disease burden of S. aureus bacteremia in Japan.


Assuntos
Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Bacteriemia/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Japão/epidemiologia , Tempo de Internação , Meticilina , Resistência a Meticilina , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus
16.
Med J Malaysia ; 76(5): 630-636, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34508367

RESUMO

INTRODUCTION: Pseudomonas aeruginosa is known to be the epitome of nosocomial infections associated with high morbidity and mortality. The dearth of local pseudomonal studies has prompted us to conduct this study with the following objectives: (1) to examine the local pseudomonal bacteraemia (PB) epidemiology and clinical characteristics, (2) to compare the 30-day mortality among PB of different onsets and (3) to determine the predictors of 30-day mortality outcome. METHODS: This retrospective study was conducted in Hospital Seri Manjung, Perak, Malaysia. All cases of blood culture proven PB that occurred between 1st January 2015 and 31st December 2019 were reviewed. Subjects below 12 year old and whose index blood cultures grew more than one organism were excluded. Demographic, clinical and treatment data were collected using pre-tested data collection forms and analysed using SPSS version 20.0. RESULTS: Among the 59 subjects included, healthcare associated (HCA) infections were the most prevalent, next to hospital onset (HO) and community onset (CO) infections. The commonest underlying comorbidities were cardiovascular disease, diabetes mellitus, and chronic kidney disease. Respiratory tract was the most frequently implicated source amongst all, while the urinary tract was more frequently implicated as the source of infection among HCA cases. Seventeen patients were admitted to ICU, and they were predominantly from the HO group. Despite having a higher rate of adequate empirical antibiotics administered, the HO group reported the lowest 30-day survival rate. Multiple logistic regression analysis demonstrated the following were independent predictors of 30-day mortality: requiring mechanical ventilator support, requiring central venous line insertion, not requiring surgery, and receiving inappropriate definite antibiotics. CONCLUSION: The incidence of community onset PB was appreciably low, as cases were predominantly HCA and HO in origin. Significant morbidities were observed among pseudomonal infections, with HO infections portending the worst prognosis. Lastly, prognostic factors for determining the mortality caused by PB depended more on the severity of sepsis than the timeliness of appropriate antibiotics.


Assuntos
Bacteriemia , Infecções Comunitárias Adquiridas , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Criança , Hospitais de Distrito , Humanos , Pseudomonas aeruginosa , Estudos Retrospectivos , Fatores de Risco
17.
Arch Argent Pediatr ; 119(5): 325-330, 2021 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34569740

RESUMO

INTRODUCTION: Infections due to bacteremia in burn patients are a common cause of complications and an extended length of stay. Knowing causative microorganisms and identifying associated risk factors allow to reduce infectious complications, morbidity, mortality, and health care expenditure. This study assesses the extent of the association between risk factors and bacteremia in burn patients and identifies the most common microorganisms found in blood cultures. POPULATION AND METHODS: Case-control study conducted at the Burn Intensive Care Unit of Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan" between June 1st, 2014 and September 30th, 2019 in patients with bacteremia events and a positive blood culture (cases) and patients with a negative blood culture (controls). RESULTS: During the study period, 29 cases of bacteremia were identified. The median length of stay at the time of bacteremia was 23 days. The most commonly identified microorganism was Pseudomonas (7 cases). The only risk factor that showed a significant association was the presence of a central venous line for 7 days or more (OR: 3.18; 95 % confidence interval: 1.20- 8.38). The overall mortality rate was 9.1%; 13.8% for cases and 3.4% for controls. CONCLUSIONS: Central venous lines for more than 7 days are an independent risk factor for bacteremia in critically ill burn children. No statistically significant association was established with other studied risk factors. Pseudomonas, Acinetobacter, and coagulase-negative Staphylococcus were the most common microorganisms found in bacteremia.


Assuntos
Bacteriemia , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Estudos de Casos e Controles , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Estudos Retrospectivos , Fatores de Risco , Staphylococcus
18.
Hosp Pediatr ; 11(9): e184-e188, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34465602

RESUMO

BACKGROUND AND OBJECTIVES: Data on invasive bacterial infection (IBI), defined as bacteremia and/or bacterial meningitis, in febrile infants aged <60 days old primarily derive from smaller, dated studies conducted at large, university-affiliated medical centers. Our objective with the current study was to determine current prevalence and epidemiology of IBI from a contemporary, national cohort of well-appearing, febrile infants at university-affiliated and community-based hospitals. PATIENTS AND METHODS: Retrospective review of well-appearing, febrile infants aged 7 to 60 days was performed across 31 community-based and 44 university-affiliated centers from September 2015 to December 2017. Blood and cerebrospinal fluid bacterial culture results were reviewed and categorized by using a priori criteria for pathogenic organisms. Prevalence estimates and subgroup comparisons were made by using descriptive statistics. RESULTS: A total of 10 618 febrile infants met inclusion criteria; cerebrospinal fluid and blood cultures were tested from 6747 and 10 581 infants, respectively. Overall, meningitis prevalence was 0.4% (95% confidence interval [CI]: 0.2-0.5); bacteremia prevalence was 2.4% (95% CI: 2.1-2.7). Neonates aged 7 to 30 days had significantly higher prevalence of bacteremia, as compared with infants in the second month of life. IBI prevalence did not differ between community-based and university-affiliated hospitals (2.7% [95% CI: 2.3-3.1] vs 2.1% [95% CI: 1.7-2.6]). Escherichia coli and Streptococcus agalactiae were the most commonly identified organisms. CONCLUSIONS: This contemporary study of well-appearing, febrile infants supports previous epidemiological estimates of IBI prevalence and suggests that the prevalence of IBI may be similar among community-based and university-affiliated hospitals. These results can be used to aid future clinical guidelines and prediction tool development.


Assuntos
Bacteriemia , Infecções Bacterianas , Meningites Bacterianas , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Febre/epidemiologia , Humanos , Lactente , Recém-Nascido , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/epidemiologia , Prevalência , Estudos Retrospectivos
19.
Ann Hematol ; 100(11): 2825-2830, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34591161

RESUMO

Central venous catheters (CVCs) are generally required for chemotherapy in patients with acute leukemia, but catheter-related infection is one of the common causes of neutropenic fever. We investigated the in-hospital mortality according to early removal of CVCs and the factors influencing the mortality in patients with acute leukemia undergoing remission induction chemotherapy. This study retrospectively analyzed the hospital record data of 278 patients with acute leukemia treated with non-tunneled CVCs and remission induction chemotherapy in a single institution. Bloodstream infection was more common (p < 0.0001) and median peak C-reactive protein (CRP) levels after neutropenic fever were significantly higher (23.3 vs. 14.5 mg/dl, p = 0.003) in the group with early removal than in the group with maintenance of the CVC. Multivariate analysis of the patients revealed a significant decrease in the mortality with female gender (odds ratio (OR): 0.19, 95% confidence interval (CI): 0.06-0.54, p = 0.002) and a significant increase in the mortality according to the peak CRP (OR 1.12, 95% CI: 1.07-1.17, p < 0.0001). By contrast, early removal of the CVC had no significant effect on the mortality (OR = 1.16, 95% CI: 0.54-2.47, p = 0.706) in univariate analysis. Furthermore, subsequent bloodstream infection after clinical decision for maintenance or early removal of the CVC was confirmed more frequently in the group with early removal (early removal, 22.6%; maintenance, 7.6%, p < 0.0001). Early removal of the CVC had no benefit regarding the mortality and prophylaxis of bloodstream infection in patients with acute leukemia undergoing remission induction chemotherapy. Therefore, maintaining a CVC for as long as possible may be considered, if catheter-related bloodstream infection is not strongly suspected.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/efeitos adversos , Remoção de Dispositivo , Mortalidade Hospitalar , Leucemia Mieloide Aguda/mortalidade , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/etiologia , Neutropenia Febril/etiologia , Feminino , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
20.
BMC Infect Dis ; 21(1): 806, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34384380

RESUMO

BACKGROUND: The management of non-fermentative gram-negative bloodstream infection (NFGN-BSI) offers numerous challenges. In this study the aim is to analyse a large cohort of patients with NFGN-BSI recruited in the northern Italy to describe epidemiology, etiological and susceptibility pattern, therapeutic management and outcome. METHODS: Multicentre retrospective cohort study of patients hospitalised at three large teaching hospitals in northern Italy in a fourth year period. RESULTS: 355 BSI episodes were analyzed, due to P. aeruginosa (72.7%), A. baumannii (16.6%), and Stenotrophomonas maltophilia (10.7%). Overall, 21.4% of isolates were defined as DTR, highest rate among A. baumannii (64.4%). All-cause 30-day mortality rate was 17.5%. Rates of XDR or DTR A. baumannii isolation were significantly higher in non-surviving patients. Independent risk factors for 30-day mortality were: age (HR 1.03, 95%CI 1.00-1.04, p = 0.003), septic shock (HR 2.84, 95%CI 1.67-4.82, p < 0.001) and BSI due to Acinetobacter baumannii (HR 2.23, 95%CI 1.27-3.94, p = 0.005). CONCLUSION: The overall prevalence of DTR was high in the NFGN BSI cohort analyzied, mainly among Acinetobacter baumannii episodes (64.4%). Acinetobacter baumannii is showed to be an independent predictor of mortality. These evidences marked the urgent need of new therapeutic options against this pathogen. TRIAL REGISTRATION NUMBER: 79/2017/O/OssN. Approved: March14th, 2017.


Assuntos
Acinetobacter baumannii , Bacteriemia , Stenotrophomonas maltophilia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Farmacorresistência Bacteriana , Humanos , Estudos Retrospectivos
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