Changes in antimicrobial resistance and outcomes of health care-associated infections.

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.

Evaluation of Clinical Approach and Outcomes Staphylococcus aureus Bacteremia.

Objective: Despite appropriate treatment and early diagnosis methods, Staphylococcus aureus bacteremia (SAB) is still associated with a high mortality rate. This study aims to evaluate the clinical features and approaches to SAB and to analyze the parameters that may affect 7-day and 30-day mortality. Materials and Methods: Adult patients with SAB data between 2011 and 2018 were evaluated retrospectively. Clinical data, patient demographics, and 7-day and 30-day mortality rates were obtained from their medical records. Results: In total, 144 patients were included in the study; 57.6% (83/144) of patients were men, and the mean age was 65.2±16.5 years. The most common source of infection was the central-line catheter (38.9%), followed by intra-abdominal (21%), respiratory (16.7), infective endocarditis (5.6%), and osteoarticular foci (2.1%). Fifteen percent (15%) of the strains were methicillin resistant. Transthoracic echocardiography (TTE) was performed for 80.6% (116/144) patients. Infectious diseases specialist consultation within 96 hours from blood culture signal was requested in 79.9%. Overall, 7-day mortality was 11.8%, and 30-day mortality was 21.5%. Staying in intensive care units (ICU) increased the risk of 30-day mortality by 1.1 times, and respiratory-focused SAB increased the risk by 4.3 times. Conclusion: SAB is still a big threat. Staphylococcal pneumonia remains a severe infection. Several prognostic factors influence mortality. Identifying the source, ensuring source control, and appropriate initial therapy as soon as possible are critical for reducing mortality and morbidity in SAB.

Bloodstream Infections among Solid Organ Transplant Recipients: Eight Years' Experience from a Turkish University Hospital.

BACKGROUND: Bloodstream infections (BSI) are frequently seen after solid organ transplantation. The incidence of bloodstream infections differs among the types of transplantation. The microbiological features and antimicrobial resistance patterns change from centre to centre. AIMS: To evaluate the incidence and spectrum of aetiological agents of bloodstream infections among solid organ transplantation recipients. STUDY DESIGN: Retrospective descriptive study. METHODS: Medical records of solid organ transplant recipients in the period between January 1(st) 2004 and August 15(th) 2012 were assessed retrospectively. The study population comprised 927 (64 heart, 556 kidney, 307 liver) consecutive recipients. Bloodstream infections were divided into three groups according to the onset time of bloodstream infections after transplantation: early, mid-term and late. The incidence and microbiological features of bloodstream infections were evaluated. RESULTS: The number of bloodstream infection episodes was 317 in 191 recipients which was distributed as 228 (72%) in liver, 70 (22%) in kidney and 19 (6%) in heart transplantation. Ninety-eight 98 (30.9%) of the episodes were diagnosed within the early period, 134 (42.3%) within the mid-term and 85 (26.8%) in the late period. Early and mid-term bloodstream infections were seen statistically more often in liver than in kidney or heart transplantation (p=0.01 and p=0.031, respectively). Late bloodstream infections were also common in liver transplant recipients which was not statistically significant (p=0.229). CONCLUSION: Liver transplant recipients are at the highest risk for developing BSI after transplantation in early, mid-term and late periods.