Subsequent infection with extended-spectrum ß-lactamase-producing Enterobacteriaceae in patients with prior infection or fecal colonization.

In clinical practice, there is a growing need to assess the impact of prior colonization or infection with extended-spectrum ß-lactamase-producing Enterobacteriaceae (EPE) on new EPE infections. We have investigated the frequency of, and duration to, a subsequent EPE infection in patients with prior fecal carriage or infection with EPE. Culture data for 3272 EPE-positive patients in Western Sweden during 2004-2014 were evaluated. The median follow-up time was 3.7 years. The first recorded EPE-positive fecal screen, or clinical (urine, blood) culture, and subsequent EPE-positive clinical samples were analyzed, focusing on the first and last recurrence of EPE infection. ESBL Escherichia coli dominated (95%). Almost all (94%) patients initially positive in fecal screen (n = 1436) and 72 and 71% of those initially positive in urine (n = 1717) and blood (n = 119) had no further EPE clinical isolates. Subsequent EPE bacteremia was only detected in 0.7, 1.6, and 4.2% of the respective patient group. Recurrent EPE-positive urine cultures occurred in 27% (460/1717), most (75%) within 6 months, and rarely (13%) after 1 year. Repeated EPE-positive clinical samples were significantly (p < 0.01) more common in patients > 65 years and in men with ESBL Klebsiella pneumoniae. In our low-endemic setting, subsequent EPE infections in previously colonized patients were rare. On the other hand, in patients previously EPE-positive in urine or blood, subsequent EPE urinary tract infections were common, especially within 6 months and in patients > 65 years old.

Tidig infektionskonsult gav effekt vid Staphylococcus aureus-bakteriemi - Konsultationen minskade återinläggningsfrekvens och mortalitet, visar retrospektiv studie.

Automatic infectious disease consultant alert is associated with decreased mortality and readmission rate in Staphylococcus aureus bacteriemia A management plan was implemented at a 2000 bed teaching hospital where positive blood cultures with growth of Staphylococcus aureus were reported simultaneously to the ordering unit and to the Infectious Disease Consultant. Readmission rate and 30-day mortality were compared one year before and one year after introduction of the management plan. Out of totally 320 respectively 321 patients with SAB 252 and 244 were included in the study. 30-day mortality decreased from 26/252 (10%) to 14/244 (5,7%) (p=0.059) when all patients with SAB were included and to 9/193 (4,7%) (p=0,026) when only patients who received a formal consultation after introduction of the management plan were included. The rate of readmission within 30 days declined from 38/227 (17%) in 2014-2015 to 24/230 (10%) in 2015-2016 (p=0,049).