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Bloodstream Infections (bloodstream + infections)
Selected AbstractsSystemic Inflammatory Response Syndrome in Nosocomial Bloodstream Infections with Pseudomonas aeruginosa and Enterococcus Species: Comparison of Elderly and Nonelderly PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006Alexandre R. Marra MD OBJECTIVES: To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients. DESIGN: Historical cohort study. SETTING: An 820-bed tertiary care facility. PARTICIPANTS: One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI. MEASUREMENTS: SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (,65, n=37) were compared with nonelderly patients (<65, n=90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model. RESULTS: No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology And Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivariate analysis revealed that hematological failure (odds ratio (OR)=8.1, 95% confidence interval (CI)=2.78,23.47), cardiovascular failure (OR=4.7, 95% CI=1.69,13.10), and adjusted APACHE II , 15 at BSI onset (OR=3.1, 95% CI=1.12,8.81) independently predicted death. CONCLUSION: Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients. [source] Bloodstream infections in a secondary and tertiary care hospital settingINTERNAL MEDICINE JOURNAL, Issue 4 2007L. J. Worth No abstract is available for this article. [source] Bloodstream infections in hospitalized adults with sickle cell disease: A retrospective analysisAMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2006Lalita Chulamokha Abstract Bloodstream infections (BSI) are a common cause of morbidity and mortality in people with sickle cell disease (SCD). In children with SCD, BSI are most often caused by encapsulated organisms. There is a surprising paucity of medical literature that is focused on evaluating SCD adults with BSI. We reviewed the charts of adults with SCD and BSI who were admitted to our hospital between April 1999 and August 2003. During this period a total of 1,692 hospital admissions for 193 adults with SCD were identified and 28% of these patients had at least 1 episode of positive blood cultures, with 69 episodes (17%) considered true BSI. Nosocomial BSI occurred in 34 episodes (49%). Among community BSI, in contrast to BSI in children with SCD, Streptococcus pneumoniae was rarely encountered. A high incidence of staphylococcal BSI in adults with SCD was noted. Twenty-eight percent of all BSI were caused by Staphylococcus aureus, and 15 of 22 isolates (68%) of these were methicillin-resistant. Gram-negative organisms, anaerobes, and yeast were found in 21 (27%), 3 (4%), and 4 isolates (5%) of BSI, respectively. Since over 80% of BSI were considered catheter-related, the higher incidence of gram-positive bacterial infections was likely due to the presence of indwelling central venous catheters. Empiric therapy for adults with SCD suspected of having BSI, especially in the presence of indwelling central venous catheters, should include antimicrobial therapy targeted at gram-positive bacteria (especially MRSA) and gram-negative bacteria. Also, if patients are critically ill, consideration should be made to include antifungal agents. Additional research into the adult SCD population appears necessary to further define this problem. Am. J. Hematol., 2006. © 2006 Wiley-Liss, Inc. [source] Septicaemia due to glucose non-fermenting, Gram-negative bacilli other than Pseudomonas aeruginosa in childrenACTA PAEDIATRICA, Issue 3 2002S Ladhani Bloodstream infections due to non-fermenting Gram-negative bacilli other than Pseudomonas aeruginosa (NF-GNB) are uncommon in children but their incidence is reported to be increasing. The aim of this study was to determine the characteristics of such infections in children in a London teaching hospital. All paediatric patients with positive NF-GNB blood cultures and clinical evidence of sepsis between July 1995 and June 2000 were included in the study. A total of 10278 blood cultures was performed, of which 356 (3.5%) represented clinically significant episodes of bacteraemia. Of these, 12 (0.1%) were due to NF-GNB. Nine of the 12 (75%) patients were receiving haemodialysis for end-stage renal failure (ESRF). Only one patient was receiving immunosuppressive therapy and none was neutropenic or had any malignancy. An intravascular catheter was identified as the focus of infection in all 12 cases. Stenotrophomonas maltophilia was the most common organism isolated (67%). Six patients were successfully treated with antibiotics alone. Four others received antibiotics, but also required line removal, and two patients responded to line removal without the need for antibiotics. Conclusion: An association was found between ESRF and NF-GNB infections, possibly related to the requirement for long-term catheters for dialysis. Antibiotic treatment alone was only successful in half the cases of catheter-related NF-GNB septicaemia, while removal of the infected catheter ensured complete cure in the cases where antibiotic treatment alone did not suffice. [source] Population pharmacokinetics of cefepime in neonates with severe nosocomial infectionsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 3 2008V. Lima-Rogel MD Summary Objective:, To define the pharmacokinetic behaviour of cefepime in neonates with severe nosocomial infections using a mixed effects model. Patients and methods:, Thirty-one newborn infants were included in the study; 10 additional infants participated in the validation of the pharmacokinetic model. Cefepime CL and V were determined using an open monocompartmental model with first-order elimination. The influence of demographic and clinical characteristics on the model was evaluated. The non-linear mixed effect model (nonmem) program was used to determine the pharmacokinetic population model. Results:, The mean corrected gestational age for infants participating in the construction and validation of the model were 35 and 33 weeks, respectively. Factors included in the final pharmacokinetic model were body surface area (BSA) and calculated CLCR. The final population model was CL (L/h) = 0·457 BSA (m2) + 0·243 CLCR (L/h) and V(L) = 4·12 BSA (m2). This model explains 33·3% of the interindividual variability for CL and 12·8% for V. This model was validated in ten neonates with nosocomial infections by assessing the predictive capacity of plasma cefepime concentrations using a priori and Bayesian strategies. Conclusions:, The predictive performance of this population model for cefepime plasma concentrations was adequate for clinical purposes and can be used for individualizing cefepime therapy in newborn infants with severe infections. Cefepime plasma concentrations can be predicted based on BSA and calculated CLCR. Cefepime therapy using a 250 mg/m2 dose administered every 12 h is adequate to achieve plasma concentrations greater than 8 ,g/mL during more than 60% of the dosing interval and is expected to be effective in the treatment of bloodstream infections caused by most gram negative organisms in newborn infants. A dose of 550 mg/m2 would be required for the treatment of infections caused by Pseudomonas sp. [source] Healthcare-associated candidemia,A distinct entity?,JOURNAL OF HOSPITAL MEDICINE, Issue 5 2010Joyti Gulia MD Abstract BACKGROUND: The concept of health care-associated infection (HCAI) was developed to address the fact that select patients now present to the hospital with infections due to traditionally nosocomial pathogens. Although epidemiologic studies document the clear existence of health care-associated pneumonia, little is known about fungal pathogens and their role in HCAIs. OBJECTIVE: To describe the epidemiology of health care-associated bloodstream infections (BSIs) due to candida species and to compare patients with HCA candidemia to nosocomial candidemia. DESIGN: Retrospective case series. SETTING: Academic, tertiary care hospital. MEASUREMENTS: We measured the proportion of cases of candidal BSI classified as health care-associated along with the microbiology of these infections. We compared health care-associated and nosocomial cases of candidemia with respect to demographics, severity of illness, and fluconazole susceptibility. RESULTS: We noted 233 cases of candidal BSI over a 3-year period. Nearly one-quarter represented an HCAI that presented to the hospital, as opposed to a nosocomial process. Although patients with HCA candidemia were similar to subjects with nosocomial infection in terms of underlying comorbidities and severity of illness, those with HCA yeast BSI were more likely to be immunosuppressed and to have their infection caused by a fluconazole-resistant organism. C. glabrata was seen more often in patients presenting to the hospital with an HCA case of candidemia. CONCLUSIONS: Clinicians must recognize the potential for candida species to cause HCA infections and to be present at time of hospital presentation. Physicians need to consider this and the distribution of species of yeast causing BSI in their institution when considering initial therapy for patients with a suspected BSI. Journal of Hospital Medicine 2010;5:298,301. © 2010 Society of Hospital Medicine. [source] Evidence-based algorithms for diagnosing and treating ventilator-associated pneumonia,JOURNAL OF HOSPITAL MEDICINE, Issue 5 2008Richard J. Wall MD Abstract BACKGROUND: Ventilator-associated pneumonia (VAP) is widely recognized as a serious and common complication associated with high morbidity and high costs. Given the complexity of caring for heterogeneous populations in the intensive care unit (ICU), however, there is still uncertainty regarding how to diagnose and manage VAP. OBJECTIVE: We recently conducted a national collaborative aimed at reducing health care,associated infections in ICUs of hospitals operated by the Hospital Corporation of America (HCA). As part of this collaborative, we developed algorithms for diagnosing and treating VAP in mechanically ventilated patients. In the current article, we (1) review the current evidence for diagnosing VAP, (2) describe our approach for developing these algorithms, and (3) illustrate the utility of the diagnostic algorithms using clinical teaching cases. DESIGN: This was a descriptive study, using data from a national collaborative focused on reducing VAP and catheter-related bloodstream infections. SETTING: The setting of the study was 110 ICUs at 61 HCA hospitals. INTERVENTION: None. MEASUREMENTS AND RESULTS: We assembled an interdisciplinary team that included infectious disease specialists, intensivists, hospitalists, statisticians, critical care nurses, and pharmacists. After reviewing published studies and the Centers for Disease Control and Prevention VAP guidelines, the team iteratively discussed the evidence, achieved consensus, and ultimately developed these practical algorithms. The diagnostic algorithms address infant, pediatric, immunocompromised, and adult ICU patients. CONCLUSIONS: We present practical algorithms for diagnosing and managing VAP in mechanically ventilated patients. These algorithms may provide evidence-based real-time guidance to clinicians seeking a standardized approach to diagnosing and managing this challenging problem. Journal of Hospital Medicine 2008;3:409,422. © 2008 Society of Hospital Medicine. [source] Nosocomial infections and antimicrobial resistance in critical care medicineJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2006Jennifer S. Ogeer-Gyles DVM Abstract Objective: To review the human and companion animal veterinary literature on nosocomial infections and antimicrobial drug resistance as they pertain to the critically ill patient. Data sources: Data from human and veterinary sources were reviewed using PubMed and CAB. Human data synthesis: There is a large amount of published data on nosocomially-acquired bloodstream infections, pneumonia, urinary tract infections and surgical site infections, and strategies to minimize the frequency of these infections, in human medicine. Nosocomial infections caused by multi-drug-resistant (MDR) pathogens are a leading cause of increased patient morbidity and mortality, medical treatment costs, and prolonged hospital stay. Epidemiology and risk factor analyses have shown that the major risk factor for the development of antimicrobial resistance in critically ill human patients is heavy antibiotic usage. Veterinary data synthesis: There is a paucity of information on the development of antimicrobial drug resistance and nosocomially-acquired infections in critically ill small animal veterinary patients. Mechanisms of antimicrobial drug resistance are universal, although the selection effects created by antibiotic usage may be less significant in veterinary patients. Future studies on the development of antimicrobial drug resistance in critically ill animals may benefit from research that has been conducted in humans. Conclusions: Antimicrobial use in critically ill patients selects for antimicrobial drug resistance and MDR nosocomial pathogens. The choice of antimicrobials should be prudent and based on regular surveillance studies and accurate microbiological diagnostics. Antimicrobial drug resistance is becoming an increasing problem in veterinary medicine, particularly in the critical care setting, and institution-specific strategies should be developed to prevent the emergence of MDR infections. The collation of data from tertiary-care veterinary hospitals may identify trends in antimicrobial drug resistance patterns in nosocomial pathogens and aid in formulating guidelines for antimicrobial use. [source] Nosocomial bloodstream infections associated with Candida species in a Turkish University HospitalMYCOSES, Issue 2 2006Nur Yapar Summary In recent years, a progressive increase in the frequency of nosocomial candidaemia has been observed, especially among the critically ill or immunocompromised patients. The aim of this study was to evaluate the trend in incidence of candidaemia together with potential risk factors in an 850-bed Turkish Tertiary Care Hospital in a 4-year period. A total of 104 candidaemia episodes were identified in 104 patients. The overall incidence was 0.56 per 1000 hospital admissions and the increase in incidence of candidaemia from 2000 to 2003 was found to be statistically significant (P = 0.010). Candida albicans was the most common species (57.7%) and non- albicans species accounted for 42.3% of all episodes. The most common non- albicans Candida sp. isolated was C. tropicalis (20.2%) followed by C. parapsilosis (12.5%). The most frequent risk factors possibly associated with the candidaemia were previous antibiotic treatment (76.9%), presence of central venous catheter (71.2%) and total parenteral nutrition (55.8%). Our results show the fact that the incidence of candidaemia caused by non- albicans species is frequent and increasing significantly, although the most common isolated Candida species were C. albicans and further investigations are necessary to evaluate the mechanisms of increasing incidence of candidaemia caused by non- albicans species. [source] Reduction of catheter related bloodstream infections in intensive care: one for all, all for one?NURSING IN CRITICAL CARE, Issue 3 2009Onno K Helder [source] Catheter-related Infections via Temporary Vascular Access Catheters: A Randomized Prospective StudyARTIFICIAL ORGANS, Issue 3 2010Hajime Nakae Abstract Temporary vascular access catheters (VACs) are important devices used in acute blood purification therapies. The aim of this study was to determine whether a catheterization duration of 2 weeks increased the risk of nosocomial complications when compared with a 1-week duration. Fifty-six patients with 90 double lumen VACs were randomly chosen, and received either 1- or 2-week catheterizations from operators experienced in the placement of such catheters at three sites such as the internal jugular, subclavian, or femoral vein. The characteristics of the VACs, including the sites, procedures, and lengths, were similar in both groups. No significant difference in the rate of catheter colonization was observed between the groups (14.6% vs 26.2%, P = 0.1371). No significant difference in the rate of catheter-related bloodstream infections was observed between the groups (2.1% vs 4.8%, P = 0.5967). Two-week indwelling did not increase the risk of infection compared with 1-week indwelling at any of the sites in critically ill patients. [source] Central venous catheter and Stenotrophomonas maltophilia bacteremia in cancer patients,CANCER, Issue 9 2006Maha Boktour M.D. Abstract BACKGROUND Stenotrophomonas maltophilia bacteremia is frequently found in cancer patients. This study attempted to determine how often the catheters were the source of this infection and the risk factors associated with catheter-related bacteremias. METHODS The microbiology records were retrospectively reviewed of all cancer patients having S. maltophilia bacteremia and indwelling central venous catheters seen between January 1998 and January 2004. In a multivariate analysis the patients' clinical characteristics, antimicrobial therapy, outcome, and source of bacteremia that were significantly associated with definite catheter-related S. maltophilia bacteremia as opposed to secondary bacteremia were identified. RESULTS A total of 217 bacteremias were identified in 207 patients: 159 (73%) were primary catheter-related (53 definite, 89 probable, and 17 possible), 11 (5%) were primary noncatheter-related, and 47 (22%) were secondary. Multivariate analysis showed the following factors to be independently associated with definite catheter-related bacteremias: 1) polymicrobial bacteremia (odds ratio [OR], 7.6; 95% confidence interval [95% CI], 1.3,45.5); 2) no prior intensive care unit admission (OR, 0.06; 95% CI, 0.005,0.578); and 3) nonneutropenic status at onset (OR, 0.07; 95% CI, 0.013,0.419). The response rate to appropriate antibiotics and catheter removal was 95% in the patients with definite catheter-related bloodstream infections, compared with only 56% in the patients with secondary bacteremias (P = .001). CONCLUSIONS The majority of the S. maltophilia bacteremias occurring in cancer patients with indwelling central venous catheters appear to be catheter-related and are often polymicrobial. Catheter-related S. maltophilia bacteremias occurred more frequently in noncritically ill, nonneutropenic patients, and prompt removal of the catheter was found to be associated with a better prognosis. Cancer 2006. © 2006 American Cancer Society. [source] Bacteraemia in children in Iceland 1994,2005ACTA PAEDIATRICA, Issue 10 2010Sigurður Árnason Abstract Aim:, To investigate the aetiology of bacteraemia in children in Iceland, the antibiotic resistance and possible preventive measures. Methods:, All positive bacterial blood cultures from children 0,18 years old isolated at Landspítali University Hospital Iceland from 1994 to 2005 were included in the study. Epidemiological and microbiological data were registered. The blood cultures were categorized according to likelihood of infection or contamination. Results:, During the study period 1253 positive blood cultures were obtained from 974 children; 647 from boys and 606 from girls. Positive blood cultures were most common during the first year of life (594; 47.4%) with 252 of them from neonates. Coagulase negative staphylococci were most common (37%). Of probable or definite infections Streptococcus pneumoniae was the most common (19.3%) followed by Staphylococcus aureus (17.6%) and Neisseria meningitidis (13.5%). The most common pneumococcal serogroups were 23, 6, 7, 19 and 14. Commercially available vaccines contain up to 88% of all pneumococcal strains and 67% of all multi-resistant strains. N. meningitidis group C was not isolated after vaccinations were started in 2002. Conclusion:, Our study provides important epidemiological data on bacterial bloodstream infections in children in Iceland. The results demonstrate the excellent efficacy of meningococcal group C vaccination. [source] Clinical and molecular epidemiology of community-acquired, healthcare-associated and nosocomial methicillin-resistant Staphylococus aureus in SpainCLINICAL MICROBIOLOGY AND INFECTION, Issue 12 2009J. Rodríguez-Baño Abstract A prospective cohort study including all new cases of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in 64 Spanish hospitals during June 2003 was performed to investigate the epidemiology of MRSA in Spain. Only patients who yielded clinical MRSA-positive samples were included. Epidemiological and clinical data for a total of 370 cases were collected. Genotyping was performed using pulsed-field gel electrophoresis and multilocus sequence typing. Panton,Valentine leukocidin genes and the staphylococcal chromosomal cassette mec (SCCmec) were identified in representative isolates. MRSA was considered to be nosocomially acquired in 202 cases (55%), healthcare-associated (HCA) in 139 cases (38%), community-acquired (CA) in three cases, and of uncertain mode of acquisition in 26 (7%) cases. The pooled population-based rate was 2.31 cases/100 000 population/month, and the pooled nosocomial rate was 0.21 cases/1000 hospital stays (20.2% of S. aureus). Peripheral vascular disease, respiratory tract infections, catheter infections, bloodstream infections and crude mortality were more frequent among HCA cases, whereas neoplasia and urinary tract infections were more frequent among nosocomially acquired cases. Two clones related to the paediatric clone ST5-IV accounted for 71% of the isolates; EMRSA-16 has emerged in two different geographical areas. Only one isolate belonged to the formerly predominant Iberian clone. The three CA isolates were related to the USA300 clone. SCCmec type IV was the most frequent type in nosocomial and HCA isolates. The epidemiology of MRSA has changed in Spain; outpatients with previous healthcare contact represent a very important reservoir of MRSA, and community isolates are emerging. [source] Clinical impact of antibiotic-resistant Gram-positive pathogensCLINICAL MICROBIOLOGY AND INFECTION, Issue 3 2009H. M. Lode Abstract The European Union's attention to the problem of antibacterial resistance will soon reach a 10-year mark, but the rates of resistance in Gram-positive and Gram-negative bacteria are still increasing. This review focuses on the clinical impact of resistant Gram-positive bacteria on patients. Multiple drug resistance in pneumococcal infections will lead to more treatment failures and higher mortality, which so far have been seen with penicillins and pathogens with high-level resistance. Several studies have demonstrated higher mortality, prolonged length of hospital stay and higher costs associated with methicillin-resistant Staphylococcus aureus infections, in comparison with methicillin-susceptible Staphylococcus aureus infections. Similarly, vancomycin-resistant enterococci bloodstream infections have a negative impact with respect to mortality, length of hospital stay and costs, in comparison with infections due to vancomycin-susceptible enterococci. Several distinctive prophylactic and therapeutic approaches have to be undertaken to successfully prevent the clinical consequences of antibiotic resistance in Gram-positive bacteria. This review addresses the impact of antibiotic-resistant Gram-positive pathogens on clinical outcomes. [source] Intravenous catheter infections associated with bacteraemia: a 2-year study in a University HospitalCLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2004M. Paragioudaki Abstract The aim of this retrospective study was to assess the incidence and aetiology of central and peripheral venous catheter (C/PVC) infections during a 2-year period (1999,2000) and to determine the susceptibility of isolated microorganisms to various antimicrobial agents. Catheter tips were processed using the semiquantitative method and blood cultures were performed with the BacT/Alert automated system. Antibiotic susceptibilities were performed by disk agar diffusion and MICs were determined by Etest, according to NCCLS standards. During the study period, samples from 1039 C/PVC infections were evaluated, yielding 384 (37.0%) positive cultures. Blood cultures were also available from 274 patients, of which 155 (56.6%) yielded the same microorganism as from the catheter. No bloodstream infections were detected in 104 C/PVC-positive cases. Methicillin-resistant coagulase-negative staphylococci were the most frequent isolates, followed by Gram-negative bacteria, especially Pseudomonas aeruginosa. Resistance to glycopeptides among staphylococci and enterococci was not detected, whereas 60% of Gram-negative bacilli were resistant to ,-lactams. [source] Pathogenesis of catheter-related infections: lessons for new designsCLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2002A. Pascual In the last decade, two main strategies have been employed in the prevention of catheter-related infections: the creation of anti-adhesive biomaterials using physicochemical methods, and the incorporation of antimicrobial or antiseptic agents into current polymer biomaterials. There has been limited success with the first approach. Intravascular catheters and cuffs with an antimicrobial coating have been developed in recent years. Nevertheless, preventive strategies should avoid the use of therapeutic antibiotics. Exposure to antimicrobial agents could favor the development of resistance or the expression of genes responsible for biofilm formation. The use of these catheters should be restricted to situations where the rate of infection is high despite adherence to other strategies that do not incorporate antimicrobial agents. Better knowledge of the pathogenesis of catheter-related infections will facilitate the design of new devices that avoid the use of antimicrobial agents and decrease the risk of associated bloodstream infections. This could include the use of ,biospecific polymers' coated with anti-adhesive molecules or the use of agents which might block the expression of genes controlling biofilm formation for the most prevalent pathogens. [source] | ||||||||||