National Bloodstream Infection Surveillance in Switzerland 2008–2014: Different Patterns and Trends for University and Community Hospitals

2016 ◽  
Vol 37 (9) ◽  
pp. 1060-1067 ◽  
Author(s):  
Niccolò Buetti ◽  
Jonas Marschall ◽  
Andrew Atkinson ◽  
Andreas Kronenberg ◽  
Keyword(s):  
Bloodstream Infection ◽  
Bloodstream Infections ◽  
Community Hospitals ◽  
University Hospitals ◽  
Coagulase Negative Staphylococci ◽  
E Coli ◽  
Infection Surveillance ◽  
Laboratory Surveillance ◽  
Predominant Pathogen ◽  
Hospital Acquired

OBJECTIVETo characterize the epidemiology of bloodstream infections in Switzerland, comparing selected pathogens in community and university hospitals.DESIGNObservational, retrospective, multicenter laboratory surveillance study.METHODSData on bloodstream infections from 2008 through 2014 were obtained from the Swiss infection surveillance system, which is part of the Swiss Centre for Antibiotic Resistance (ANRESIS). We compared pathogen prevalences across 26 acute care hospitals. A subanalysis for community-acquired and hospital-acquired bloodstream infections in community and university hospitals was performed.RESULTSA total of 42,802 bloodstream infection episodes were analyzed. The most common etiologies were Escherichia coli (28.3%), Staphylococcus aureus (12.4%), and polymicrobial bloodstream infections (11.4%). The proportion of E. coli increased from 27.5% in 2008 to 29.6% in 2014 (P = .04). E. coli and S. aureus were more commonly reported in community than university hospitals (34.3% vs 22.7%, P<.001 and 13.9% vs 11.1%, P<.001, respectively). Fifty percent of episodes were community-acquired, with E. coli again being more common in community hospitals (41.0% vs 32.4%, P<.001). The proportion of E. coli in community-acquired bloodstream infections increased in community hospitals only. Community-acquired polymicrobial infections (9.9% vs 5.6%, P<.001) and community-acquired coagulase-negative staphylococci (6.7% vs 3.4%, P<0.001) were more prevalent in university hospitals.CONCLUSIONSThe role of E. coli as predominant pathogen in bloodstream infections has become more pronounced. There are distinct patterns in community and university hospitals, potentially influencing empirical antibiotic treatment.Infect Control Hosp Epidemiol 2016;37:1060–1067

Distribution of Pathogens in Central Line–Associated Bloodstream Infections among Patients with and without Neutropenia following Chemotherapy Evidence for a Proposed Modification to the Current Surveillance Definition

2013 ◽  
Vol 34 (2) ◽  
pp. 171-175 ◽  
Author(s):  
James P. Steinberg ◽  
Chad Robichaux ◽  
Sheri Chernetsky Tejedor ◽  
Mary Dent Reyes ◽  
Jesse T. Jacob
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
University Hospitals ◽  
Central Venous ◽  
E Coli ◽  
National Healthcare Safety Network ◽  
Proposed Modification ◽  
Definition Of ◽  
Hospital Acquired ◽  
Study Hospital

Objective.Many bloodstream infections (BSIs) occurring in patients with febrile neutropenia following cytotoxic chemotherapy are due to translocation of intestinal microbiota. However, these infections meet the National Healthcare Safety Network (NHSN) definition of central line-associated BSIs (CLABSIs). We sought to determine the differences in the microbiology of NHSN-defined CLABSIs in patients with and without neutropenia and, using these data, to propose a modification of the CLABSI definition.Design.Retrospective review.Setting.Two large university hospitals over 18 months.Methods.All hospital-acquired BSIs occurring in patients with central venous catheters in place were classified using the NHSN CLABSI definition. Patients with postchemotherapy neutropenia (500 neutrophils/mm3or lower) at the time of blood culture were considered neutropenic. Pathogens overrepresented in the neutropenic group were identified to inform development of a modified CLABSI definition.Results.Organisms that were more commonly observed in the neutropenic group compared with the nonneutropenic group includedEscherichia coli(22.7% vs 2.5%;P< .001) but not other Enterobacteriaceae,Enterococcus faecium(18.2% vs 6.1%;P= .002), and streptococci (18.2% vs 0%;P< .001). Application of a modified CLABSI definition (removing BSI with enterococci, streptococci, orE. coli) excluded 33 of 66 neutropenic CLABSIs and decreased the CLABSI rate in one study hospital with large transplant and oncology populations from 2.12 to 1.79 cases per 1,000 line-days.Conclusions.Common gastrointestinal organisms were more common in the neutropenia group, suggesting that many BSIs meeting the NHSN criteria for CLABSI in the setting of neutropenia may represent translocation of gut organisms. These findings support modification of the NHSN CLABSI definition.

Nosocomial Bacteremia in Children: A 15-Year Experience at a General Hospital in Mexico

2007 ◽  
Vol 28 (4) ◽  
pp. 418-422 ◽  
Author(s):  
Luis Fernando Pérez-González ◽  
Juana María Ruiz-González ◽  
Daniel E. Noyola
Keyword(s):  
General Hospital ◽  
Bloodstream Infection ◽  
Active Surveillance ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Coagulase Negative Staphylococci ◽  
Hospital Acquired Infection ◽  
Nosocomial Bacteremia ◽  
Laminar Air Flow ◽  
Hospital Acquired

Objective.To describe the incidence and etiology of nosocomial bloodstream infections in children at a general hospital.Design.Review of nosocomial bloodstream infections detected in children during 1991-2005. Data were prospectively gathered through active surveillance. Annual rates of infection were compared.Setting.A public general hospital in San Luis Potosi, Mexico.Patients.Children younger than 15 years of age admitted to pediatric wards and subjected to prospective surveillance for nosocomial infection.Interventions.Measures instituted to decrease the incidence of hospital-acquired infection during the 15-year study period included establishing active surveillance for hospital-acquired infection, reinforcing compliance with handwashing recommendations, decreasing the degree of crowding on wards, establishing guidelines for the management of intravenous catheters and solutions, preparing parenteral nutrition and intravenous solutions under a laminar air-flow hood, and increasing nursing personnel.Results.There were 868 nosocomial bloodstream infections detected in 29,273 subjects (overall rate, 2.94 episodes per 100 discharges). Infection rates were greatest among children admitted to the neonatal intensive care unit and lowest for those admitted to the school-age ward and the infectious diseases ward. There was a significant decrease in rates of nosocomial bacteremia in all of the wards. The organisms isolated most commonly were Klebsiella pneumoniae, Candida species, and coagulase-negative staphylococci. Mortality rates were higher for children with a gram-negative bacterial bloodstream infection (45.2%) and lower for children with a gram-positive bacterial infection (19.2%).Conclusions.Rates of nosocomial bloodstream infection decreased over the past 15 years at our hospital but continue to cause significant mortality. Continuing efforts to decrease the frequency of and mortality due to bloodstream infection are warranted.

scholarly journals 1037. Effect of Oral Step-Down Therapy on Readmission Rates in Escherichia coli Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S310-S310 ◽  
Author(s):  
Julia Sessa ◽  
Kelly M Conn ◽  
Lisa Avery
Keyword(s):  
Escherichia Coli ◽  
Primary Outcome ◽  
Absolute Risk ◽  
Significant Risk ◽  
Bloodstream Infections ◽  
Risk Difference ◽  
E Coli ◽  
Lactam Antibiotic ◽  
Step Down ◽  
Hospital Acquired

Abstract Background Escherichia coli is the most common cause of community-acquired bloodstream infections. Fluoroquinolones (FQ) and trimethoprim/sulfamethoxazole (TS) are preferred for oral step-down therapy due to high bioavailability. Antimicrobial stewardship programs commonly restrict FQ use, promoting consideration of non-FQ agents for treatment of sensitive organisms. We hypothesized that oral β-lactams would be non-inferior to FQ and TS with a primary outcome of 30-day all-cause readmission. Methods This was a retrospective non-inferiority study that reviewed electronic health records for patients with E. coli bacteremia from January 1, 2016 to December 31, 2017. Exclusion criteria included hospital acquired infections, death during hospitalization and concomitant infections. Patient demographics, Pitt Bacteremia Score, Charleston Comorbidity Index, antibiotic regimen (IV/PO), and readmission were collected. Patients were divided into two groups, oral FQ/TS verses β-lactams. A pretrial noninferiority margin for the primary outcome was set at 3%. Secondary outcomes included 30-day infection and E. coli readmission. Significant risk factors for readmission were entered into a multiple logistic regression model in a forward stepwise approach using SPSS. Results Demographics were similar between groups, 57 patients received FQ/TS and 151 received β-lactams. The 30-day-all cause readmission rate was 15.8% and 29.1%, respectively (absolute risk difference 13.3%, CI: 1–25).β-lactams were found to be inferior to FQ/TS for 30-day all-cause readmission. readmission occurred in 5.3% of patients in the FQ/TS group verses 14.6% of patients in the β-lactam group (P = 0.07). E.coli accounted for 100% of the infection-related readmissions in the FQ/ST group and 70% in the β-lactam group. Patients who received a β-lactam antibiotic were more likely to be readmitted then those patients treated with FQ/TS (odds ratio: 2.25, CI: 0.95–5.30, P = 0.06). Conclusion Step-down therapy to oral β-lactams resulted in higher rates of 30-day all-cause and infection-related readmissions in patients with E. coli bacteremia. Disclosures All authors: No reported disclosures.

scholarly journals Comparison of Total Hospital-Acquired Bloodstream Infections to Central Line–Associated Bloodstream Infections and Implications for Outcome Measures in Infection Control

2013 ◽  
Vol 34 (9) ◽  
pp. 984-986 ◽  
Author(s):  
Surbhi Leekha ◽  
Shanshan Li ◽  
Kerri A. Thom ◽  
Michael Anne Preas ◽  
Brian S. Caffo ◽  
...  
Keyword(s):  
Intensive Care ◽  
Infection Control ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Outcome Measures ◽  
Bloodstream Infections ◽  
Central Line ◽  
Total Hospital ◽  
Prevention Intervention ◽  
Hospital Acquired

The validity of the central line-associated bloodstream infection (CLABSI) measure is compromised by subjectivity. We observed significant decreases in both CLABSIs and total hospital-acquired bloodstream infections (BSIs) following a CLABSI prevention intervention in adult intensive care units. Total hospital-acquired BSIs could be explored as an adjunct, objective CLABSI measure.

scholarly journals Three cases of mcr-1-positive colistin-resistant Escherichia coli bloodstream infections in Italy, August 2016 to January 2017

2017 ◽  
Vol 22 (16) ◽  
Author(s):  
Marta Corbella ◽  
Bianca Mariani ◽  
Carolina Ferrari ◽  
Francesco Comandatore ◽  
Erika Scaltriti ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistance ◽  
Whole Genome Sequencing ◽  
Bloodstream Infection ◽  
Genome Sequencing ◽  
Bloodstream Infections ◽  
Tertiary Hospital ◽  
Whole Genome ◽  
E Coli ◽  
Sequence Types

We describe three cases of bloodstream infection caused by colistin-resistant Escherichia coli in patients in a tertiary hospital in Italy, between August 2016 and January 2017. Whole genome sequencing detected the mcr-1 gene in three isolated strains belonging to different sequence types (STs). This occurrence of three cases with mcr-1-positive E. coli belonging to different STs in six months suggests a widespread problem in settings where high multidrug resistance is endemic such as in Italy.

scholarly journals The Profile of Microorganisms Responsible for Port-Related Bacteremia in Pediatric Hemato-Oncological Patients

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482090469
Author(s):  
Ewelina Gowin ◽  
Bogna Świątek-Kościelna ◽  
Przemysław Mańkowski ◽  
Danuta Januszkiewicz-Lewandowska
Keyword(s):  
Medical Records ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Complete Information ◽  
Incidence Density ◽  
Coagulase Negative Staphylococci ◽  
Patients With Cancer ◽  
Oncological Patients ◽  
Increased Risk ◽  
Predominant Pathogen

Patients with pediatric cancer face an increased risk of infections. In most cases, these infections are associated with the use of a long-term central venous catheter. This study describes the epidemiology of a port-associated bacteremia as well as a profile of microorganisms responsible for port-associated bloodstream infections (PABSIs) in pediatric patients with cancer treated in a single center. The retrospective analysis included patients with cancer who had implanted a port, hospitalized between 2010 and 2015 at the Department of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences. The medical records of patients were reviewed for demographic characteristics, diagnosis, port-related complications, and their management. Data were collected from patients’ electronic medical records containing complete information on medical examinations and supplementary tests, diagnosis, timing, and type of port-associated complications. In a study period, 277 ports were inserted to 241 patients. A total of 183 094 catheter days were analyzed. Sixteen patients had more than 1 insertion of a port. The commonest observed complication was PABSI (40.07%) and the incidence density was 0.6 per 1000 port-days. Staphylococcus was the most commonly isolated organisms from patients with PABSI. From all port-associated complications, bloodstream infections and mechanical complications were the most often observed complications. The commonest pathogens responsible for PABSI were coagulase-negative staphylococci. Pathogens resistant to standard antibiotic treatment play an important role in PABSI, with methicillin-resistant Staphylococcus epidermidis being the predominant pathogen. Port-associated bloodstream infections are a common reason for preterm removal of a port.

scholarly journals Increase in bloodstream infections in Finland, 1995–2002

2007 ◽  
Vol 136 (1) ◽  
pp. 108-114 ◽  
Author(s):  
K. SKOGBERG ◽  
O. LYYTIKÄINEN ◽  
P. RUUTU ◽  
J. OLLGREN ◽  
J. P. NUORTI
Keyword(s):  
Poisson Regression ◽  
Clinical Microbiology ◽  
Rate Increase ◽  
Reporting System ◽  
Age Groups ◽  
Bloodstream Infections ◽  
Population Based ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Laboratory Surveillance

SUMMARYA national, population-based laboratory surveillance of bloodstream infections (BSI) in Finland was performed. Blood-culturing rates were determined from data from clinical microbiology laboratories and trends in rates were evaluated using Poisson regression. During 1995–2002, 51 510 cases of BSI were notified; the annual incidence increased from 104 to145 cases/100 000 (40%). Rates increased in all age groups but persons aged ⩾75 years accounted for 28% of cases and showed the largest rate increase. Escherichia coli, coagulase-negative staphylococci, Staphylococcus aureus and Streptococcus pneumoniae accounted for 58% of isolates and their relative proportions were unchanged over time. The annual blood-culturing rate increased by one-third during the study period but the number of BSI detected per blood cultures remained unchanged. Regional BSI incidence was significantly associated with blood-culturing rates. We conclude that the increase in BSI rates may have been due to more frequent blood culturing but was not associated with changes in the reporting system or aetiology of BSI.

Epidemiology and outcome of bacteraemia in neutropenic patients in a single institution from 1991–2012

2014 ◽  
Vol 143 (4) ◽  
pp. 734-740 ◽  
Author(s):  
M. ORTEGA ◽  
F. MARCO ◽  
A. SORIANO ◽  
M. ALMELA ◽  
J. A. MARTÍNEZ ◽  
...  
Keyword(s):  
Empirical Therapy ◽  
Underlying Disease ◽  
Progressive Increase ◽  
Single Institution ◽  
Coagulase Negative Staphylococci ◽  
Surveillance Programme ◽  
E Coli ◽  
Infection Surveillance ◽  
Neutropenic Patients ◽  
Independent Risk Factors

SUMMARYThis study was part of a bloodstream infection surveillance programme that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2012. We included 2092 bacteraemias in neutropenic patients. Shock and mortality accounted for 299 and 349 cases, respectively (14% and 17%). The main microorganisms isolated were coagulase-negative staphylococci (CoNS, 634, 30%), Escherichia coli (468, 22%) and Pseudomonas aeruginosa (235, 11%). During 2006–2012, there were 155 (27%) E. coli isolates; of these, 73% were fluoroquinolone resistant and 26% cefotaxime resistant. The independent risk factors for mortality were shock on presentation, rapidly fatal prognosis of underlying disease, corticosteroid use, and polymicrobial bacteraemia. Factors associated with lower mortality were the isolation of CoNS [odds ratio (OR) 0·38, 95% confidence interval (CI) 0·20–0·73, P = 0·004] and empirical therapy with amikacin (OR 0·50, 95% CI 0·29–0·88, P = 0·016). The progressive increase of Gram-negative microorganisms resistant to antibiotics influences the choice of empirical treatment in febrile neutropenia and in our experience, the addition of amikacin could be beneficial for such patients.

scholarly journals Molecular epidemiology of paediatric bloodstream infections caused by Gram-negative bacteria in Oxfordshire, UK

2021 ◽  
Author(s):  
Samuel Lipworth ◽  
Karina-Doris Vihta ◽  
Timothy Davies ◽  
Sarah Wright ◽  
Merline Tabirao ◽  
...  
Keyword(s):  
Population Structure ◽  
Bloodstream Infection ◽  
Treatment Guidelines ◽  
Bloodstream Infections ◽  
Paediatric Population ◽  
Control Measures ◽  
High Morbidity ◽  
Gram Negative ◽  
E Coli ◽  
Klebsiella Spp

Background: Gram-negative organisms are common causes of bloodstream infection during the neonatal period and early childhood with high morbidity and mortality as well as increasing concern about associated antimicrobial resistance. Whilst several large sequencing studies have permitted detailed analysis of the population structure of these isolates in adults, equivalent data is lacking in the paediatric population. Methods: We performed an epidemiological and sequencing based analysis of Gram-negative bloodstream infections in children under the age of 18 between 2008 and 2018 in Oxfordshire, UK. Findings: 327 isolates (of which 296 were successfully sequenced) from 287 patients were included in the study. The burden of infection in the paediatric population lies predominantly in neonates. Most infections were caused by E. coli/Klebsiella spp. and Enterobacter hormaechei. There was no evidence of an increasing incidence of E. coli bloodstream infections and for Klebsiella spp. there was some evidence that the incidence decreased slightly. Similarly the proportion of resistant isolates did not change over time, though we did identify some evidence of sub-breakpoint increases in gentamicin resistance. The population structure of E. coli isolates causing bloodstream infection in neonates and children mirrors that seen in adults. In most cases there was no evidence of transmission between patients/point source acquisition and whole genome sequencing was able to refute a previously suspected outbreak. Conclusion: Our findings support continued use of current empirical treatment guidelines and likely highlight the success of infection control measures in this population. Our data suggest that O-antigen targeted vaccines may have a role in reducing the incidence of neonatal sepsis, potentially by vaccination of pregnant women. Clinical trials to further investigate this possibility are warranted.

scholarly journals Epidemiology and Outcomes of Bloodstream Infections in HIV-Patients during a 13-Year Period

2020 ◽  
Vol 8 (8) ◽  
pp. 1210
Author(s):  
E. Franceschini ◽  
Antonella Santoro ◽  
Marianna Menozzi ◽  
Erica Bacca ◽  
Claudia Venturelli ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Mortality Rates ◽  
Multidrug Resistant ◽  
People Living With Hiv ◽  
Coagulase Negative Staphylococci ◽  
Carbapenem Resistant ◽  
Distribution Family ◽  
Living With Hiv ◽  
Hospital Acquired ◽  
Single Center Observational Study

No data on antibiotic resistance in bloodstream infection (BSI) in people living with HIV (PLWH) exist. The objective of this study was to describe BSI epidemiology in PLWH focusing on multidrug resistant (MDR) organisms. A retrospective, single-center, observational study was conducted including all positive blood isolates in PLWH from 2004 to 2017. Univariable and multivariable GEE models using binomial distribution family were created to evaluate the association between MDR and mortality risk. In total, 263 episodes (299 isolates) from 164 patients were analyzed; 126 (48%) BSI were community-acquired, 137 (52%) hospital-acquired. At diagnosis, 34.7% of the patients had virological failure, median CD4 count was 207/μL. Thirty- and 90-day mortality rates were 24.2% and 32.4%, respectively. Thirty- and 90-day mortality rates for MDR isolates were 33.3% and 46.9%, respectively (p < 0.05). Enterobacteriaceae were the most prevalent microorganisms (29.8%), followed by Coagulase-negative staphylococci (21.4%), and S. aureus (12.7%). In BSI due to MDR organisms, carbapenem-resistant K. pneumoniae and methicillin-resistant S. aureus were associated with mortality after adjustment for age, although this correlation was not confirmed after further adjustment for CD4 < 200/μL. In conclusion, BSI in PLWH is still a major problem in the combination antiretroviral treatment era and it is related to a poor viro-immunological status, posing the question of whether it should be considered as an AIDS-defining event.

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