Risk factors and outcomes of patients colonized with carbapenemase-producing and non–carbapenemase-producing carbapenem-resistant Enterobacteriaceae

2020 ◽  
Vol 41 (10) ◽  
pp. 1154-1161
Author(s):  
Amal Kassem ◽  
Aman Raed ◽  
Tal Michael ◽  
Orli Sagi ◽  
Orly Shimoni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Rectal Swab ◽  
Tertiary Care ◽  
Mortality Prediction ◽  
Charlson Index ◽  
University Hospital ◽  
Historical Study ◽  
Carbapenem Resistant

AbstractObjective:To compare risk factors and outcome of patients colonized with carbapenemase-producing (CP) carbapenem-resistant Enterobactereaceae (CRE) and non–CP-CRE.Design:A comparative historical study.Setting:A 1,000-bed tertiary-care university hospital.Patients:Adults with CP-CRE positive rectal swab cultures, non–CP-CRE positive rectal swab cultures, and negative rectal swab cultures (non-CRE).Methods:CP-CRE and non–CP-CRE colonized adult patients versus patients not colonized with CRE hospitalized during 24 months were included. We identified patients retrospectively through the microbiology laboratory, and we reviewed their files for demographics, underlying diseases, Charlson Index, treatment, and outcome.Results:This study included 447 patients for whom a rectal swab for CRE was obtained: 147 positive for CP-CRE, 147 positive for non–CP-CRE, and 147 negative for both. Patients with CP-CRE and non–CP-CRE versus no CRE more frequently resided in nursing homes (P<0.001), received antibiotics 3 months prior to admission (P < .001), and received glucocorticosteroids 3 months prior to admission (P = .047 and P < .001, respectively). Risk factors unique for non–CP-CRE versus CP-CRE colonization included mechanical ventilation and patient movement between hospital departments. Non–CP-CRE was a predictor for mechanical ventilation 2.5 that of CP-CRE colonization. In-hospital mortality was highest among non–CP-CRE–colonized patients. On COX multivariate regression for mortality prediction age, Charlson index and steroid treatment 3 months before admission influenced mortality (P = .027, P = .023, and P = .013, respectively).Conclusions:Overlapping and unique risk factors are associated with CP-CRE and non–CP-CRE colonization. Non–CP-CRE colonized patients had a higher in-hospital mortality rate.

The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting

2009 ◽  
Vol 137 (9) ◽  
pp. 1333-1341 ◽  
Author(s):  
B. KHWANNIMIT ◽  
R. BHURAYANONTACHAI
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Hospital Setting ◽  
University Hospital ◽  
Apache Ii Score ◽  
Sepsis And Septic Shock ◽  
Hospital Acquired

SUMMARYThis study investigated the clinical characteristics of, and outcomes and risk factors for hospital mortality of 390 patients admitted with severe sepsis or septic shock in an intensive care unit (ICU). Prospectively collected data from patients collected between 1 July 2004 and 30 June 2006 were analysed. Overall hospital mortality was 49·7% and comorbidities were found in 40·3% of patients, the most common of which was haematological malignancy. The respiratory tract was the most common site of infection (50%). Hospital-acquired infections accounted for 55·6% of patients with Gram-negative bacteria predominant (68%). Multivariate analysis showed that acute respiratory distress syndrome, pulmonary artery catheter placement, comorbidities, hospital-acquired infection, APACHE II score and maximum LOD score, were independent risk factors for hospital mortality. In conclusion, severe sepsis and septic shock are common causes of ICU admission. Patients with risk factors for increased mortality should be carefully monitored and aggressive treatment administered.

scholarly journals 495. Risk Factors of Carbapenem-Resistant Enterobacteriaceae (CRE) Infections Among Intensive Care Unit (ICU) Patients in a Tertiary Hospital in the Philippines

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S241-S242
Author(s):  
Roderick Oreal Torio ◽  
Danielle Nicole T Paras ◽  
Cybele Lara R Abad
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
The Philippines ◽  
Common Site ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The threat of Carbapenem-Resistant Enterobacteriaceae (CRE) is increasing worldwide, and the epidemiology, risk factors, and outcomes of CRE in the Philippines is unknown. Methods We performed a retrospective case–control study of 128 CRE cases and Carbapenem-Susceptible Enterobacteriaceae (CSE) controls matched 1:1 based on site of infection and date of admission among all adult patients in the Intensive Care Unit (ICU) between January 2014 and May 2018 at The Medical City. Predictors of CRE infection among matched cases and controls were determined through multiple conditional logistic regression analysis. In-hospital mortality was analyzed using z-test of two proportions and length of stay among patients with CRE and CSE were compared. Results The mean age in both groups was similar at 65.8 (range 23–92) and 64.3 (range 23–98) years, respectively. There were more males among cases than controls [(76/128, 59%) vs. 62/128 (48%)]. Those with CRE were more likely to have a co-morbid illness and an invasive device. Pneumonia was the most common site of CRE infection (40%) followed by the urinary tract (27%). Enterobacter cloacae (54.68%) was the most common organism, followed by Klebsiella pneumoniae (30.46%). On univariate analysis, the use of piperacillin–tazobactam, third or fourth-generation cephalosporins and carbapenems, mechanical ventilation, and acute kidney injury (AKI) increased the risk of developing CRE infections by an OR of 7.5 (CI 1.88–29.95, P = 0.004), 9.32 (CI 1.48–58.59, P = 0.017), and 10.76 (CI 1.69–68.53, P = 0.012), respectively. Those with CRE had a higher in-hospital mortality than the CSE group [(49/79, 38.3%) vs. (33/95, 25.8%); P = 0.032]. Length of hospital stay among CRE cases was also longer with a mean of 43.9 vs. 28 days compared with controls. Conclusion In our cohort, older patients w/ comorbidities developed CRE with pneumonia being the most common site of infection. Prior use of broad-spectrum antimicrobials, mechanical ventilation and AKI appeared to increase the risk of CRE infection in the ICU. CRE infection also increased patient mortality and length of hospital stay. Interventions that target these risk factors should be undertaken to help prevent CRE infection. Disclosures All authors: No reported disclosures.

Risk factors and clinical outcomes associated with blood culture contamination

2021 ◽  
pp. 1-7
Author(s):  
Justin M. Klucher ◽  
Kevin Davis ◽  
Mrinmayee Lakkad ◽  
Jacob T. Painter ◽  
Ryan K. Dare
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Patient Specific ◽  
Contaminated Blood

Abstract Objective: To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. Design: A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). Setting: A 509-bed tertiary-care university hospital. Methods: Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Results: Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16). Conclusions: These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p &lt; 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p &lt; 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

scholarly journals Resistome Profiles, Plasmid Typing, and Whole-Genome Phylogenetic Tree Analyses of BlaNDM-9 and Mcr-1 Co-Harboring Escherichia coli ST617 from a Patient without a History of Farm Exposure in Korea

Pathogens ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 212 ◽  
Author(s):  
Le Phuong Nguyen ◽  
Naina Adren Pinto ◽  
Thao Nguyen Vu ◽  
Hung Mai ◽  
An HT Pham ◽  
...  
Keyword(s):  
Rectal Swab ◽  
Asymptomatic Carrier ◽  
University Hospital ◽  
Surveillance Culture ◽  
Whole Genome ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Plasmid Replicon ◽  
Donor Cells ◽  
History Of

Recently, a blaNDM-9 and mcr-1 co-harboring E. coli ST 617 isolate was identified from an asymptomatic carrier in Korea. An 81-year-old female was admitted to a university hospital for aortic cardiac valve repair surgery. Following surgery, she was admitted to the intensive care unit (ICU) for three days, and carbapenem-resistant E. coli YMC/2017/02/MS631 was isolated from a surveillance culture (rectal swab). Antimicrobial susceptibility testing (AST) for colistin was not performed at that time. Upon retrospective study, further AST revealed resistance to all tested antibiotics, including meropenem, imipenem, ceftazidime-avibactam, amikacin, gentamicin, ciprofloxacin, trimethoprim-sulfamethoxazole, and colistin, with the exception of tigecycline. Whole genome sequencing analyses showed that this strain belonged to the ST617 serotype O89/162: H10 and harbored three β-lactamase genes (blaTEM-1B, blaCTX-M-55, blaNDM-9), mcr-1, and 14 other resistance genes. Seven plasmid replicon types (IncB, IncFII, IncI2, IncN, IncY, IncR, IncX1) were identified. Horizontal transfer of blaNDM-9 and mcr-1 from donor cells to the recipient E. coli J53 has been observed. blaNDM-9 and mcr-1 were carried by IncB and IncI2 plasmids, respectively. To speculate on the incidence of this strain, routine rectal swab screening to identify asymptomatic carriers might be warranted, in addition to the screening of ICU patients.

Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-ResistantStaphylococcus aureusFrom Culture of a Single Clinical Specimen From Colonized or Infected Patients

2009 ◽  
Vol 30 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Sang Hoon Han ◽  
Bum Sik Chin ◽  
Han Sung Lee ◽  
Su Jin Jeong ◽  
Hee Kyung Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Multivariate Logistic Regression Analysis ◽  
University Hospital ◽  
Cell Contact ◽  
Patient Risk ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Objective.To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistantStaphylococcus aureus(MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.Design.A retrospective cohort and case-control study.Setting.A tertiary care university hospital and referral center in Seoul, Korea.Methods.We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.Results.The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00;P= .012), urinary catheterization (OR, 3.36;P= .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03;P< .001).Conclusion.We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer ofvanA,close observation and surveillance for vancomycin-resistantS. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

scholarly journals The Incidence, Risk Factors, Predictors, and Prognoses of Cytomegalovirus Reactivation in Immunocompetent Mechanical Ventilation Patients: A Prospective Observational Study

2021 ◽  
Author(s):  
Zhihui Zhang ◽  
Xuesong Liu ◽  
Ling Sang ◽  
Sibei Chen ◽  
Zhan Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Area Under The Curve ◽  
University Hospital ◽  
Laboratory Findings ◽  
Cytomegalovirus Reactivation ◽  
Cmv Reactivation ◽  
Immunocompetent Patients

Abstract Background: Cytomegalovirus (CMV) reactivation can seriously affect the clinical prognoses of critically ill patients. However, the epidemiology and predictors of CMV in immunocompetent patients with mechanical ventilation are not very clear. Methods: A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with mechanical ventilation at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week until 28 days (Day1, 7, 14, 21, 28) and serology, laboratory findings, and clinical data were obtained at admission.Results: Among 71 patients, 13 (18.3%) showed CMV reactivation within ICU 28-day admission. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body weight, body mass index (BMI), sepsis, NT-proBNP, BUN, and Hb levels (P< 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were associated with CMV reactivation patients (P< 0.05). Moreover, the area under the curve (AUC) of BMI, Hb and BMI combined Hb was 0.69, 0.70, 0.76, respectively. The rate of complications, duration of mechanical ventilation, hospitalization expense, length of ICU stay, and 90-day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P< 0.05).Conclusions: Among immunocompetent patients with mechanical ventilation, the incidence of CMV reactivation was high. CMV reactivation can lead to various adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.

REFERRAL PATTERN AND OUTCOMES OF NEONATES FROM SECONDARY CARE SETTING OF AGA KHAN UNIVERSITY HOSPITAL TO TERTIARY CARE CENTERS IN PAKISTAN

2021 ◽  
pp. 1-13
Author(s):  
Suneeta khemani ◽  
Nazia Shamim ◽  
Adnan Mirza ◽  
Nadia Muhammad ◽  
Safdar Kagazwala ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Neonatal Mortality ◽  
Secondary Care ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
University Hospital ◽  
P Value ◽  
Tertiary Care Centers ◽  
Tertiary Care Hospitals

ABSTRACT:Objective: To determine the reasons of neonatal referrals from secondary care settings of Aga Khan University Hospital (AKUH) to tertiary care centers of Karachi, Pakistan and to assess the neonatal outcomes for referred cases. Methodology: This retrospective observational study was conducted at AKUH from July 2015 tjune 2019. All neonates born after 32 weeks of gestation at AKUH secondary care(Kharadar, Garden & Karimabad)and referred to tertiary care hospitals were consecutively enrolled. The reason for referral, i.e. surgical intervention, respiratory support, care of prematurity; need of mechanical ventilation, referral place and neonatal outcomes like discharge in stable condition, left against medical advice (LAMA) and mortality, were noted. Results: Of 348 referred cases, 306 (87.9%)were reported alive. neonatal mortality was reported in 42 (12.1%) of the cases. Of these 306 alive participants, 284 (92.81%) were discharged from the hospital whereas 22 (7.18%) LAMA. Of 348 patients, the referral place of most of the patients was outside AKU,i.e.189(56.3%).The need of mechanical ventilation was reported in, 63 (18.1%) patients. A significant association of mechanical ventilation in tertiary centers was observed in neonates born with low APGAR score at 1 and 5 min (p-value <0.001), shorter duration of stay at secondary care(p-value 0.007),and aggressive resuscitation requirement at birth (p-value <0.001). Conclusion: Most common reasons for referral of newborns to tertiary care hospital was respiratory diseases requiring respiratory support and surgical intervention. Neonatal mortality noted for referrals made to AKUH were much less as compared to cases referred to other tertiary care hospitals. Continuous...  

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