scholarly journals Epidemiology and Risk Factors Associated With Mortality in Consecutive Patients With Bacterial Bloodstream Infection: Impact of MDR and XDR Bacteria

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Antonella Santoro ◽  
Erica Franceschini ◽  
Marianna Meschiari ◽  
Marianna Menozzi ◽  
Stefano Zona ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Condition ◽  
Gram Negative Bacteria ◽  
Charlson Score ◽  
Patient Death ◽  
Gram Negative ◽  
Factors Associated ◽  
Risk Of Death ◽  
Crude Mortality ◽  
Independent Risk Factors

Abstract Background  Mortality related to bloodstream infections (BSIs) is high. The epidemiology of BSIs is changing due to the increase in multidrug resistance, and it is unclear whether the presence of multidrug-resistant (MDR) organisms, per se, is an independent risk factor for mortality. Our objectives were, first, to describe the epidemiology and outcome of BSIs and, second, to determine the risk factors associated with mortality among patients with BSI. Methods  This research used a single-center retrospective observational study design. Patients were identified through microbiological reports. Data on medical history, clinical condition, bacteria, antimicrobial therapy, and mortality were collected. The primary outcome was crude mortality at 30 days. The relationships between mortality and demographic, clinical, and microbiological variables were analyzed by multivariate analysis. Results  A total of 1049 inpatients were included. MDR bacteria were isolated in 27.83% of patients, where 2.14% corresponded to an extremely drug-resistant (XDR) isolate. The crude mortality rates at days 7, 30, and 90 were 12.11%, 25.17%, and 36.13%, respectively. Pitt score >2, lung and abdomen as site of infection, and XDR Pseudomonas aeruginosa were independent risk factors for 7-, 30-, and 90-day mortality. Charlson score >4, carbapenem-resistant Klebsiella pneumoniae, and XDR Acinetobacter baumannii were independent risk factors for 30- and 90-day mortality. Infection by XDR gram-negative bacteria, Charlson score >4, and immunosuppression were independent risk factors for mortality in patients who were stable at the time of BSI. Conclusions  BSI is an event with an extreme impact on mortality. Patients with severe clinical condition are at higher risk of death. The presence of XDR gram-negative bacteria in blood is strongly and independently associated with patient death.

Risk factors associated with the isolation of colistin-resistant Gram-negative bacteria: A matched case-control study

2008 ◽  
Vol 36 (3) ◽  
pp. 807-811 ◽  
Author(s):  
Dimitrios K. Matthaiou ◽  
Argyris Michalopoulos ◽  
Petros I. Rafailidis ◽  
Drosos E. Karageorgopoulos ◽  
Vassiliki Papaioannou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Case Control ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Factors Associated ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

scholarly journals Risk Factors Associated With Imipenem-Resistance Among Isolated Gram -Negative Bacteria From Patients in Sanandaj Hospitals, Iran

2016 ◽  
Vol 3 (1) ◽  
pp. 29989-29989
Author(s):  
Behzad Mohsenpour ◽  
Samaneh Rouhi ◽  
Roghaye Mehrdel ◽  
Tayyebe Faraji ◽  
Milad Masaeli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Factors Associated ◽  
Imipenem Resistance

scholarly journals Risk Factors for Carbapenemase Producing-Carbapenem Resistant Enterobacteriaceae in Those With CRE Positive Cultures

2020 ◽  
Vol 41 (S1) ◽  
pp. s376-s377
Author(s):  
Geneva Wilson ◽  
Christopher Pfeiffer ◽  
Margaret Fitzpatrick ◽  
Katie Suda ◽  
Brian Bartle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Geographic Region ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Factors Associated ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are gram-negative bacteria resistant to at least 1 carbapenem and are associated with high mortality (50%). Carbapenemase-producing CRE (CP-CRE) are particularly serious because they are more likely to transmit carbapenem resistance genes to other gram-negative bacteria and they are resistant to all carbapenem antibiotics. Few studies have evaluated risk factors associated with CP-CRE colonization. The goal of this study was to determine the risk factors associated with CP-CRE colonization in a cohort of US veterans. Methods: We conducted a retrospective cohort study of patients seen at VA medical centers between 2013 and 2018 who had positive cultures for CRE from any site, defined by resistance to at least 1 of the following carbapenems: imipenem, meropenem, doripenem, or ertapenem. CP-CRE was defined via antibiotic sensitivity data that coded the culture as being ‘carbapenemase producing,’ being ‘Hodge test positive,’ or ‘KPC producing.’ Only the first positive culture for CRE was included. Patient demographics (year of culture, age, sex, race, major comorbidities, infectious organism, culture site, inpatient status, and CP-CRE status) and facility demographics (rurality, geographic region, and facility complexity) were collected. Bivariate analysis and multiple logistic regression were performed to determine variables associated with CP-CRE versus non–CP-CRE. Results: In total, 3,322 patients were identified with a positive CRE culture: 546 (16.4%) with CP-CRE and 2,776 (83.63%) with non–CP-CRE. Most patients were men (95%) and were older (mean age, 71; SD, 12.5) and were diagnosed at a high-complexity VA medical center (65%). Most of the cultures were urine (63%), followed by sputum (13%), and blood (7%). Most were from inpatients (46%), followed by outpatients (42%), and long-term care facilities (12%). Multivariable analysis showed the following variables to be associated with CP-CRE positive cultures: congestive heart failure (P = .0136), African American (P = .0760), Klebsiella spp (P < .0001), GI cancers (P = .0087), culture collected in 2017 (P = .0004), and culture collected in 2018 (P < .0001). There were also significant differences CP-CRE frequencies by geographic region (P < .001). Discussion: CP-CRE diagnoses are relatively rare; however, the serious complications associated make them important infections to investigate. In our analysis, we found that congestive heart failure and gastric cancer were comorbidities strongly associated with CP-CRE. In 2017, the VA formalized their CP-CRE definition, which led to more accurate reporting. Conclusions: After the guideline was implemented, CP-CRE detection dramatically increased in noncontinental US facilities. More work should be done in the future to determine the different risk factors between non–CP-CRE and CP-CRE infections.Funding: NoneDisclosures: None

scholarly journals A Comparative Study of the Microbiological Efficacy of Polymyxin B on Different Carbapenem-Resistant Gram-Negative Bacteria Infections

2021 ◽  
Vol 8 ◽  
Author(s):  
Qiong Lu ◽  
Hai-Hong Zhu ◽  
Guo-Hua Li ◽  
Ting-Ting Qi ◽  
Liang-Jun Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Clearance Rate ◽  
Bacterial Species ◽  
Polymyxin B ◽  
Gram Negative Bacteria ◽  
Bacterial Clearance ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Independent Risk Factors

Objective: The emergence of carbapenem-resistant gram-negative bacteria (CR-GNB) has brought great challenges to clinical anti-infection treatment around the world. Polymyxins are often considered as the last line of defense in the treatment of CR-GNB infections. In this study, we explored the microbiological efficacy of Polymyxin B (PMB) on different CR-GNB infections as well as the factors influencing microbiological efficacy.Methods: CR-GNB infected patients with PMB-based regimens were enrolled. Clinical and microbiological data were collected from the medical electronic record system of the Second Xiangya hospital. The efficacy of PMB on different CR-GNB was evaluated by the clearance rate at 7-days and within the course of treatment, as well as the 30-day mortality rate.Results: A total of 294 CR-GNB infected patients were enrolled: 154 CR-Acinetobacter baumannii (CRAB), 55 CR-Klebsiella pneumoniae (CRKP), and 85 CR-Pseudomonas aeruginosa (CRPA). The CRAB group had the highest 7-day bacterial clearance rate [(CRAB: 39.0%) vs. (CRKP: 29.4%) vs. (CRPA: 14.5%), P = 0.003] and total bacterial clearance rate [(CRAB: 49.0%) vs. (CRKP: 39.8%) vs. (CRPA: 18.2%), P &lt; 0.001] among the three groups, while the bacterial clearance rate of the CRPA group was the lowest. Multivariate logistic regression showed that the differences among the three groups were multiple CR-GNB infections (P = 0.004), respiratory infections (P = 0.001), PMB resistance (P &lt; 0.001), and the combination of tigecycline (P &lt; 0.001). Binary logistic regression showed that multiple CR-GNB infection [(7-day bacterial clearance: P = 0.004) &amp; (total bacterial clearance: P = 0.011)] and bacterial species [(7-day bacterial clearance: P &lt; 0.001) &amp; (total bacterial clearance: P &lt; 0.001)] were independent risk factors for microbiological efficacy.Conclusion: PMB exhibited differential microbiological efficacy on different types of CR-GNB infections; it had the best effect on CRAB, followed by CRKP and CRPA. Multiple CR-GNB infections and bacterial species were independent risk factors for microbiological efficacy.

scholarly journals Active Surveillance of Carbapenem-resistant Gram-negative Bacteria to guide antibiotic therapy: a single-center prospective observational study

2021 ◽  
Author(s):  
Qiqiang Liang ◽  
Juan Chen ◽  
Yongshan Xu ◽  
Yibing Chen ◽  
Man Huang
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Antibiotic Therapy ◽  
Prospective Observational Study ◽  
Gram Negative Bacteria ◽  
Empirical Antibiotic Therapy ◽  
Single Center ◽  
Gram Negative ◽  
Factors Associated ◽  
Carbapenem Resistant

Abstract Background Carbapenem-resistant Gram-negative Bacteria (CRGNB) have become a public health concern worldwide. The risk factors associated with CRGNB infection after colonization are unknown, nor is the optimal timing of antibiotic treatment, warranting further investigation. Methods A 4-year single-center prospective observational study was conducted. CRGNB-colonized patients were incorporated on admission into our observation cohort for an active surveillance culture program, and analysis of risk factors associated with infections after CRGNB colonization was performed. We divided patients into empirical antibiotic therapy groups and standard antibiotic therapy groups according to whether antibiotics were used before or after cultures yielded a result to explore the relationship between the timing of antibiotics and clinical efficacy. Results 152 out of 451 CRGNB-colonized patients in the prospective observational cohort developed CRGNB infection. The risk factors associated with CRGNB infection after colonization included CRKP (P < 0.001, OR = 3.27) and CRPA (P < 0.001, OR = 2.97) colonization, history of carbapenems use (P < 0.001, OR = 5.48), and immunocompromise (P < 0.001, OR = 7.07). There were 88 infected patients in the empirical antibiotic therapy groups and 64 in standard antibiotic therapy groups. The mortality was lower in empirical therapy groups than standard therapy groups (17.0% vs. 37.5%, P = 0.004, OR = 0.32). Conclusions CRGNB colonization increased the risk of infection, and risk factors included CRKP and CRPA colonization, immunocompromise, and prior carbapenems use. Once infection occurs in CRGNB-colonized patients, susceptibility-guided antibiotic treatment can be given according to previous susceptibility results of colonized CRGNB, reducing mortality.

scholarly journals 1371. Identification of Risk Factors to Predict Gram negative bacteria in Patients with Upper Extremity Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S771-S772
Author(s):  
Sophia Zhitomirsky ◽  
Hendrik Sy ◽  
Arsheena Yassin ◽  
Christine Stavropoulos ◽  
Andras Farkas
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Upper Extremity ◽  
Drug Exposure ◽  
Clinical Care ◽  
Gram Negative Bacteria ◽  
Final Model ◽  
Gram Negative ◽  
Factors Associated ◽  
Prosthetic Joint Infections

Abstract Background Gram negative bacteria (GNB) have been identified as a cause of upper extremity infections and empiric treatment directed to both gram positive and negative organisms is often recommended. Risk-based approaches to establish need for gram-negative coverage may help to minimize unnecessary drug exposure, but further information on such methods are currently lacking. The aim of this study was to identify risk factors associated with the isolation of GNB in patients with upper extremity infections. Methods We reviewed records of patients with upper extremity infections treated in two urban hospitals between March 2018 and July 2020. Prosthetic joint infections were excluded. Baseline demographic, clinical, surgical and microbiology data was collected. Multivariable logistic regression models were screened using Akaike Information Criterion to establish the best model and risk factors associated with isolation of a GNB. Results We identified 111 patients, the majority of whom were male with frequent history of IV drug use. Deep wound cultures in 30 (33.3%) individuals yielded a GNB, and 80% of these cases were polymicrobial. Among the GNB, most prevalent were Enterobacterales (10.4%), HACEK group (6.39%), and Pseudomonas spp. (4.5%) (Tables 1. and 2.). Infections were mostly limited to the soft tissue structures of the hand and the forearm, with involvements of the joint and bone being second and third most common. The final model identified the use of IV medications (OR 4.14, 95% CI 1.3 - 14.46) together with prior surgery at the site of infection within the last year (OR 5.56, 95% CI 1.06 - 30.98), and having an open wound on presentation (OR 3.03, 95% CI 1.04 - 9.47) as factors independently associated with isolation of a GNB (Table 3). AUROC of 0.702 indicates acceptable model discrimination. Table 1: Baseline characteristics Table 2: Bacterial isolates Table 3: Final model Conclusion Our logistic regression model identified significant predictors for isolation of GNB in upper extremity infections within this population. Results of this study will assist clinicians in making a better informed decision for the need of empiric gram negative coverage aimed to support the reduction of patient exposure to unnecessary antimicrobial coverage. External validation of the model is warranted prior to application to clinical care. Figure 1: AUROC Disclosures All Authors: No reported disclosures

Activities and risk factors associated with fall-related injuries among US Army soldiers

2020 ◽  
pp. bmjmilitary-2020-001564
Author(s):  
Raina D Brooks ◽  
T Grier ◽  
B H Jones ◽  
M C Chervak
Keyword(s):  
Risk Factors ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Physically Active ◽  
Us Army ◽  
Factors Associated ◽  
Younger Age ◽  
Near Falls ◽  
Independent Risk Factors ◽  
Army Soldiers

IntroductionFalls/near falls are the second leading cause of hospitalisation and outpatient visits among US Army soldiers. While numerous studies have evaluated fall-related or near fall-related injuries among elderly adults, few have evaluated this association among young adults. The objective of this study is to describe the characteristics and risk factors associated with fall-related or near fall-related injuries among male US Army soldiers.MethodsThis is a cross-sectional study of male US Army Airborne Division soldiers (n=5187). Electronic surveys captured demographic, lifestyle, physical training (PT), fitness and injury data during spring/summer of 2016. Multiple logistic regression was used to identify independent risk factors of fall-related or near fall-related injuries, adjusting for potential confounders.ResultsPrimary findings indicated that activities and risk factors associated with fall-related or near fall-related injuries among soldiers included younger age (≤35 years), holding a job that required minimal lifting activities, slower 2-mile run times and not running during personal PT.ConclusionsThe findings from this study suggest that male US Army soldiers and other physically active men may benefit from (1) obtaining and/or maintaining higher aerobic endurance and muscular strength, and (2) training focused on preventing fall-related injuries during PT, road marching and sports/recreational activities. Moreover, prevention strategies and education should further target younger soldiers (≤35 years old), as younger age is not modifiable.

scholarly journals Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A Retrospective Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 340
Author(s):  
Raquel Bandeira da Silva ◽  
Mauro José Salles
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Revision Arthroplasty ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Postoperative Hematoma ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan–Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates.

scholarly journals Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

2021 ◽  
Vol 10 (5) ◽  
pp. 928
Author(s):  
Takuya Okugawa ◽  
Tadayuki Oshima ◽  
Keisuke Nakai ◽  
Hirotsugu Eda ◽  
Akio Tamura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Colorectal Polyp ◽  
Control Group ◽  
Single Center ◽  
Antithrombotic Agents ◽  
Delayed Bleeding ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
Continuous Use

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6–2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection. Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared. Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction. Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

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

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