scholarly journals Comparison of risk factors and outcomes in carbapenem-resistant and carbapenem-susceptible Gram-negative bacteremia

2020 ◽  
Author(s):  
Sinan Cetin
Keyword(s):  
Risk Factors ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Gram Negative Bacteremia

Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients

2013 ◽  
Vol 39 (7) ◽  
pp. 1253-1261 ◽  
Author(s):  
Christina Routsi ◽  
Maria Pratikaki ◽  
Evangelia Platsouka ◽  
Christina Sotiropoulou ◽  
Vasileios Papas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Gram Negative Bacteremia

scholarly journals 116. Risk Factors and Clinical Outcomes of Carbapenem Non-Susceptible Gram-Negative Bacteremia in Patients with Acute Myelogenous Leukemia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S89-S89
Author(s):  
Dong Hoon Shin ◽  
Kang Il Jun ◽  
Song Mi Moon ◽  
Wan Beom Park ◽  
Ji Hwan Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Resistant Organism ◽  
Time Interval ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Acute Myelogenous ◽  
Independent Risk Factors

Abstract Background Early administration of susceptible antibiotics is crucial in Gram-negative bacteremia (GNB), especially in immunocompromised patients. We aimed to explore risk factors and clinical outcomes of carbapenem non-susceptible (Carba-NS) GNB in patients with acute myelogenous leukemia (AML). Methods Cases of all GNB during induction or consolidation chemotherapy for AML in a 15-year period in a tertiary hospital were retrospectively reviewed. Independent risk factors for Carba-NS GNB were sought and its clinical outcomes were compared with those of carbapenem susceptible (Carba-S) GNB. Results Among 485 GNB cases from 930 patients, 440 (91%) were Carba-S and 45 (9%) were Carba-NS GNB. Frequent Carba-NS isolates were Stenotrophomonas maltophilia (n = 23), Pseudomonas aeruginosa (n = 11), and Acinetobacter baumannii (n = 10). Independent risk factors for Carba-NS GNB were carbapenem use at the onset of GNB (aOR [95% CI], 78.6 [24.4–252.8]; P < 0.001), the isolation of imipenem-resistant A. baumannii in the prior 1 year (aOR [95% CI], 14.6 [2.7–79.9]; P = 0.002), time interval from chemotherapy to GNB ≥20 days (aOR [95% CI], 4.7 [1.7–13.1]; P = 0.003), and length of hospital stay ≥30 days (aOR [95% CI], 3.4 [1.3–9.1]; P = 0.013). Except breakthrough GNBs which occurred during carbapenem treatment, the frequency of Carba-NS GNB was 48% (19/40) in cases having ≥2 risk factors other than carbapenem use. 30-day overall mortality (Carba-NS, 36% vs. Carba-S, 6%; P < 0.001) and in-hospital mortality (Carba-NS, 47% vs. Carba-S, 9%; P < 0.001) were significantly higher in Carba-NS GNB. Conclusion Carba-NS GNB in AML patients was independently associated with the use of carbapenem, the past isolation of resistant organism, and late onset of GNB, and its clinical outcomes were poorer than those of Carba-S GNB. Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors. Disclosures All authors: No reported disclosures.

Risk Factors for Mortality in Patients with Nosocomial Gram-Negative Bacteremia

2012 ◽  
Vol 32 (6) ◽  
pp. 1641-1647 ◽  
Author(s):  
M. Gökhan GÖZEL ◽  
Ayşe ERBAY ◽  
Hürrem BODUR ◽  
Selim Sırrı EREN ◽  
Neriman BALABAN
Keyword(s):  
Risk Factors ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

2016 ◽  
Vol 60 (11) ◽  
pp. 6673-6678 ◽  
Author(s):  
Ji-Yong Lee ◽  
Cheol-In Kang ◽  
Jae-Hoon Ko ◽  
Woo Joo Lee ◽  
Hye-Ri Seok ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Respiratory Infections ◽  
Hematologic Malignancy ◽  
Tertiary Hospital ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Content Type ◽  
Gram Negative Bacteremia ◽  
Infection Types

ABSTRACTWith the increasing use of carbapenems, carbapenem-resistant Gram-negative bacteria have become a major concern in health care-associated infections. The present study was performed to evaluate the clinical and microbiological features of breakthrough Gram-negative bacteremia (GNB) during carbapenem therapy and to assess risk factors for development of breakthrough GNB. A case-control study was performed at a tertiary hospital from 2005 to 2014. Case patients were defined as individuals whose blood cultures grew Gram-negative bacteria while the patients were receiving carbapenems for at least 48 h before breakthrough GNB. Age-, sex-, and date-matched controls were selected from patients who received carbapenem for at least 48 h and did not develop breakthrough GNB during carbapenem treatment. A total of 101 cases of breakthrough GNB were identified and compared to 100 controls. The causative microorganisms for breakthrough GNB wereStenotrophomonas maltophilia(n= 33),Acinetobacter baumannii(n= 32),Pseudomonas aeruginosa(n= 21), and others (n= 15). Approximately 90% ofS. maltophiliaisolates were susceptible to levofloxacin and trimethoprim-sulfamethoxazole. The most common infection types were primary bacteremia (38.6%) and respiratory infections (35.6%). More than half of the patients died within a week after bacteremia, and the 30-day mortality rate was 70.3%. In a multivariate analysis, a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization by causative microorganisms were significantly associated with breakthrough GNB. Our data suggest thatS. maltophilia,A. baumannii, andP. aeruginosaare the major pathogens of breakthrough GNB during carbapenem therapy, in association with a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization.

scholarly journals Bloodstream Infections Caused by Antibiotic-Resistant Gram-Negative Bacilli: Risk Factors for Mortality and Impact of Inappropriate Initial Antimicrobial Therapy on Outcome

2005 ◽  
Vol 49 (2) ◽  
pp. 760-766 ◽  
Author(s):  
Cheol-In Kang ◽  
Sung-Han Kim ◽  
Wan Beom Park ◽  
Ki-Deok Lee ◽  
Hong-Bin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Mortality Rate ◽  
Antimicrobial Therapy ◽  
Treated Group ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Initial Antimicrobial Therapy ◽  
Risk Source

ABSTRACT The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial antimicrobial therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with Escherichia coli bacteremia, 65 with Klebsiella pneumoniae bacteremia, 74 with Pseudomonas aeruginosa bacteremia, and 86 with Enterobacter bacteremia, were analyzed retrospectively. If a patient received at least one antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture collection, the initial antimicrobial therapy was considered to have been appropriate. High-risk sources of bacteremia were defined as the lung, peritoneum, or an unknown source. The main outcome measure was 30-day mortality. Of the 286 patients, 135 (47.2%) received appropriate initial empirical antimicrobial therapy, and the remaining 151 (52.8%) patients received inappropriate therapy. The adequately treated group had a 27.4% mortality rate, whereas the inadequately treated group had a 38.4% mortality rate (P = 0.049). Multivariate analysis showed that the significant independent risk factors of mortality were presentation with septic shock, a high-risk source of bacteremia, P. aeruginosa infection, and an increasing APACHE II score. In the subgroup of patients (n = 132) with a high-risk source of bacteremia, inappropriate initial antimicrobial therapy was independently associated with increased mortality (odds ratio, 3.64; 95% confidence interval, 1.13 to 11.72; P = 0.030). Our data suggest that inappropriate initial antimicrobial therapy is associated with adverse outcome in antibiotic-resistant gram-negative bacteremia, particularly in patients with a high-risk source of bacteremia.

scholarly journals Risk factors for and clinical outcomes of carbapenem non-susceptible gram negative bacilli bacteremia in patients with acute myelogenous leukemia

2020 ◽  
Author(s):  
Dong Hoon Shin ◽  
Dong-Yeop Shin ◽  
Chang Kyung Kang ◽  
Suhyeon Park ◽  
Jieun Park ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Acute Myelogenous Leukemia ◽  
Tertiary Care ◽  
Myelogenous Leukemia ◽  
Care Hospital ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Appropriate Treatment ◽  
Acute Myelogenous

Abstract Background: Carbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients. Consequently, appropriate treatment could be delayed in GNB bacteremia cases involving organisms which are not susceptible to carbapenem (carba-NS), resulting in a poor clinical outcomes. Here, we explored risk factors for carba-NS GNB bacteremia and its clinical outcomes in patients with acute myelogenous leukemia (AML) that underwent chemotherapy. Methods: We reviewed all GNB bacteremia cases that occurred during induction or consolidation chemotherapy, over a 15-year period, in a tertiary-care hospital. Results: Among 489 GNB bacteremia cases from 324 patients, 45 (9.2%) were carba-NS and 444 (90.8%) were carbapenem susceptible GNB. Independent risk factors for carba-NS GNB bacteremia were: carbapenem use at bacteremia onset (adjusted odds ratio [aOR]: 91.2; 95% confidence interval [95%CI]: 29.3-284.1; P<0.001); isolation of carbapenem-resistant Acinetobacter baumannii (aOR: 19.4, 95%CI: 3.4-112.5; P=0.001) in the prior year; and days from chemotherapy to GNB bacteremia (aOR: 1.1 per day, 95%CI: 1.1-1.2; P<0.001). Carba-NS bacteremia was independently associated with in-hospital mortality (aOR: 6.6, 95%CI: 3.0-14.8; P<0.001). Conslusion: Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors.

scholarly journals Risk Factors of Bloodstream Infections Caused by Carbapenem-resistant Gram-negative Pathogens in Pediatric Critical Care Settings

2019 ◽  
Vol 6 (3) ◽  
pp. 180-185
Author(s):  
Zümrüt Şahbudak Bal ◽  
Muhterem Duyu ◽  
Fulya Kamit ◽  
Pınar Yazıcı ◽  
Ayşe Berna Anıl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Bloodstream Infections ◽  
Pediatric Critical Care ◽  
Gram Negative ◽  
Carbapenem Resistant
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