Clinical characteristics and outcome of 125 polymicrobial bloodstream infections in hematological patients: an 11-year epidemiologic survey

Introduction: The aim of our study was to evaluate the epidemiology, clinical features and risk factors for shock and mortality from Escherichia coli bacteremia among children and adolescents with hematological disorders. Methodology: A retrospective observational study of E. coli bacteremia in the hematology department at Xiangya Hospital from January 2013 to June 2018 was conducted. Clinical characteristics, laboratory results and antimicrobial susceptibility were analysed. Risk factors for shock and mortality were also investigated. Results: Of the 45 strains of E. coli, 73.3% were multidrug-resistant (MDR). Septic shock was observed in 51.1% of patients, and the 30-day all-cause mortality was 22.2%. The risk factors associated with shock were an elevated red blood cell distribution (RDW) value when bloodstream infections (BSIs) occurred (> 15%, OR, 6.840; 95% CI, 1.571 – 29.788) and a lower WBC count (< 300/mm3, OR, 6.761; 95% CI, 1.383 – 33.044). Multivariate analysis showed that only an elevated D-dimer level (> 0.5 mg/L, OR 12.250, 95% CI 1.268 – 118.361) was a risk factor for 30-day mortality. Furthermore, we observed decreases for RDW changes at two time points (neutropenia and BSIs occurred) in the non-shock group and survival group. Conclusions: MDR infections from E. coli bacteremia were common in pediatric hematological patients. In our setting, the laboratory results may serve as a clue for physicians to distinguish patients at higher risk for shock and mortality. Furthermore, RDW could be used as a biomarker to elucidate potential disorders in hematological patients.

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Clinical Characteristics of Bloodstream Infections in Pediatric Acute Leukemia

Chinese Medical Journal ◽

10.4103/0366-6999.213411 ◽

2017 ◽

Vol 130 (17) ◽

pp. 2076-2081 ◽

Cited By ~ 1

Author(s):

Jia-Feng Yao ◽

Nan Li ◽

Jin Jiang

Keyword(s):

Acute Leukemia ◽

Clinical Characteristics ◽

Bloodstream Infections

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Clinical Characteristics of Carbapenem-Resistant Klebsiella Pneumoniaee Infections In A Tertiary Hospital In China

10.21203/rs.3.rs-636758/v1 ◽

2021 ◽

Author(s):

Zhiwen Cui ◽

Lirui Wang ◽

Wei Chang ◽

Minghui Li ◽

Yuexia Li ◽

...

Keyword(s):

Survival Time ◽

Sofa Score ◽

Clinical Characteristics ◽

Bloodstream Infections ◽

Polymyxin B ◽

Apache Ii ◽

Apache Ii Score ◽

Drainage Fluid ◽

Carbapenem Resistant ◽

Antimicrobial Regimen

Abstract Background：The infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) have become an important problem. The aim of the study is to evaluate the clinical characteristics of CR-KP.Methods: A retrospective cohort study has been made on all patients presenting with CR-KP infections. 615 patients with CR-KP humor infections diagnosed were identified. 135 patients who did not meet the requirements were excluded. Clinical characteristics, antimicrobial regimens, and outcomes of patients have been analyzed.Results: The CR-KP infections overall mortality was 37.3%, and bloodstream infections mortality was 66.2%. Survival analysis revealed that there were statistically significant differences between bloodstream infection and pulmonary and drainage fluid infection. Logistics regression analysis showed that hemopathy, age (>60 years), solid tumors, diabetes, septic shock, acute kidney injury and stroke were independent predictors associated with the 30-day mortality. Multivariate linear regression was performed in APACHE II score, SOFA score, lymphocyte absolute value (LYM) and survival time. Survival time was negatively correlated with APACHE II score and SOFA score, while positively correlated with LYM. Finally, we investigated different antimicrobial regimens for CR-KP infections. Chi-square test showed that antimicrobial regimen combined carbapenems, tigecycline with polymyxin B was superior the one combined carbapenems with polymyxin B. Ceftazidime avibactam-based antimicrobial regimens also had no advantage over other therapeutic regimens.Conclusions: Our study confirmed there is a high mortality rate in CR-KP infections, especially in the bloodstream infections. The outcome is greatly influenced by the patients’ clinical conditions. Antimicrobial regimen combined carbapenems, tigecycline with polymyxin B might be a better choice.

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Clinical Characteristics And Risk Factors In Mixed-Enterococcal Bloodstream Infections

Infection and Drug Resistance ◽

10.2147/idr.s217905 ◽

2019 ◽

Vol Volume 12 ◽

pp. 3397-3407 ◽

Cited By ~ 2

Author(s):

Cheng Zheng ◽

Jiachang Cai ◽

Haizhou Liu ◽

Shufang Zhang ◽

Li Zhong ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Bloodstream Infections

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Impact of a Central Line Infection Prevention Bundle in Newborn Infants

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.127 ◽

2016 ◽

Vol 37 (9) ◽

pp. 1029-1036 ◽

Cited By ~ 9

Author(s):

Rowena McMullan ◽

Adrienne Gordon

Keyword(s):

Neonatal Intensive Care ◽

Dwell Time ◽

Clinical Characteristics ◽

Infection Prevention ◽

Newborn Infants ◽

Bloodstream Infections ◽

Central Line ◽

Before And After ◽

Central Line Infection ◽

Line Infection

OBJECTIVETo compare central line use and central line–associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement.DESIGNRetrospective cohort analysis of prospectively collected data.SETTINGLevel 5 neonatal intensive care unit in Sydney, Australia.PATIENTSNewborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted.METHODSData regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback.RESULTSBaseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0–11.8 days] vs 7.3 days [4.0–10.4 days], P=.0004). Central line–associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC–related bloodstream infections (1.2/1,000 central line–days vs 11.5/1,000 central line–days, P<.0001).CONCLUSIONThis central line infection bundle was effective in reducing CVC use, dwell time, and central line–associated bloodstream infections.Infect Control Hosp Epidemiol 2016;37:1029–1036

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