scholarly journals Enterobacteriaceae resistant to third generation cephalosporins upon hospital admission: risk factors and clinical outcomes

2015 ◽  
Vol 19 (3) ◽  
pp. 239-245 ◽  
Author(s):  
Mirian Cristina Oliveira ◽  
Clara Rodrigues Alves Oliveira ◽  
Karine Valéria Gonçalves ◽  
Marciléa Silva Santos ◽  
Amanda Cristina Silva Tardelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Third Generation ◽  
Third Generation Cephalosporins

scholarly journals Risk Factors for and Outcomes Associated with Clinical Isolates ofEscherichia coliandKlebsiellaSpecies Resistant to Extended-Spectrum Cephalosporins among Patients Admitted to Canadian Hospitals

2009 ◽  
Vol 20 (3) ◽  
pp. e43-e48 ◽  
Author(s):  
Marianna Ofner-Agostini ◽  
Andrew Simor ◽  
Michael Mulvey ◽  
Alison McGeer ◽  
Zahir Hirji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Care Facility ◽  
P Value ◽  
Third Generation ◽  
Multivariate Logistic Regression ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins

BACKGROUND: Clinical features associated with Gram-negative bacterial isolates with extended-spectrum beta-lactamase (ESBL)- and AmpC-mediated resistance identified in Canadian hospitals is largely unknown. The objective of the present study was to determine the demographics, risk factors and outcomes of patients with ESBL- or AmpC-mediated resistant organisms in Canadian hospitals.METHODS: Patients with clinical cultures ofEscherichia coliorKlebsiellaspecies were matched with patients with a similar organism but susceptible to third-generation cephalosporins. Molecular identification of the AmpC or ESBL was determined using a combination of polymerase chain reaction and sequence analysis. Univariate and multivariate logistic regression analysis was performed to identify variables associated with becoming a case.RESULTS: Eight Canadian hospitals identified 106 cases (ESBL/AmpC) and 106 controls. All risk factors identified in the univariate analysis as a predictor of being an ESBL/AmpC cases at the 0.20 P-value were included in the multivariate analysis. No significant differences in outcomes were observed (unfavourable responses 17% versus 15% and mortality rates 13% versus 7%, P not significant). Multivariate logistic regression found an association of becoming an ESBL/AmpC case with: previous admission to a nursing home (OR 8.28, P=0.01) or acute care facility (OR 1.96, P=0.03), length of stay before infection (OR 3.05, P=0.004), and previous use of first-generation cephalosporins (OR 2.38, P=0.02) or third-generation cephalosporins (OR 4.52, P=0.01). Appropriate antibiotics were more likely to be given to controls (27.0% versus 13.3%, P=0.05) and number of days to appropriate antibiotics was longer for cases (median 2.8 days versus 1.2 days, P=0.05).CONCLUSION: The importance of patient medical history, present admission and antibiotic use should be considered for allE coliorKlebsiellaspecies patients pending susceptibility testing results.

scholarly journals Bleomycin Use in the Treatment of Hodgkin Lymphoma (HL): Toxicity and Outcomes in the Modern Era

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4038-4038
Author(s):  
Kekoa Taparra ◽  
Heshan Liu ◽  
Mei-Yin Polley ◽  
Kay M. Ristow ◽  
Thomas M. Habermann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Hodgkin Lymphoma ◽  
Clinical Outcomes ◽  
Mayo Clinic ◽  
Research Funding ◽  
Treatment Strategies ◽  
Respiratory Therapy ◽  
Inclusion Criteria ◽  
Genetics Research

BACKGROUND: Historically, one in five Hodgkin Lymphoma (HL) patients treated with bleomycin develop bleomycin pulmonary toxicity (BPT), a life-threatening interstitial pneumonitis. The current treatment paradigm consists of prompt discontinuation of bleomycin, administration of corticosteroids, antibiotics, hospital admission, respiratory therapy, or intensive care. BPT represents a challenge for patients with HL as it not only impairs respiratory function, but also has negative impacts on clinical outcomes. A collection of a dozen studies suggest BPT has a mortality rate just short of 10% of patients who develop BPT. Given recent data on bleomycin omission with negative interim PET scan, we assessed changes in BPT rates and severity over the past 15 years. Overall, treatment protocol characterization and patient characteristics most responsive to BPT treatment are poorly understood. OBJECTIVES: In this study, we investigated the clinical impact and treatment strategies in patients with BPT. Our goals were to: 1) Identify HL patients in the last decades who developed BPT and identify risk factors for BPT, 2) evaluate the impact of BPT on long-term clinical outcomes, and 3) characterize patterns of treatment strategies among patients with HL who develop BPT. METHODS: A single-center, retrospective analysis was preformed using patient data from the Mayo Clinic Lymphoma Database (Rochester, MN) consisting of 1,299 patients diagnosed with HL. All patients were diagnosed between 2003-2018. Inclusion criteria included 1) newly diagnosed, biopsy proven HL, 2) upfront treatment with ABVD, 3) treatment was received at our institution. All patients were assessed for clinically relevant HL characteristics including stage of disease, presence of bulky disease, presence of B symptoms, Eastern Cooperative Oncology Group (ECOG) performance status, BPT risk factors, and bleomycin treatment regimen. BPT was clinically defined as 1) Presence of pulmonary symptoms, 2) bilateral interstitial infiltrates on imaging, and 3) no evidence of infectious etiology. Patients treated in the "Early Era" (2000s) were compared to patients in the "Recent Era" (2010s). Comparison of continuous variables between BPT groups was assessed with Wilcox rank-sum test. OS and PFS were estimated via the Kaplan-Meier method. Approval of the protocol by the Mayo Clinic Institutional Review Board (IRB) was obtained and all patients were consented accordingly. RESULTS: One-hundred twenty six patients met the inclusion criteria for this study. Median follow-up for PFS and OS was 5.5 years (95%CI = 4.8-6.4) and 5.8 years (95%CI = 5.0-7.0), respectively. The 10-year OS and PFS among all patients were 85.1% (95%CI = 77.8-93.1) and 86.3% (95%CI = 80.1-93.0), respectively. Forty-seven patients (37% of all patients) met criteria for BPT. The estimated 10-year OS for BPT and non-BPT patients were 74.7% (95%CI = 61.8-90.5) and 91.7% (95%CI = 83.9-100.0), respectively. The estimated 10-year PFS for BPT and non-BPT patients were 84.7% (95%CI = 74.8-95.8) and 87.0% (95%CI = 79.1-95.8), respectively. In univariable analysis, BPT negatively impacted OS (HR=3.6, 95%CI: 1.2-10.6). However, bleomycin omission did not impact OS (HR=1.3, 95%CI=0.5-3.7). BPT-mortality was 17%. In multivariable analysis, BPT was not significantly associated with OS after adjusting for baseline characteristics (HR=3.0, 95%CI=0.9-9.9). Patients were older (median: 46 vs 33 years) and received less bleomycin (median: 107 vs 215 units) compared to non-BPT patients. BPT was most often managed with bleomycin omission with 59% of patients (74 of 126 patients) having omitted bleomycin at some point during treatment. Patients treated in the "Recent Era" (2010s) had lower BPT rates (28% vs 48%), mortality (10% vs 21%), bleomycin dose (143 vs 204 units), and bleomycin cycles (7 vs 12 cycles), yet higher prophylactic bleomycin omission (59% vs 8%) compared to "Early Era" (2000s). Patients treated in the Recent Era compared to Early Era had a reduction of BPT treatment with steroids, hospital admission, respiratory therapy, and ICU admission by 12%, 22%, 14%, 13%, respectively. CONCLUSION: Overall, our data suggests BPT continues to impact OS in HL patients treated with ABVD, however BPT treatment is decreasing as management changed in recent years. Disclosures Ansell: Bristol-Myers Squibb: Research Funding; Mayo Clinic Rochester: Employment; LAM Therapeutics: Research Funding; Trillium: Research Funding; Affimed: Research Funding; Seattle Genetics: Research Funding; Affimed: Research Funding; Mayo Clinic Rochester: Employment; Regeneron: Research Funding; Trillium: Research Funding; Seattle Genetics: Research Funding; LAM Therapeutics: Research Funding; Regeneron: Research Funding; Bristol-Myers Squibb: Research Funding.

scholarly journals Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors

2016 ◽  
Vol 71 (10) ◽  
pp. 2957-2963 ◽  
Author(s):  
A. Hamprecht ◽  
A. M. Rohde ◽  
M. Behnke ◽  
S. Feihl ◽  
P. Gastmeier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Admission Prevalence

Empirical Antimicrobial Prescriptions in Patients with Clostridium difficile Infection at Hospital Admission and Impact on Clinical Outcome

2012 ◽  
Vol 33 (11) ◽  
pp. 1101-1106 ◽  
Author(s):  
Aurora Pop-Vicas ◽  
Eman Shaban ◽  
Cecile Letourneau ◽  
Angel Pechie
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Prolonged Exposure ◽  
Adverse Outcomes ◽  
Concurrent Use ◽  
Independent Risk Factors ◽  
The Impact

Objective.To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.Design.Retrospective cohort study.Setting.University-affiliated community hospital.Methods.We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures.Results.Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8–28.5]; P = .005), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03–1.36]; P = .016), and age (OR, 1.1 [95% CI, 1.0–1.1]; P = .043) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8–15.8]; P = .003) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9–32.3]; P< .001) were independently associated with unnecessary antimicrobial prescriptions.Conclusions.Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.

Reduced Use of Third-Generation Cephalosporins Decreases the Acquisition of Extended-Spectrum Beta-Lactamase-ProducingKlebsiella pneumoniae

2004 ◽  
Vol 25 (10) ◽  
pp. 832-837 ◽  
Author(s):  
Sang-Oh Lee ◽  
Eun Sun Lee ◽  
Shin Young Park ◽  
Sue-Yun Kim ◽  
Yiel-Hae Seo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Tertiary Care ◽  
Prior Exposure ◽  
Third Generation ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins

AbstractObjectives:To identify risk factors for the respiratory acquisition of extended-spectrum beta-lactamase (ESBL)-producingKlebsiella pneumoniaeamong patients admitted to a neurosurgical intensive care unit (NSICU) and to modify them without changing general infection control measures.Design:Nested case-control and intervention study.Setting:A 1,200-bed, tertiary-care teaching hospital with a 17-bed NSICU.Methods:Sputa of all patients admitted to the NSICU were cultured weekly during the study. From October 2002 through February 2003, 29 case-patients from whose sputum ESBL-producingK. pneumoniaewas isolated were detected and 59 controls-patients were randomly selected among patients without any positive isolate of ESBL-producingK. pneumoniae.After analyzing the risk factors, we intervened to modify them and compared the acquisition rate of ESBL-producingK. pneumoniaebefore (October 2002 to February 2003) and after (April to August 2003) the intervention.Results:Multivariate analysis showed that prior exposure to third-generation cephalosporins (TGCs) (OR, 6.0; CI95, 1.9 to 18.6;P= .002) was an independent risk factor of ESBL-producingK. pneumoniaeacquisition. The neurosurgical team was notified of the result, and the infectious diseases specialist visited the NSICU three times a week to regulate TGC use during the intervention period. Patients admitted before the intervention were older than patients admitted after. The respiratory acquisition of ESBL-producingK. pneumoniaeper 1,000 patient-days (13.5 [CI95, 8.9 to 18.1] vs 2.7 [CI95, 0.9 to 4.6]) and the antimicrobial use density of TGCs (38.2 ± 5.0 vs 17.3 ± 2.6;P< .001) decreased significantly after the intervention.Conclusion:Prior exposure to TGCs was an independent risk factor for the respiratory acquisition of ESBL-producingK. pneumoniae,and less use of TGCs was associated with a decrease in acquisition.

scholarly journals Acinetobacter spp. colonization and infection risk factors in surgical patients

2011 ◽  
Vol 58 (4) ◽  
pp. 81-87 ◽  
Author(s):  
Vesna Mioljevic ◽  
Aleksandar Simic ◽  
Dejan Radenkovic ◽  
Danijel Galun ◽  
Ivan Palibrk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
University Hospital ◽  
Tube Placement ◽  
Individual Risk ◽  
Causative Organism ◽  
Third Generation ◽  
Significant Difference ◽  
Acinetobacter Spp ◽  
Third Generation Cephalosporins

INTRODUCTION: The results of numerous studies carried out over the last two decades have indicated that Acinetobacter spp. represents an increasingly important cause of intrahospital infections (IHI). The aim of the study was to determine potential differences in distribution of individual risk factors between the group of patients in whom multiresistant Acinetobacter spp. was isolated and the group of patients in whom it was not. MATERIAL AND METHODS: A prospective cohort study of 64 patients hospitalized with recorded IHI at the University Hospital for Digestive Surgery, Clinical Center of Serbia in the period between January and July 2011. The subjects were divided into two groups: patients with IHI in whom multiresistant Acinetobacter spp. was isolated from the biological material samples, and those with IHI without the presence of Acinetobacter spp. RESULTS: Univariate data analysis indicated presence of statistically significant difference in distribution of certain types of surgeries (esophageal, pancreatic and hepatobiliary) among the two groups of subjects, distribution of CVC placement, application of mechanical ventilation and nasogastric tube placement, length of stay in ICU, lethal outcomes and administration of third generation cephalosporins. The results of multivariate analysis indicated that length of hospitalization in ICU (> 7 days), CVC, mechanical ventilation, esophageal, pancreatic and hepatobiliary surgeries as well as administration of third generation cephalosporins are independent risk factors for colonization and infection of patients with Acinetobacter spp. CONCLUSION: Colonized or infected patients with Acinetobacter spp. play a major role in contamination of hands of the medical staff in the course of care and treatment, while inadequate hand hygiene of the staff leads to cross transmission of the causative organism to infection-free patients. Selective antibiotic pressure, particularly administration of quinolones and broad-spectrum cephalosporins, favor onset of multiresistant species of Acinetobacter spp., and therefore appropriate prophylaxis and treatment represent basic preventive measures against the onset and spreading of the causative organisms.

Sign in / Sign up

Export Citation Format

Share Document