Predictors of polymyxin B treatment failure in Gram-negative healthcare-associated infections among critically ill patients

Abstract Background Effective prevention of healthcare-associated infections (HAIs) requires early identification of at-risk patients. There is no score designed to predict HAIs. The present study was aimed to explore an available score, Systemic inflammatory syndrome (SIRS) score, on admission in predicting HAIs among critically ill patients. Methods This study was based on the Medical Information Mart for Intensive Care III (MIMIC III) version 1.4. Patients with HAIs were matched with control patients who had no HAIs in a 1:1 ratio based on age, gender, mechanical ventilation, deep venous catheterization, urethral catheterization, and surgical operation. Subgroup analyses were conducted according to various variables including infection likelihood on admission. The prognostic values of SIRS and infectious SIRS on admission in predicting HAIs were analyzed using logistic regression. Results A total of 2437 patients with HAIs and 2437 matched controls were enrolled in the final analysis. Adjusted odds ratio (ORs) (95% confidence interval [CI]) for HAIs of SIRS scores (1 to 4) on admission was 1.48 (0.77-2.83), 1.86 (0.99-3.47), 2.14 (1.15-3.98), and 2.58 (1.39-4.80). Adjusted ORs (95%CI) for HAIs of SIRS (score≥2) and infectious SIRS were 1.57 (1.27-1.94) and 1.78 (1.52-2.09), respectively. Subgroup analyses showed that SIRS on admission was an independent risk factor for HAIs in patients admitted without definite and probable infection likelihood (OR=1.54, 95%CI 1.28-1.93). However, it was not a risk factor for HAIs inpatients admitted with infection, in non-white patients, and in patients with liver disease or obesity, and in patients who received total parenteral nutrition (TPN) (all P>0.05). In addition, it was showed that infectious SIRS on admission was not a risk factor for HAIs in black patients and in patients with obesity, and those received TPN (all P>0.05). Conclusions Infectious SIRS on admission significantly predicts HAIs among critical illness patients. SIRS on admission was a predictor of HAIs in ICU patients admitted without infection but not in patients admitted with infection.

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Healthcare associated infections caused by non-fermenting Gram negative rods (NFGNR): six years of experience of a tertiary hospital

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v7i2.19326 ◽

2013 ◽

Vol 7 (2) ◽

pp. 06-12

Author(s):

Zahidul Hasan ◽

Md. Kamrul Islam ◽

Arifa Hossain

Keyword(s):

Blood Stream Infection ◽

Tertiary Care ◽

Blood Stream ◽

Tertiary Hospital ◽

Healthcare Associated Infections ◽

Care Hospital ◽

Gram Negative ◽

Acinetobacter Spp ◽

Tract Infections ◽

Healthcare Associated

Recently non-fermenting Gram negative rods (NFGNR) are playing an important role in healthcare associated infections. This observational study in a tertiary care hospital of Dhaka city conducted during 01August 2007 to 30 June 2013 found that 34.8% isolated organisms from patients with healthcare associated infections were NFGNR. Majority (74.3 %) of these infections were occurring inside critical care areas. Pseudomonas and Acinetobacter together constituted 79.6% of the total NFGNR whereas Burkholderia cephacia complex (15.4%), Stenotrophomonas (4.3%) and Chryseobacterium species (0.7%) combined constituted remaining 20.4%. Out of total NFGNRs, Pseudomonas was responsible for highest number of catheter associated urinary tract infections (55.6%), ventilator associated pneumonia (46.3%), respiratory tract infection (65.8%) and surgical site infection (70.6%). Blood stream infection was predominantly caused by Burkholderia cephacia complex (33.5%) and Acinetobacter spp. (39.5%). Other than colistin most of the organisms were resistant to antibiotics commonly recommended for NFGNR.DOI: http://dx.doi.org/10.3329/bjmm.v7i2.19326 Bangladesh J Med Microbiol 2013; 07(02): 6-12

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Follow-up blood cultures in Gram-negative bacilli bacteremia: are they needed for critically ill patients?

Minerva Anestesiologica ◽

10.23736/s0375-9393.20.14040-9 ◽

2020 ◽

Vol 86 (5) ◽

Cited By ~ 2

Author(s):

Martina Spaziante ◽

Alessandra Oliva ◽

Giancarlo Ceccarelli ◽

Francesco Alessandri ◽

Francesco Pugliese ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Blood Cultures ◽

Gram Negative

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Mortality and microbiological clearance among critically ill patients receiving Polymyxin B in a Malaysian ICU: A 10 years retrospective study

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2020.09.724 ◽

2020 ◽

Vol 101 ◽

pp. 276

Author(s):

A.M. Lim ◽

N.A.Rahim ◽

P. Periyasamy ◽

W.R.W. Mat ◽

C. Lau

Keyword(s):

Retrospective Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Polymyxin B

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The impact of previous hospitalization in the preceding 90 days on the outcome in critically ill patients with gram-negative bloodstream infection

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2014.06.015 ◽

2014 ◽

Vol 80 (2) ◽

pp. 136-140 ◽

Cited By ~ 1

Author(s):

Qiaojun Zeng ◽

Fengqin Xu ◽

Shanping Jiang

Keyword(s):

Bloodstream Infection ◽

Critically Ill ◽

Critically Ill Patients ◽

Gram Negative ◽

Previous Hospitalization ◽

The Impact

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Patterns of c-reactive protein predicts response to therapy in healthcare-associated pneumonia in critically ill patients with cancer

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a254 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

L Sarmet Cunha Farah Rabello ◽

T Lisboo ◽

L Azevedo ◽

JR Lapa e Silva ◽

M Soares ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Response To Therapy ◽

C Reactive Protein ◽

Patients With Cancer ◽

Reactive Protein ◽

Healthcare Associated

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Current Pattern and Clinico-Bacteriological Profile of Healthcare Associated Infections (HAI) in an ICU Setting: An Observational Study

10.21203/rs.3.rs-874099/v1 ◽

2021 ◽

Author(s):

Mradul Kumar Daga ◽

Govind Mawari ◽

Saman Wasi ◽

Naresh Kumar ◽

Udbhav Sharma ◽

...

Keyword(s):

Age Groups ◽

Healthcare Facility ◽

Central Line ◽

Multidrug Resistant ◽

Gram Negative Bacteria ◽

Healthcare Associated Infections ◽

Acinetobacter Species ◽

Gram Negative ◽

Causative Agents ◽

Healthcare Associated

Abstract Objective To understand the pattern and types of healthcare associated infections (HAI) at our healthcare facility, and to determine the common causative agents and their antibiotic susceptibility profile. Methods One hundred consecutive patients diagnosed with HAI were enrolled and monitored; the causative organisms isolated on culture were recorded and their sensitivity profile was generated. Results Of the 100 patients diagnosed with HAI (mean age ± SD being 42 ± 17 years), there were a total of 110 hospital acquired infections with 10 patients having two infections each. Out of 100 patients with HAI, 69 patients had ventilator associated pneumonia (VAP), 21 patients had catheter associated urinary tract infection (CAUTI) patients, and 20 patients had central line associated bloodstream infection (CLABSI). There were 10 patients with both VAP and CAUTI. All of the HAIs were device associated. A total of 76 pathogens were isolated on culture. No organism was isolated in 40 HAI. Majority (94.7%) of the organisms isolated from HAIs were gram-negative bacteria and all were multidrug resistant. Seventy-seven of the enrolled patients expired while 23 were discharged from the hospital Conclusions Our study demonstrated that HAIs occur in patients of all age groups; younger patients are not spared. Majority of the HAIs were caused by multidrug resistant gram-negative bacteria and were associated with high patient mortality. Acinetobacter species was the most common organism associated with HAI.

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