Bloodstream infections (BSI) with multidrug resistant organism (MDRO) in a pediatric oncology unit: Outcomes and risk factors

The aim of this study was to characterize COVID-19 (SARS-CoV-2-infected) patients who develop bloodstream infection (BSI) and to assess risk factors associated with in-hospital mortality. We conducted a retrospective observational study of adult patients admitted for ≥48 h to a large Central Italy hospital for COVID-19 (1 March to 31 May 2020) who had or had not survived at discharge. We included only patients having blood cultures drawn or other inclusion criteria satisfied. Kaplan–Meier survival or Cox regression analyses were performed of 293 COVID-19 patients studied, 46 patients (15.7%) had a hospital-acquired clinically relevant BSI secondary to SARS-CoV-2 infection, accounting for 58 episodes (49 monomicrobial and 9 polymicrobial) in total. Twelve episodes (20.7%) occurred at day 3 of hospital admission. Sixty-nine species were isolated, including Staphylococcus aureus (32.8%), Enterobacterales (20.7%), Enterococcus faecalis (17.2%), Candida (13.8%) and Pseudomonas aeruginosa (10.3%). Of 69 isolates, 27 (39.1%) were multidrug-resistant organisms. Twelve (54.5%) of 22 patients for whom empirical antimicrobial therapy was inappropriate were infected by a multidrug-resistant organism. Of 46 patients, 26 (56.5%) survived and 20 (43.5%) died. Exploring variables for association with in-hospital mortality identified > 75-year age (HR 2.97, 95% CI 1.15–7.68, p = 0.02), septic shock (HR 6.55, 95% CI 2.36–18.23, p < 0.001) and BSI onset ≤ 3 days (HR 4.68, 95% CI 1.40–15.63, p = 0.01) as risk factors independently associated with death. In our hospital, mortality among COVID-19 patients with BSI was high. While continued vigilance against these infections is essential, identification of risk factors for mortality may help to reduce fatal outcomes in patients with COVID-19.

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#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.048 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S15-S16

Author(s):

Miguel A Minero ◽

Asia Castro ◽

Martha Avilés-Robles

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Febrile Neutropenia ◽

Pediatric Oncology ◽

Pediatric Patients ◽

Bloodstream Infections ◽

Oncology Patients ◽

Factors Associated ◽

Patients With Cancer ◽

The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

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MRSA contamination in ambulances: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckz186.500 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Fattorini ◽

C Quercioli ◽

G Messina ◽

N Nante

Keyword(s):

Systematic Review ◽

Medical Equipment ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

European Countries ◽

Hospital Environment ◽

Resistant Organism ◽

Healthcare Settings ◽

Search Terms ◽

Potential Reservoir

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism (MDRO) frequently involved in skin, soft tissue and bone infections. Moreover, it is one of the most frequently isolated pathogen in bloodstream infections in European countries. Because of its capacity to survive on inanimate surfaces, this microorganism could be detected not only on hospital environment, but also in other healthcare settings such as ambulances. We performed a systematic review in order to study the level of MRSA contamination in ambulances (vehicle surfaces and medical equipment). Methods In March 2019 we searched studies in PubMed using the key search terms “MRSA, ambulance”. We included different designs of studies in English. Results The research yielded 18 publications: after title, abstract and full text’s analysis, 9 manuscripts were included in this review. Studies were conducted from 2007 to 2018 in USA, Egypt, Poland, Germany and South Korea. Overall, the number of ambulances sampled for MRSA was 511 (min. 3-max. 150), and 64 (12.5%) resulted contaminated by MRSA. Sampling points examined for each vehicle varied from 5 to 33, for a total of 5872 (min. 39-max. 2136) samplings performed. The amount of MRSA positive samplings was 145/5872 (2.5%) (min. 1-max. 43). Stretcher resulted the most frequently contaminated fomite (29 of the 145 MRSA positive samplings, 20%). Conclusions Despite MRSA prevalence is decreasing in Europe, recent studies showed how this MDRO could still be responsible of a remarkable burden in terms of attributable deaths and costs. Implementing effective sanitation procedures with a continuative monitoring of the processes is highly recommended in all the healthcare settings, including ambulances. Automated terminal disinfection of these vehicles, adopting technologies such as ultraviolet germicidal irradiation or hydrogen peroxide aerosol, could reduce bacterial contamination hosted on surfaces and medical equipment. Key messages Although the percentage of isolates of MRSA in European countries is decreasing, the burden this multidrug resistant organism in terms of mortality and costs remains remarkable. Ambulances must be considered as a potential reservoir of MRSA because of its ability to survive on inanimate surfaces, and adequate sanitation procedures should be frequently performed.

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Risk Factors for Bloodstream Infections due to Multidrug-resistant Gram-negative Non-fermenting Bacteria in a Burn Unit

International Journal of Infectious Diseases ◽

10.1016/s1201-9712(08)60096-x ◽

2008 ◽

Vol 12 ◽

pp. S39-S40

Author(s):

Süheyla Senger ◽

Funda Timurkaynak ◽

Hande Arslan ◽

Turhan Togan ◽

Özgür Başaran ◽

...

Keyword(s):

Risk Factors ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Gram Negative ◽

Burn Unit ◽

Fermenting Bacteria

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Bloodstream infections caused by ST2 Acinetobacter baumannii : Risk factors, antibiotic regimens, and virulence over 6 years period in China

10.21203/rs.3.rs-60220/v3 ◽

2020 ◽

Author(s):

Kaihang Yu ◽

Weiliang Zeng ◽

Ye Xu ◽

Wenli Liao ◽

Wenya Xu ◽

...

Keyword(s):

Risk Factors ◽

Acinetobacter Baumannii ◽

Bloodstream Infection ◽

Bloodstream Infections ◽

Tertiary Hospital ◽

Multidrug Resistant ◽

High Serum ◽

Hospitalized Patients ◽

Effective Treatment Option ◽

Difficult Challenge

Abstract Background: Bloodstream infection (BSI) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) has been increasingly observed among hospitalized patients. The following study analyzed the epidemiology and microbiological characteristics of MDR-AB, as well as the clinical features, antimicrobial treatments, and outcomes in patients over a six years period in ChinaMethods: This retrospective study was conducted in a large tertiary hospital in China between January 2013 and December 2018. The clinical and microbiological data of all consecutive hospitalized patients with MDR-AB induced bloodstream infection were included and analyzed. Results: A total of 108 BSI episodes were analyzed. All MDR isolates belonged to ST2, a sequence type that has spread all over the world. Overall, ST2 strains showed strong biofilm formation ability, high serum resistance, and high pathogenicity. As for the clinical characteristics of the patient, 30-day mortality was 69.4% (75/108). The three main risk factors included mechanical ventilation, intensive care unit (ICU) stay, and thrombocytopenia; three protective factors included a change of antimicrobial regimen within 48 h after positive blood culture, use of the antibacterial agent combination, and more inpatient days. The most effective antibacterial regimen was the combination of cefoperazone/sulbactam and tigecycline.Conclusions: BSI caused by ST2 A.baumannii represents a difficult challenge for physicians, considering the high mortality associated with this infection. The combination of cefoperazone/sulbactam and tigecycline may be an effective treatment option.

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Risk Factors for Candidemia in Pediatric Oncology Patients.

Blood ◽

10.1182/blood.v114.22.4735.4735 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4735-4735 ◽

Cited By ~ 2

Author(s):

Theoklis E Zaoutis ◽

Priya A Prasad ◽

A. Russell Localio ◽

Anne Reilly ◽

Louis M Bell ◽

...

Keyword(s):

Risk Factors ◽

Pediatric Oncology ◽

Research Funding ◽

Incidence Density ◽

Candida Spp ◽

Oncology Patients ◽

Targeted Interventions ◽

Significant Difference ◽

Independent Risk Factors ◽

Oncology Unit

Abstract Abstract 4735 Background Candida species are among the most common causes of bloodstream infection and are associated with significant morbidity and mortality, particularly in oncology patients. Few studies have identified the risk factors for candidemia in pediatric oncology patients. Methods We conducted a nested case-control study within a cohort of pediatric patients admitted to the oncology unit at a children's hospital between 2001 and 2004. A case was defined as a patient with a positive blood culture for Candida spp. As time at risk is an important confounding variable in nosocomial studies assessing antibiotic risk factors, we selected two controls per case based on incidence-density sampling. Demographic and clinical data were collected by medical record review. Assessment of exposures was focused on the 2 weeks prior to the development of infection (case)/study entry (control). Conditional multivariate analyses were performed to determine independent risk factors for candidemia. Results We identified 45 oncology patients with candidemia during the study period. The most commonly isolated species were C. albicans (49%), C. parapsilosis (18%), C. glabrata (9%), and C. lusitaniae (9%). The median age of cases was 6.2 years (Interquartile Range (IQR): 2.9– 13.8 years). Median time to candidemia was 12 days (IQR: 4-22 days). There was no significant difference in mortality between cases (7%) and controls (7%). Independent risk factors for candidemia included receipt of aminoglycosides for >3 days (OR: 10.51, CI: 2.96, 64.43), receipt of total parenteral nutrition (OR: 13.82, CI: 2.48, 44.49), and Graft versus Host Disease (GVHD) (OR: 15.09, CI: 0.91, 250.24). Conclusion The receipt of aminoglycosides for >3 days, use of TPN, and GVHD were independently associated with candidemia in pediatric oncology patients. These results may inform targeted interventions to reduce the risk of candidemia in pediatric oncology patients. Disclosures: Zaoutis: Merck & Co.: Research Funding; Cephalon: Research Funding; Enzon: Research Funding.

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Candida parapsilosisBloodstream Infection in Pediatric Oncology Patients: Results of an Epidemiologic Investigation

Infection Control and Hospital Epidemiology ◽

10.1086/502454 ◽

2004 ◽

Vol 25 (8) ◽

pp. 641-645 ◽

Cited By ~ 24

Author(s):

Brunella Posteraro ◽

Stefania Bruno ◽

Stefania Boccia ◽

Antonio Ruggiero ◽

Maurizio Sanguinetti ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Pediatric Oncology ◽

Genetic Relatedness ◽

Bloodstream Infections ◽

Venous Catheter ◽

Staff Members ◽

First Case ◽

Catheter Tip ◽

Oncology Unit ◽

Gastrointestinal Colonization

AbstractObjective:To investigate an outbreak ofCandida parapsilosisbloodstream infections (BSIs) involving three patients admitted to a pediatric oncology unit between April and June 2002.Methods:After the third case was documented, cultures were performed of the hands of all medical and paramedical staff members in the pediatric oncology unit and of environmental surfaces in the rooms occupied by the three patients. Electrophoretic karyotyping with pulsed-field gel electrophoresis and arbitrarily primed polymerase chain reaction were used to assess the genetic relatedness amongC. parapsilosisisolates.Results:The three cases ofC. parapsilosisBSI were diagnosed based on blood cultures performed during a 38-day period. Evidence of priorC. parapsilosiscolonization of the gastrointestinal tract was present in only the first case. Each patient had an indwelling central venous catheter (CVC), which was promptly removed, and semiquantitative catheter tip cultures also revealedC. parapsilosis. None of the 30 environmental cultures performed was positive forC. parapsilosis, but the fungus was isolated from the hands of 6 of the 20 nurses tested. Both molecular typing methods revealed identical DNA fingerprinting patterns for all 13 patient isolates (7 from blood, 3 from CVC tips, and 3 from the gastrointestinal tract) and for 5 of the 6 recovered from the nurses' hands.Conclusions:These findings suggest the possibility of cross-infection with a singleC. parapsilosisstrain that was transmitted (probably during CVC dressing changes) by nurses whose hands were colonized with it. The role of previous gastrointestinal colonization in the first case cannot be excluded.

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Clinical Experience with Aminoglycosides in Dialysis-Dependent Patients: Risk Factors for Mortality and Reassessment of Current Dosing Practices

Annals of Pharmacotherapy ◽

10.1345/aph.1q403 ◽

2011 ◽

Vol 45 (11) ◽

pp. 1338-1345 ◽

Cited By ~ 7

Author(s):

Brett H Heintz ◽

George R Thompson ◽

William E Dager

Keyword(s):

Risk Factors ◽

Average Duration ◽

Bloodstream Infections ◽

Optimal Dose ◽

Empiric Therapy ◽

Multidrug Resistant ◽

Gram Negative ◽

Factors Associated ◽

Aminoglycoside Therapy ◽

Increased Risk

Background:: A resurgence of aminoglycoside use has followed the recent increase of multidrug-resistant gram-negative pathogens and is often needed even in the treatment of dialysis-dependent patients; however, studies evaluating the treatment of gram-negative infections with aminoglycosides, including the optimal dose, in the setting of dialysis are limited. Objective: To evaluate the current patterns of aminoglycoside use, including microbiologic and clinical indications, and identify risk factors associated with mortality in dialysis-dependent patients receiving aminoglycosides. Methods: Utilization, clinical, and microbiologic data were collected retrospectively over a 2-year period (July 2008-June 2010) for adults with a diagnosis of renal failure requiring dialysis and aminoglycoside therapy. Binary logistic and multivariate regression analyses were performed to identify risk factors for alt-cause 30-day mortality. Results: Ninety-five consecutive aminoglycoside courses in 88 patients met inclusion criteria for evaluation. A wide variety of clinical and microbiologic indications were documented. The average duration of aminoglycoside therapy was 5.2 days (range 1-42), the average duration of antimicrobial therapy was 13.5 days (1-60), and the all-cause 30-day mortality rate was 36.5%. Factors associated with all-cause 30-day mortality were gram-negative rod (GNR) bacteremia (OR 28.6; p = 0.035), advanced age (OR 8.5; p = 0.030), recent admission (OR 33.4; p = 0.038). and inadequate empiric therapy (OR 14.9; p = 0.024). Intravenous catheter removal was protective of all-cause 30-day mortality (OR 0.01; p = 0.005). A first pre-dialysis plasma concentration relative to the minimum inhibitory concentration (Cp:MIC) <6 mg/L (gentamicin/tobramycin) was associated with an increased risk of mortality (p = 0.026) upon subgroup analysis of dialysis-dependent patients with GNR bloodstream infections. Conclusions: Outcomes among dialysis-dependent patients who received aminoglycosides were below expectations. Various risk factors for mortality were identified, including retention of the catheter, inadequate empiric therapy, and a Cp:MIC <6 mg/L. Improved approaches to dosing of aminoglycosides in dialysis-dependent patients, including more aggressive dosing practices, should be urgently explored in attempts to maximize favorable patient outcomes.

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Bloodstream infections caused by ST2 Acinetobacter baumannii: Risk factors, antibiotic regimens, and virulence over 6 years period in China

10.21203/rs.3.rs-60220/v2 ◽

2020 ◽

Author(s):

Kaihang Yu ◽

Weiliang Zeng ◽

Ye Xu ◽

Wenli Liao ◽

Wenya Xu ◽

...

Keyword(s):

Risk Factors ◽

Acinetobacter Baumannii ◽

Bloodstream Infection ◽

Bloodstream Infections ◽

Tertiary Hospital ◽

Multidrug Resistant ◽

High Serum ◽

Hospitalized Patients ◽

Effective Treatment Option ◽

Difficult Challenge

Abstract Background: Bloodstream infection (BSI) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) has been increasingly observed among hospitalized patients. The following study analyzed the epidemiology and microbiological characteristics of MDR-AB, as well as the clinical features, antimicrobial treatments, and outcomes in patients over a six years period in ChinaMethods: This retrospective study was conducted in a large tertiary hospital in China between January 2013 and December 2018. The clinical and microbiological data of all consecutive hospitalized patients with MDR-AB induced bloodstream infection were included and analyzed.Results: A total of 108 BSI episodes were analyzed. All MDR isolates belonged to ST2. Overall, ST2 strains showed strong biofilm formation ability, high serum resistance, and high pathogenicity. As for the clinical characteristics of the patient, 30-day mortality was 69.4% (75/108). The three main risk factors included mechanical ventilation, intensive care unit (ICU) stay, and thrombocytopenia; three protective factors included a change of antimicrobial regimen within 48 h after bacteria isolation from blood, use of the antibacterial agent combination, and more inpatient days. The most effective antibacterial regimen was the combination of cefoperazone/sulbactam and tigecycline.Conclusions: BSI caused by ST2 A.baumannii represents a difficult challenge for physicians, considering the high mortality associated with this infection. The combination of cefoperazone/sulbactam and tigecycline may be an effective treatment option.

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Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11099 ◽

2019 ◽

Vol 13 (05) ◽

pp. 365-373 ◽

Cited By ~ 1

Author(s):

Haichen Wang ◽

Jianling Liu ◽

Ziyan Huang ◽

Xiaoyan Tao ◽

Jun Li ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Survival Group ◽

Hematological Disorders ◽

E Coli ◽

Hematological Patients ◽

Laboratory Results ◽

Wbc Count

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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