scholarly journals Between Community and Hospital: Healthcare-Associated Gram-Negative Bacteremia among Hospitalized Patients

2009 ◽  
Vol 30 (11) ◽  
pp. 1050-1056 ◽  
Author(s):  
Jonas Marschall ◽  
Victoria J. Fraser ◽  
Joshua Doherty ◽  
David K. Warren
Keyword(s):  
Prospective Cohort ◽  
Tertiary Care ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Intravascular Catheter ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
Epidemiological Characteristics

Objective.Healthcare-associated, community-acquired bacteremia is a subcategory of community-acquired bacteremia distinguished by recent exposure of the patient to the healthcare system before hospital admission. Our objective was to apply this category to a prospective cohort of hospitalized patients with gram-negative bacteremia to determine differences in the epidemiological characteristics, treatment, and outcome of community-acquired bacteremia; healthcare-associated, community-acquired bacteremia; and hospital-acquired bacteremia.Design.A 6-month prospective cohort study.Setting.A 1,250-bed tertiary care hospital.Patients.Adults hospitalized with gram-negative bacteremia.Results.Among 250 patients, 160 (64.0%) had bacteremia within 48 hours after admission; 132 (82.5%) of these were considered to have healthcare-associated, community-acquired bacteremia, according to previously published criteria. For patients with healthcare-associated, community-acquired bacteremia, compared with patients with community-acquired bacteremia, malignancies (59 [44.7%] of 132 patients vs 3 [10.7%] of 28 patients; P = .001), open wounds at admission (42 [31.8%] vs 3 [10.7%]; P = .02), and intravascular catheter-related infections (26 [19.7%] vs 0; P = .009) were more frequent and Escherichia coli as a causative agent was less frequent (16 [57.1%] vs 33 [25.0%]; P = .001). There was no difference between these 2 groups in inadequate empirical antibiotic treatment (36 [27.3%] vs 6 [21.4%]; P = .5) and hospital mortality (18 [13.6%] vs 2 [[7.1%]; P = .5). Compared with 90 patients with hospital-acquired bacteremia, patients with healthcare-associated, community-acquired bacteremia had a higher Charlson score (odds ratio [OR], 1.31 [95% confidence interval (CI), 1.14–1.49]) but were less likely to have lymphoma (OR, 0.07 [95% CI, 0.01–0.51]), neutropenia (OR, 0.21 [95% CI, 0.07–0.61]), a removable foreign body (OR, 0.08 [95% CI, 0.03–0.20]), or Klebsiella pneumoniae infection (OR, 0.26 [95% CI, 0.11–0.62]).Conclusions.Many cases of gram-negative bacteremia that occurred in hospitalized patients were healthcare associated. The patients differed in some aspects from patients with community-acquired bacteremia and from those with hospital-acquired bacteremia, but not in mortality.

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

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

scholarly journals Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital

2010 ◽  
Vol 52 (3) ◽  
pp. 133-137 ◽  
Author(s):  
M. Beatriz Souza Dias ◽  
Juliana Yamashiro ◽  
Vera L. Borrasca ◽  
Valeska A. Stempliuk ◽  
Maria Rita E. Araújo ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Acute Onset ◽  
Hospitalized Patients ◽  
Diagnostic Methods ◽  
Care Hospital ◽  
Toxin A ◽  
Patient Admissions ◽  
Positive Stool ◽  
Hospital Acquired ◽  
Present On Admission

The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (³ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired.

scholarly journals Procalcitonin levels in patients with suspected sepsis

2021 ◽  
Vol 12 (11) ◽  
pp. 108-112
Author(s):  
Tribeni Goswami ◽  
Renu Mathew ◽  
Marina Thomas ◽  
Reena Anie Jose ◽  
Anjali Jacob ◽  
...  
Keyword(s):  
Early Recognition ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Care Hospital ◽  
Gram Positive ◽  
Suspected Sepsis ◽  
Gram Negative ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
Gram Negative Bacteremia

Background: Procalcitonin (PCT) was found to be a valuable and reliable biomarker for sepsis, especially in critical care patients for whom early recognition and prompt treatment could reduce mortality. Aims and Objectives: This study was aimed at correlating the levels of PCT as diagnostic marker for sepsis in relation to the culture positivity of various samples from blood, respiratory, urine, and exudates from patients admitted in a tertiary care hospital. Materials and Methods: Results of PCT level along with bacterial culture results of blood, respiratory, urine, and exudates were analyzed from 780 patients for a period of 1 year. Results: High PCT values ranging from 0.52 to 200 ng/ml were found in 331 patients admitted with suspected sepsis. Out of 135 cases of sepsis, 85 had blood culture positivity alone and 50 had culture positivity in blood and in other sites with the same organism. Among the 85 cases of bloodstream infections, in which no localized infections were identified, the median PCT was 33 for Gram-negative bacteremia, which was significantly higher as compared with a median of 16 for Gram-positive cocci. In UTI with bacteremia, the median PCT was 45.34 and in UTI without bacteremia, it was 5. Conclusion: From this study, we concluded that PCT values may be useful to distinguish Gram-negative and Gram-positive bacteremia, and furthermore, a high PCT value for patients with UTI may be helpful in predicting bacteremia.

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