Gram-negative bloodstream infections and sepsis: risk factors, screening tools and surveillance

2019 ◽  
Vol 132 (1) ◽  
pp. 5-15
Author(s):  
Eleanor Mitchell ◽  
Mark S Pearce ◽  
Anthony Roberts
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Screening Tools ◽  
Topic Area ◽  
Gram Negative ◽  
Sepsis Risk ◽  
Comorbidity Scores ◽  
Associated Risk Factors ◽  
The Uk ◽  
Healthcare Associated

Abstract Introduction and background Incidence of gram-negative bloodstream infections (GNBSIs) and sepsis are rising in the UK. Healthcare-associated risk factors have been identified that increase the risk of infection and associated mortality. Current research is focused on identifying high-risk patients and improving the methods used for surveillance. Sources of data Comprehensive literature search of the topic area using PubMed (Medline). Government, professional and societal publications were also reviewed. Areas of agreement A range of healthcare-associated risk factors independently associate with the risk of GNBSIs and sepsis. Areas of controversy There are calls to move away from using simple comorbidity scores to predict the risk of sepsis-associated mortality, instead more advanced multimorbidity models should be considered. Growing points and areas for developing research Advanced risk models should be created and evaluated for their ability to predict sepsis-associated mortality. Investigations into the accuracy of NEWS2 to predict sepsis-associated mortality are required.

scholarly journals Characterization of Neonatal Infections by Gram-Negative Bacilli and Associated Risk Factors, Havana, Cuba

2021 ◽  
Vol 13 (1) ◽  
pp. 219-229
Author(s):  
Arlenis Oliva ◽  
Yenisel Carmona ◽  
Elizabeth de La C. López ◽  
Roberto Álvarez ◽  
Meiji Soe Aung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Late Onset ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Neonatal Infections ◽  
Cross Sectional ◽  
Prolonged Stay ◽  
Gram Negative ◽  
Associated Risk Factors ◽  
Resistance Rates

Infections represent an important problem in neonates because of the high mortality. An increase in neonatal infections has been found in Cuban hospitals in recent years. The aim of this study was to provide evidence on the clinical and microbiological behavior of Gram-negative bacilli that cause neonatal infections in hospitals of Havana, Cuba. It was carried out as a descriptive cross-sectional investigation from September 2017 to July 2018 in The Tropical Medicine Institute “Pedro Kouri” (IPK). Sixty-one Gram-negative bacilli isolated from neonates with infections in six Gyneco-Obstetric and Pediatric Hospitals of Havana were analyzed for their species and antimicrobial susceptibility. Late-onset infections were more common than early-onset ones and included urinary tract infection in the community (87%) and sepsis in hospitals (63.3%). Catheter use (47%) and prolonged stay (38%) were the most frequent risk factors. Species of major pathogens were Escherichia coli (47%) and Klebsiella spp. (26%). The isolated Gram-negative bacilli showed high resistance rates to third-generation cephalosporins, ciprofloxacin and gentamicin, while being more susceptible to carbapenems, fosfomycin, colistin and amikacin. The present study revealed the clinical impact of Gram-negative bacilli in neonatology units in hospitals of Havana. Evaluation of antimicrobial susceptibilities to the isolates from neonates is necessary for selection of appropriate empirical therapy and promotion of the rational antibiotic use.

Bloodstream Infections in Preterm Neonates and Mortality Associated Risk Factors

2021 ◽  
Author(s):  
Michelle Baczynski ◽  
Ashraf Kharrat ◽  
Faith Zhu ◽  
Xiang Y. Ye ◽  
Prakesh S. Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Preterm Neonates ◽  
Associated Risk Factors

Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

2021 ◽  
Author(s):  
Mariana Chumbita ◽  
Pedro Puerta-Alcalde ◽  
Carlota Gudiol ◽  
Nicole Garcia-Pouton ◽  
Júlia Laporte-Amargós ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Kidney Injury ◽  
Bloodstream Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Prospective Cohorts ◽  
Independent Risk Factors ◽  
The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

PEDIATRICS ◽  
2021 ◽  
Author(s):  
William J.H. Ford ◽  
David G. Bundy ◽  
Suzette Oyeku ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Secondary Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Type Number ◽  
Central Venous ◽  
Medical Centers ◽  
Associated Risk Factors

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients &lt;22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

Preventing healthcare-associated Gram-negative bloodstream infections

2018 ◽  
Vol 98 (3) ◽  
pp. 225-227 ◽  
Author(s):  
J. Gray ◽  
B. Oppenheim ◽  
N. Mahida
Keyword(s):  
Bloodstream Infections ◽  
Gram Negative ◽  
Healthcare Associated

scholarly journals Metastatic Spreading of Community AcquiredStaphylococcus aureusBacteraemia

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Giovanna Fabio ◽  
Maria Carrabba ◽  
Luca Mellace ◽  
Cinzia Hu ◽  
Diego Spagnoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Epidural Abscess ◽  
Tertiary Care ◽  
Skin Lesions ◽  
University Hospital ◽  
Serious Infection ◽  
History Of ◽  
Associated Risk Factors ◽  
Healthcare Associated ◽  
And Control

A 29-year-old woman presented to the Fondazione IRCCS “Cà Granda” Ospedale Maggiore, a tertiary care university hospital in Milan (Italy), with skin lesions, fever, myalgia, joint pain and swelling, and a one-week history of low back pain. The diagnosis wasStaphylococcus aureus(S. aureus) bacteraemia spreading to skin, bones, and joints and a lumbosacral epidural abscess L5-S2. Neither initial focus nor predisposing conditions were apparent. The antibiotic therapy was prolonged for six-weeks with the resolution of fever, skin lesions, articular inflammation, and the epidural abscess. Community-acquiredS. aureusinfections can affect patients without traditional healthcare-associated risk factors, and community acquisition is a risk-factor for the development of complications. Raised awareness ofS. aureusbacteraemia, also in patients without healthcare-associated risk factors, is important in the diagnosis, management, and control of this infection, because failure to recognise patients with serious infection and lack of understanding of empirical antimicrobial selection are associated with a high mortality rate in otherwise healthy people.

Sign in / Sign up

Export Citation Format

Share Document