Catheter-related bloodstream infections: predictive factors for Gram-negative bacteria aetiology and 30 day mortality in a multicentre prospective cohort

2020 ◽  
Vol 75 (10) ◽  
pp. 3056-3061
Author(s):  
Federica Calò ◽  
Pilar Retamar ◽  
Pedro María Martínez Pérez-Crespo ◽  
Joaquín Lanz-García ◽  
Adrian Sousa ◽  
...  
Keyword(s):  
Septic Shock ◽  
Protective Factors ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Empirical Treatment ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
National Cohort

Abstract Background Catheter-related bloodstream infections (CRBSIs) increase morbidity and mortality, prolong hospitalization and generate considerable medical costs. Recent guidelines for CRBSI recommend empirical therapy against Gram-positive bacteria (GPB) and restrict coverage for Gram-negative bacteria (GNB) only to specific circumstances. Objectives To investigate predictors of GNB aetiology in CRBSI and to assess the predictors of outcome in patients with CRBSI. Methods Patients with CRBSI were selected from the PROBAC cohort, a prospective, observational, multicentre national cohort study including patients with bloodstream infections consecutively admitted to 26 Spanish hospitals in a 6 month period (October 2016–March 2017). Outcome variables were GNB aetiology and 30 day mortality. Adjusted analyses were performed by logistic regression. Results Six hundred and thirty-one episodes of CRBSI were included in the study. Risk factors independently related to GNB aetiology were central venous catheter (CVC) [OR 1.60 (95% CI: 1.05–2.44), P = 0.028], sepsis/septic shock [OR: 1.76 (95% CI: 1.11–2.80), P = 0.016], antibiotic therapy in the previous 30 days [OR: 1.56 (95% CI: 1.02–2.36), P = 0.037], neutropenia <500/μL [OR: 2.01 (95% CI: 1.04–3.87), P = 0.037] and peripheral vascular disease [OR: 2.04 (95% CI: 1.13–3.68), P = 0.018]. GNB were not associated with increased mortality in adjusted analysis, while removal of catheter [OR: 0.24 (95% CI: 0.09–0.61), P = 0.002] and adequate empirical treatment [OR: 0.37 (95% CI: 0.18–0.77), P = 0.008] were strong protective factors. Conclusions Our study reinforces the recommendation that empirical coverage should cover GNB in patients presenting with sepsis/septic shock and in neutropenic patients. Catheter removal and adequate empirical treatment were both protective factors against mortality in patients with CRBSI.

The epidemiology of central venous catheter-related bloodstream infection in our renal units is changing

2021 ◽  
pp. 112972982199022
Author(s):  
Salvatore Mandolfo ◽  
Adriano Anesi ◽  
Vanina Rognoni
Keyword(s):  
Burkholderia Cepacia ◽  
Present Report ◽  
Statistical Significance ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Renal Unit ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Over Time

Recent reports have shown an increase in the rate of Gram-negative bacteremia in several settings, including catheter-related bloodstream infections (CRBSI). To analyze if the epidemiology of CRBSI is also changing in hemodialysis patients, we revisited the etiology of CRBSIs in our renal unit over 8 years. During the observed periods, 149 episodes of CRBSIs were reported and the CRBSI incidence rate, ranged between 0.67 and 0.82 episodes/1000 tCVC days. Of these 149 episodes, 84 (56.3%) were due to Gram-positive bacteria, 62 (41.6%) to Gram-negative bacteria, and 3 (2.1%) to polymicrobial flora, no episodes of fungi were found. There was a trend, but not statistically significative, increase over time in the number of Gram-negative CRBSIs among the total CRBSIs, rising from 37.8% in the first period to 41.2% in the second period and to 44.3% in the last period, with a parallel decrease in the percentage of Gram-positive CRBSIs (from 59.5% to 56.9% and subsequently to 54.1%). Between Gram-negative, we reported an intensification of CRBSI due to Enterobacterales, particularly Escherichia coli. Among the Gram-negative, we have isolated germs rarely reported in the literature, such as Burkholderia cepacia, Pantoea agglomerans, and Rhizobium radiobacter. Regarding Gram-positive bacteria, a triplicate incidence of Staphylococcus aureus was reported with MRSA accounting for 42% in the third period. Among the Gram-positive bacteria, we reported two episodes of Kocuria kristinae and two of Bacillus spp. Our data demonstrated that the epidemiology of CRBSI in the same center, will change over time and Gram-negative strains are an increasing cause of CRBSI. The limitation of the present report is that statistical significance has not been reached, probably due to the limited number of CRBSI. New bacteria, both Gram-negative and Gram-positive, are emerging. Collaboration with the Microbiology Department appears essential to an appropriate diagnosis.

scholarly journals Clinical pharmacokinetics of 3-h extended infusion of meropenem in adult patients with severe sepsis and septic shock: implications for empirical therapy against Gram-negative bacteria

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Amol T. Kothekar ◽  
Jigeeshu Vasishtha Divatia ◽  
Sheila Nainan Myatra ◽  
Anand Patil ◽  
Manjunath Nookala Krishnamurthy ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Modeling And Simulation ◽  
Empirical Therapy ◽  
Gram Negative Bacteria ◽  
Clinical Pharmacokinetics ◽  
Gram Negative ◽  
Arterial Blood ◽  
Days Of Therapy ◽  
Extended Infusion

Abstract Background Optimal anti-bacterial activity of meropenem requires maintenance of its plasma concentration (Cp) above the minimum inhibitory concentration (MIC) of the pathogen for at least 40% of the dosing interval (fT > MIC > 40). We aimed to determine whether a 3-h extended infusion (EI) of meropenem achieves fT > MIC > 40 on the first and third days of therapy in patients with severe sepsis or septic shock. We also simulated the performance of the EI with respect to other pharmacokinetic (PK) targets such as fT > 4 × MIC > 40, fT > MIC = 100, and fT > 4 × MIC = 100. Methods Arterial blood samples of 25 adults with severe sepsis or septic shock receiving meropenem 1000 mg as a 3-h EI eight hourly (Q8H) were obtained at various intervals during and after the first and seventh doses. Plasma meropenem concentrations were determined using a reverse-phase high-performance liquid chromatography assay, followed by modeling and simulation of PK data. European Committee on Antimicrobial Susceptibility Testing (EUCAST) definitions of MIC breakpoints for sensitive and resistant Gram-negative bacteria were used. Results A 3-h EI of meropenem 1000 mg Q8H achieved fT > 2 µg/mL > 40 on the first and third days, providing activity against sensitive strains of Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii. However, it failed to achieve fT > 4 µg/mL > 40 to provide activity against strains susceptible to increased exposure in 33.3 and 39.1% patients on the first and the third days, respectively. Modeling and simulation showed that a bolus dose of 500 mg followed by 3-h EI of meropenem 1500 mg Q8H will achieve this target. A bolus of 500 mg followed by an infusion of 2000 mg would be required to achieve fT > 8 µg > 40. Targets of fT > 4 µg/mL = 100 and fT > 8 µg/mL = 100 may be achievable in two-thirds of patients by increasing the frequency of dosing to six hourly (Q6H). Conclusions In patients with severe sepsis or septic shock, EI of 1000 mg of meropenem over 3 h administered Q8H is inadequate to provide activity (fT > 4 µg/mL > 40) against strains susceptible to increased exposure, which requires a bolus of 500 mg followed by EI of 1500 mg Q8H. While fT > 8 µg/mL > 40 require escalation of EI dose, fT > 4 µg/mL = 100 and fT > 8 µg/mL = 100 require escalation of both EI dose and frequency.

Prominent Prevalence of Coagulase-Negative Staphylococcus Bloodstream Infections in Neutropenic Hematology/Oncology Children with Central Venous Catheter

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4664-4664
Author(s):  
Young-Ho Lee ◽  
Yeon Jung Lim ◽  
Soon-young Song ◽  
Ji-hye Kim ◽  
Sung-hee Oh ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Retrospective Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Coagulase Negative Staphylococcus ◽  
Gram Negative Bacteria ◽  
Central Venous ◽  
Gram Negative ◽  
Susceptibility Tests ◽  
Febrile Episodes

Abstract A retrospective analysis was performed on febrile neutropenic episodes in children with hematologic and oncologic diseases from 2005 to 2008. We reviewed total 255 febrile episodes occurred during the 3-year period in a total of 114 patients. Twenty-eight episodes of bacteremia occurred during neutropenic period in a total of 16 patients. All these patients had central venous catheter. There were 18 febrile episodes of Grampositive bacteria (64.3%), 9 episodes of Gram-negative bacteria (32.1%), and 1 episode of Candida (3.6%). The isolated organisms were as follows: Coagulase-negative Staphylococcus (CNS, N=17, 60.7%), Staphylococcus aureus (N=1, 3.6%), Enterobacter spp. (N=2, 7.1%), Pseudomonas spp. (N=2, 7.1%), Klebsiella (N=2, 7.1%), E. coli (N=2, 7.1%), Acinetobacter (N=1, 3.6%), Candida. (N=1, 3.6%). The bloodstream infection with CNS were more prevalent in children with Chemo-port (12 episodes in 6 from 34 patients, 17.6%) than in children with Hickman catheter (5 episodes in 5 from 22 patents, 22.7%), even though statistically not significant. In antibiotic susceptibility tests, all gram positive bacteria were resistant to penicillin and oxacillin, and sensitive to vancomycin and teicoplanin. In the case of Gram-negative bacteria, resistant rates to amikacin, gentamicin, imipenem, and piperacillin/tazobactam were 4.8%, 38.1%, 14.3%, and 42.9%, respectively. Based on this retrospective analysis, which reflects predominance of CNS bacteremia in febrile neutropenic patients, more emphasis needs to be laid on the empirical antibiotic regimen including vancomycin or teicoplanin as well as the strict skin preparations during procedures in children with central venous catheter.

scholarly journals Ludwig’s Angina: Clinical Profile and Microbiology with Antibiotic Resistance and Sensitivity at Referral Hospital

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Muhamad Saifuddin ◽  
Sahudi Sahudi
Keyword(s):  
Antibiotic Resistance ◽  
Empirical Therapy ◽  
Odontogenic Infection ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Management Protocol ◽  
Common Etiology ◽  
Considerable Resistance ◽  
Staphylococcus Spp

Objective: To assess the distribution of sex and age, comorbidity factors, etiology, management protocol, isolated organisms, antibiotic resistance and sensitivity. Material and Methods: Retrospective observational study based on medical records in 2007 – 2016 and microbiological examination data from 2012 – 2016. Results: The proportion of males was greater than females 1.8 (71): 1 (29). Mean age 41 ±SD 16.99. The most comorbidity diagnoses were type 2 diabetes mellitus (DM) 24.5% (27) and the most complications were sepsis 21.8% (24). The most common etiology was odontogenic infection 92%. Patients underwent drainage incisions and were treated with empiric ceftriaxone and metronidazole for an average of 7 days of treatment. Outcomes recovery were 93.7% (102) and were death 5.4% (6). The three most common types of bacteria as the etiology were Enterobacter spp. 32% (9), Streptococcus spp. 25% (7), Staphylococcus spp. 18% (5). Ceftriaxone showed considerable resistance to gram-negative bacteria as well as to gram-positive bacteria (Streptococcus spp.). Conclusion: The ratio of male to female was 1.8:1 and odontogenic infection was 92%. DM increases the risk of complications of sepsis and prolongs the day of care. A drainage incision should be performed immediately. Gram negative bacteria were the most common bacteria found. The efficacy of using ceftriaxone as empirical therapy needs to be reviewed.

scholarly journals The diagnostic ability of procalcitonin to differentiate Gram-negative bacteria from Gram-positive bacteria and fungal bloodstream infections in critically ill patients

2019 ◽  
Vol 17 ◽  
pp. 205873921984146
Author(s):  
Di Wang ◽  
Xiaogen Tao ◽  
Wei Guo ◽  
Haihua Liu ◽  
Shaohui Cheng ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Operating Characteristic ◽  
Bloodstream Infections ◽  
Gram Negative Bacteria ◽  
Diagnostic Ability ◽  
Gram Positive ◽  
Gram Negative ◽  
Receiver Operating Characteristic Curves ◽  
Gram Positive Bacteria

Bloodstream infection (BSI) is a severe infectious complication in critically ill patients. This study was aimed to investigate the diagnostic accuracy of procalcitonin (PCT) to differentiate Gram-negative bacteria (Gram-neg) from Gram-positive bacteria (Gram-pos) and fungal BSI. PCT and other inflammation markers of monomicrobial BSI patients were retrospectively collected and compared between patients with Gram-neg, Gram-pos, or fungal BSI. The differential diagnosis performance of PCT was evaluated by receiver operating characteristic curves (ROC). The area under curve (AUC) of PCT for differentiating Gram-neg BSI from Gram-pos BSI was 0.95 with an optimal cut-off value of 4.15 ng/mL, a sensitivity of 82.05%, and a specificity of 96.15%. AUC of PCT for differentiating Gram-neg BSI from fungal BSI was 0.92 with an optimal cut-off value of 3.13 ng/mL, a sensitivity of 84.62%, and a specificity of 88.89%. Serum PCT concentration can be used to differentiate Gram-neg from Gram-pos and fungal BSI.

Rapid demonstration of septic or infectious arthritis due to Gram-negative bacteria

1992 ◽  
Vol 50 (1) ◽  
pp. 686-687
Author(s):  
Jacob S. Hanker ◽  
Paul R. Gross ◽  
Beverly L. Giammara
Keyword(s):  
Chronic Arthritis ◽  
Blood Cultures ◽  
Gram Negative Bacteria ◽  
Infectious Arthritis ◽  
Bacterial Arthritis ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria

Blood cultures are positive in approximately only 50 per cent of the patients with nongonococcal bacterial infectious arthritis and about 20 per cent of those with gonococcal arthritis. But the concept that gram-negative bacteria could be involved even in chronic arthritis is well-supported. Gram stains are more definitive in staphylococcal arthritis caused by gram-positive bacteria than in bacterial arthritis due to gram-negative bacteria. In the latter situation where gram-negative bacilli are the problem, Gram stains are helpful for 50% of the patients; they are only helpful for 25% of the patients, however, where gram-negative gonococci are the problem. In arthritis due to gram-positive Staphylococci. Gramstained smears are positive for 75% of the patients.

Antibacterial activity of magnesium oxide nanoparticles prepared by Calcination method

2019 ◽  
Vol 10 (03) ◽  
Author(s):  
Elaf Ayad Kadhem ◽  
Miaad Hamzah Zghair ◽  
Sarah , Hussam H. Tizkam, Shoeb Alahmad Salih Mahdi ◽  
Hussam H. Tizkam ◽  
Shoeb Alahmad
Keyword(s):  
Antibacterial Activity ◽  
Magnesium Oxide ◽  
Diffusion Method ◽  
Oxide Nanoparticles ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Magnesium Oxide Nanoparticles ◽  
Agar Disc

magnesium oxide nanoparticles (MgO NPs) were prepared by simple wet chemical method using different calcination temperatures. The prepared NPs were characterized by Electrostatic Discharge (ESD), Scanning Electron Microscope (SEM) and X-ray Diffraction (XRD). It demonstrates sharp intensive peak with the increase of crystallinty and increase of the size with varying morphologies with respect to increase of calcination temperature. Antibacterial studies were done on gram negative bacteria (E.coli) and gram positive bacteria (S.aureus) by agar disc diffusion method. The zones of inhibitions were found larger for gram positive bacteria than gram negative bacteria, this mean, antibacterial MgO NPs activity more active on gram positive bacteria than gram negative bacteria because of the structural differences. It was found that antibacterial activity of MgO NPs was found it has directly proportional with their concentration.

BAKTERI PADA KARANG SCLERACTINIA DI KAWASAN PERAIRAN BUNAKEN, MOROTAI DAN RAJA AMPAT

2020 ◽  
Vol 8 (1) ◽  
pp. 122
Author(s):  
Eghbert Eghbert Elvan Eghbert Elvan Ampou ◽  
Iis Iis Triyulianti ◽  
Nuryani Widagti ◽  
Suciadi Catur Nugroho ◽  
Yuli Pancawati
Keyword(s):  
Scleractinian Coral ◽  
Gram Negative Bacteria ◽  
Hard Coral ◽  
Field Sampling ◽  
Bacterial Isolation ◽  
Gram Positive ◽  
Coral Mucus ◽  
Gram Negative ◽  
Gram Positive Bacteria

Research on hard coral (Scleractinian coral) contaminated with bacteria is still not much done, especially in Indonesian waters. This study took samples of coral mucus in 2010 at 3 (three) different locations, namely Bunaken (May); Morotai (September) and Raja Ampat (November), which focused on the analysis of Research on hard coral (Scleractinian coral) contaminated with bacteria is still not much done, especially in Indonesian waters. This study took samples of coral mucus in 2010 at 3 (three) different locations, namely Bunaken (May); Morotai (September) and Raja Ampat (November), which focused on the analysis of gram-positive and gram-negative bacteria. The method used for field sampling is time swim, which is by diving at a depth of 5-10 meters for ± 30 minutes and randomly taking samples of coral mucus using siring or by taking directly on corals (reef branching). Mucus samples were analyzed by bacterial isolation in the laboratory. The result shows that there were differences between gram-positive and gram-negative bacteria in the three research sites and that gram-positive bacteria were higher or dominant. Further research that can identify the bacteria species and explain its relationship to the ecosystem is highly recommended.Keywords: Bacteria, Scleractinian coral, gram-positive and -negative, Bunaken, Morotai, Raja Ampat  AbstrakPenelitian tentang karang keras (Scleractinian coral) yang terkontaminasi bakteri masih belum banyak dilakukan, terutama di perairan Indonesia. Penelitian ini mengambil sampel mucus karang pada tahun 2010 di 3 (tiga) lokasi berbeda, yakni Bunaken (Mei); Morotai (September) dan Raja Ampat (November), yang difokuskan pada analisis bakteri gram postif dan gram negatif. Metode yang digunakan untuk pengambilan sampel di lapangan adalah time swim, yaitu dengan penyelaman pada kedalaman 5-10 meter selama ±30 menit dan mengambil sampel mucus karang secara acak menggunakan siring atau dengan mengambil langsung pada karang (fraksi cabang). Sampel mucus dianalisis dengan cara isolasi bakteri di laboratorium. Hasil analisis menunjukkan bahwa ada perbedaan antara bakteri gram positif dan gram negative di tiga lokasi survei dan bakteri gram positif lebih tinggi atau dominan. Penelitian lebih lanjut yang dapat menentukan jenis bakteri serta menjelaskan hubungannya dengan ekosistem sangat disarankan untuk dilakukan.Kata Kunci : Bakteri, Scleractinian coral, gram positif dan negatif, Bunaken, Morotai, Raja Ampat

scholarly journals N-Doped Carbon Quantum Dots as Fluorescent Bioimaging Agents

Crystals ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 789
Author(s):  
Shih-Fu Ou ◽  
Ya-Yun Zheng ◽  
Sin-Jen Lee ◽  
Shyi-Tien Chen ◽  
Chien-Hui Wu ◽  
...  
Keyword(s):  
Quantum Dots ◽  
Carbon Nanomaterials ◽  
Graphene Quantum Dots ◽  
Carbon Quantum Dots ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Fluorescence Characteristics ◽  
And Staphylococcus Aureus

Graphene quantum dots, carbon nanomaterials with excellent fluorescence characteristics, are advantageous for use in biological systems owing to their small size, non-toxicity, and biocompatibility. We used the hydrothermal method to prepare functional N-doped carbon quantum dots (N-CQDs) from 1,3,6-trinitropyrene and analyzed their ability to fluorescently stain various bacteria. Our results showed that N-CQDs stain the cell septa and membrane of the Gram-negative bacteria Escherichia coli, Salmonellaenteritidis, and Vibrio parahaemolyticus and the Gram-positive bacteria Bacillus subtilis, Listeria monocytogenes, and Staphylococcus aureus. The optimal concentration of N-CQDs was approximately 500 ppm for Gram-negative bacteria and 1000 ppm for Gram-positive bacteria, and the exposure times varied with bacteria. N-Doped carbon quantum dots have better light stability and higher photobleaching resistance than the commercially available FM4-64. When excited at two different wavelengths, N-CQDs can emit light of both red and green wavelengths, making them ideal for bioimaging. They can also specifically stain Gram-positive and Gram-negative bacterial cell membranes. We developed an inexpensive, relatively easy, and bio-friendly method to synthesize an N-CQD composite. Additionally, they can serve as a universal bacterial membrane-staining dye, with better photobleaching resistance than commercial dyes.

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