#10: Fever and neutropenia. 10 years surveillance in a pediatric Mexican hospital

Abstract Background Fever and neutropenia, is a very common complication of chemotherapy in the treatment of cancer. It could happen in 10–50% of patients with solid tumors and more than 80% of patients with blood cancer. During leukemia treatment is very important first defense mechanisms integrity, such as skin, mucous membranes, Tlaxcala Children’s Hospital is a pediatric general hospital, located in the center of Mexico and is where the pediatric cancer patients are treated, with almost 30 new cases by year, treatment with chemotherapy and as an adverse event fever and neutropenia, which increases morbidity and mortality Methods We conducted an observational, descriptive, and analytic study aiming to identify fever and neutropenic events in ALL patients, their epidemiologic characteristics, antibiotic use, isolation and antibiogram, and outcome. Results We reviewed 124 files from ALL patients between 2007–2017, we found 204 cases, 70 (33.8%) at induction, 18.6% consolidation, reinduction 17.6%, maintenance 14.2%. Out of 204 cases, we documented 177 with fever and neutropenia, 15 events of septic shock and 12 with fever and neutropenia with an identifiable source; the first-line antibiotic for fever and neutropenia was ceftazidime/amikacin, and for septic shock cefepime with an aminoglycoside, we found 3.39%, 20%, and 0% deaths from each group. Patients with fever and neutropenia with or without identifiable source had a length-stay average of 9.8 days compared with 30 days in patients with septic shock, CRP average was 12.47 mg/dL in the patients who survived and 8.23 mg/dL in those who did not. We found a very low positivity in cultures, and in most cases, those cultures did not meet criteria for diagnosis, the most common bacteria identified were E. coli, P. aeruginosa. Conclusions This is the first approach to get a better knowledge about infectious complications in patients with ALL, these findings could lead to identifying opportunities to improve diagnosis and treatment which lead to reducing cost, morbidity, healthcare-associated infections.

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Generation of Antibiotic Tolerant Bacterial Persisters in Immunocompromized Patients with Hematologic and Malignant Diseases: A New Problem of Health-Care Associated Infections

Annals of the Russian academy of medical sciences ◽

10.15690/vramn687 ◽

2016 ◽

Vol 71 (3) ◽

Author(s):

A. V. Tutelyan ◽

V. M. Pisarev ◽

N. Z. Minaeva ◽

A. M. Gaponov ◽

A. N. Gracheva ◽

...

Keyword(s):

Health Care ◽

Antibiotic Use ◽

Hematologic Malignancies ◽

Infectious Complications ◽

Opportunistic Pathogens ◽

Chronic Infections ◽

E Coli ◽

Health Care Associated Infections ◽

Sick Children ◽

Health Care Associated Infection

Background: Antibiotic tolerance (AT) represents one of the causes of the phenomenon of antibiotic resistance that allows escape of non-replicating metabolically inert microorganisms (persisters) from any antibiotics attack because molecular targets of antibiotics are lacking thereby creating the potential for chronic infections. Aims:Determine the heterogeneity of the strains of opportunistic pathogens E. coli and P. aeruginosa isolates from children with hematologic malignancies containing bacterial persisters that cause the AT phenomenon. Methods: Children with hematological malignancies were divided into 2 groups according to the intensity of antibiotic treatment of infectious complications. Ciprofloxacin-induced persisters were quantitatively determined in the biological materials obtained from sick children. Results: Within the clinical isolates of E. coli and P. aeruginosa, about a third of the strains belong to high-persisting. The numbers of persistent forms of bacteria did not correlate with a minimal inhibitory concentration values ciprofloxacin (r=0.148, n=25, p0.05). Interestingly, higher level of formation of persistent E. coli and P. aeruginosa, is associated with higher frequencies of infection attacks, massive antibiotic use and unfavorable course of the disease in children. Conclusions: Therefore, detecting the persistent forms of bacterial pathogens including those associated with the health-care associated infection, specifically, in immunocompromised patients, should be included into the contemporary algorithms of microbiological observation and monitoring of patients and intrahospital environment.

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1675. Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1853 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S823-S823

Author(s):

Kendra Foster ◽

Linnea A Polgreen ◽

Brett Faine ◽

Philip M Polgreen

Keyword(s):

United States ◽

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Urinary Tract Infections ◽

Proteus Mirabilis ◽

Antibiotic Use ◽

The United States ◽

Drug Resistant ◽

E Coli ◽

Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting. Methods We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization. Results There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively. Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common. Disclosures All Authors: No reported disclosures

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Appropriateness of antibiotics for medical prophylaxis: evaluation of data from the Italian PPS-2

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.698 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Cremona ◽

J Garlasco ◽

I Gintoli ◽

A D'Ambrosio ◽

F Quattrocolo ◽

...

Keyword(s):

Empirical Therapy ◽

Infectious Complications ◽

High Rate ◽

National Guidelines ◽

Prevalence Survey ◽

Inappropriate Use ◽

Healthcare Associated ◽

Evaluation Of Data ◽

The Eu ◽

Made In

Abstract Background Antibiotics (AB) are administered for medical prophylaxis (MP) to prevent infectious complications. The second national point prevalence survey (PPS) of healthcare-associated infections and AB use was conducted in Italy in 2016-2017. The survey found MP accounted for nearly 25% of all registered ABs, more than twice the EU/EEA proportion. The aim of this study was to evaluate how many ABs were administered for MP and how frequently general indications were followed. Methods Data from the PPS were used to evaluate the prevalence of indications for MP over the total number of ABs, the proportion - among these indications - of those justified by a motivation in the patients' charts, and the prevalence of ABs considered appropriate for MP. The evaluation was made in 12 hospitals out of 14 participating in the PPS in Piedmont, chosen on the basis of patient traceability. According to national guidelines, the indications for MP that were considered appropriate in this study were: Trimethoprim/sulfamethoxazole for P. carinii pneumonia, Rifaximin for diverticulitis, Penicillin for Streptococcal infections and for splenectomized patients, and Rifampin for TB infections. Results 1844 AB prescriptions were registered among 1334 traceable inpatients in Piedmont. The prevalence of indications for MP was 16.2% and 253 ABs (84.6%) were prescribed with a motivation. Only 3% of ABs registered as MP were appropriate for this indication: Bactrim 2%, Rifaximin 0.3%, Penicillin 0.2% and Rifampin 0.4%. Conclusions This study found an extremely high rate of inappropriate ABs for MP, that will be further investigated through qualitative analysis of medical records to evaluate whether a misunderstanding of the PPS protocol occurred and empirical therapy was confused with MP. Nevertheless, this study highlighted the need for interventions to improve prescribing appropriateness for MP. Key messages This study found that only 2.98% of ABs registered as MP among traceable patients in Piedmont were appropriate for this indication. 15.38% of prescriptions for MP were not justified by a motivation. Interventions to improve prescribing appropriateness for MP could lead to a considerable reduction in inappropriate use of ABs, which is crucial in a country facing hyperendemic levels of AMR.

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237 Stable Performance with Reduced Antibiotic Use in Piglets Vaccinated with an E. coli F4/F18 Vaccine for the Prevention of F18-ETEC Post-weaning Diarrhea

Journal of Animal Science ◽

10.1093/jas/skab054.235 ◽

2021 ◽

Vol 99 (Supplement_1) ◽

pp. 139-140

Author(s):

Frédéric A Vangroenweghe

Keyword(s):

Antibiotic Use ◽

Watery Diarrhea ◽

Economic Losses ◽

Standard Group ◽

Performance Parameters ◽

Oral Vaccination ◽

E Coli ◽

Technical Performance ◽

Stable Performance ◽

The Impact

Abstract Post-weaning Escherichia coli diarrhea (PWD) remains a major cause of economic losses for the pig industry. PWD, caused by enterotoxigenic E. coli (ETEC), typically provokes mild to severe watery diarrhea between 5–10 days after weaning. Recently, an oral live bivalent E. coli F4/F18 vaccine (Coliprotec® F4/F18; Elanco) was approved on the European market, which reduces the impact of PWD provoked by F4-ETEC and F18-ETEC. The objective was to compare technical results and antibiotic use following E. coli F4/F18 vaccination with previous standard therapeutic approach under field conditions. A 1600-sow farm (weaning at 26 days) with diagnosed problems of PWD due to F18-ETEC was selected. Piglets were vaccinated at 21 days with the oral live bivalent E. coli F4/F18 vaccine. At weaning, no standard group medication (ZnO and antibiotics) was applied for prevention of PWD. Several performance parameters were collected: treatment incidence (TI100), mortality and days in nursery. Statistical analysis was performed using JMP 14.0 – comparison of means. Oral E. coli F4/F18 vaccination significantly reduced TI100 (7 ± 2 days to 0 ± 1 days; P < 0.05). Mortality rate remained stable (2.05% in Control to 1.96% in Vaccinated group; P < 0.05). Days in nursery (40 ± 3 days) remained at the same level compared to pre-vaccination. The results show that live E. coli F4/F18 vaccination against PWD has led to similar technical performance parameters and mortality, in combination with a significant reduction in medication use. In conclusion, control of PWD through oral vaccination is a successful option in order to prevent piglets from the negative clinical outcomes of F18-ETEC infection during the post-weaning period.

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#37: Clinical Characterization of the Cases Relating to the Outbreak of Clostridioides difficile, in a Third-level Hospital in Mexico City: Diagnosis, Treatment, and Relay

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.050 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S16-S16

Author(s):

Ortiz Samuel ◽

Martínez María Elena ◽

Morayta Ramírez A

Keyword(s):

Antibiotic Use ◽

Clinical Findings ◽

Prevention Measures ◽

Clostridioides Difficile ◽

Young Infants ◽

Plastic Bags ◽

History Of ◽

Initial Episode ◽

Group Sex ◽

Healthcare Associated

Abstract Background Clostridioides difficile is an important cause of healthcare-associated infections. The epidemiology of C. difficile infection (CDI) in children has changed over the past few decades. There is now a higher incidence in hospitalized children, and there has been an emergence of community-onset infection. Neonates and young infants have high rates of colonization but rarely have symptoms. The well-known risk factor for CDI in children age 2 years or older is antibiotic use. Inflammatory bowel disease and cancer are associated with increased incidence and severity of CDI. Vancomycin or fidaxomicin is recommended for an initial episode of CDI. In environments where access to Vancomycin or Fidaxomycin is limited, it is suggested to use metronidazole for an initial episode of nonsevere CDI only. Methods A series of cases were carried out, in a study period from March to May 2018, total cases 8; the age group, sex, basic diagnosis, clinical findings, diagnostic method, and outcome in hospitalized patients in the Pediatric division of the “CMN 20 de Noviembre, ISSSTE” were described, where there is a total of 377 Sensitive beds, and 53 beds in the pediatric area of which 30 are not sensitive. Results We analyzed 8 cases of diarrhea with identification of C. difficile, in a period of 3 months, where there was a total of 148 admissions to the division of Pediatrics (100%) and presented a prevalence of 0.05% of the total income. Of those 8 cases reported, 37.5% were women and 62.5% men; The age fluctuated between 6 months and 18 years. All children had associated comorbidities. The frequency and type of comorbidities were Cancer 87.5% (Leukemias and Solid Tumors) and Neurological 12.5% (Arterial Malformation and Neurological Sequelae). The main symptom that occurred was mucous diarrhea in 100% of patients, abdominal pain in 25% and evacuation with blood in 12.5% of cases. All had a history of prior treatment with 100% broad-spectrum antibiotics, in a period of less than one month. All were treated with metronidazole (100%) and all presented clinical improvement, without complications; Similarly, all were diagnosed by PCR for toxin B (100%). The attributable risk of presenting Clostridioides disease in patients with Leukemia is 0.11. Conclusions Patients with Leukemia were the most affected during the C. difficile outbreak, of which 11 out of 100 of these patients are at risk of presenting C. difficile disease. The most important thing in these cases is prevention. Therefore, specific prevention measures were implemented to reduce the possibility of future outbreaks, such as handwashing with chlorexidine, contact isolation, handwashing every time there is contact with the patient, use of gloves when performing procedures, insulation of bedding in plastic bags and training of health personnel.

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Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland

Journal of Hospital Infection ◽

10.1016/j.jhin.2021.08.018 ◽

2021 ◽

Author(s):

D. Héquet ◽

S. Kessler ◽

G. Rettenmund ◽

E. Lemmenmeier ◽

L. Qalla-Widmer ◽

...

Keyword(s):

Long Term Care ◽

Antibiotic Use ◽

Healthcare Associated Infections ◽

Term Care ◽

Geographical Regions ◽

Healthcare Associated

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Role of UropathogenicEscherichia coliVirulence Factors in Development of Urinary Tract Infection and Kidney Damage

International Journal of Nephrology ◽

10.1155/2012/681473 ◽

2012 ◽

Vol 2012 ◽

pp. 1-15 ◽

Cited By ~ 114

Author(s):

Justyna Bien ◽

Olga Sokolova ◽

Przemyslaw Bozko

Keyword(s):

Urinary Tract ◽

Signaling Pathways ◽

Virulence Factors ◽

Host Response ◽

Defense Mechanisms ◽

Inflammatory Responses ◽

Infectious Complications ◽

Mucosal Barrier ◽

Urological Complications ◽

Tract Infections

UropathogenicEscherichia coli(UPEC) is a causative agent in the vast majority of urinary tract infections (UTIs), including cystitis and pyelonephritis, and infectious complications, which may result in acute renal failure in healthy individuals as well as in renal transplant patients. UPEC expresses a multitude of virulence factors to break the inertia of the mucosal barrier. In response to the breach by UPEC into the normally sterile urinary tract, host inflammatory responses are triggered leading to cytokine production, neutrophil influx, and the exfoliation of infected bladder epithelial cells. Several signaling pathways activated during UPEC infection, including the pathways known to activate the innate immune response, interact with calcium-dependent signaling pathways. Some UPEC isolates, however, might possess strategies to delay or suppress the activation of components of the innate host response in the urinary tract. Studies published in the recent past provide new information regarding how virulence factors of uropathogenicE. coliare involved in activation of the innate host response. Despite numerous host defense mechanisms, UPEC can persist within the urinary tract and may serve as a reservoir for recurrent infections and serious complications. Presentation of the molecular details of these events is essential for development of successful strategies for prevention of human UTIs and urological complications associated with UTIs.

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Interaction of Antimicrobial Peptide Temporin L with Lipopolysaccharide In Vitro and in Experimental Rat Models of Septic Shock Caused by Gram-Negative Bacteria

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01553-05 ◽

2006 ◽

Vol 50 (7) ◽

pp. 2478-2486 ◽

Cited By ~ 47

Author(s):

Andrea Giacometti ◽

Oscar Cirioni ◽

Roberto Ghiselli ◽

Federico Mocchegiani ◽

Fiorenza Orlando ◽

...

Keyword(s):

Septic Shock ◽

Antimicrobial Peptide ◽

Gram Negative Bacteria ◽

Amphibian Skin ◽

Necrosis Factor Alpha ◽

Gram Negative ◽

Rat Models ◽

E Coli ◽

Tnf Α

ABSTRACT Sepsis remains a major cause of morbidity and mortality in hospitalized patients, despite intense efforts to improve survival. The primary lead for septic shock results from activation of host effector cells by endotoxin, the lipopolysaccharide (LPS) associated with cell membranes of gram-negative bacteria. For these reasons, the quest for compounds with antiendotoxin properties is actively pursued. We investigated the efficacy of the amphibian skin antimicrobial peptide temporin L in binding Escherichia coli LPS in vitro and counteracting its effects in vivo. Temporin L strongly bound to purified E. coli LPS and lipid A in vitro, as proven by fluorescent displacement assay, and readily penetrated into E. coli LPS monolayers. Furthermore, the killing activity of temporin L against E. coli was progressively inhibited by increasing concentrations of LPS added to the medium, further confirming the peptide's affinity for endotoxin. Antimicrobial assays showed that temporin L interacted synergistically with the clinically used β-lactam antibiotics piperacillin and imipenem. Therefore, we characterized the activity of temporin L when combined with imipenem and piperacillin in the prevention of lethality in two rat models of septic shock, measuring bacterial growth in blood and intra-abdominal fluid, endotoxin and tumor necrosis factor alpha (TNF-α) concentrations in plasma, and lethality. With respect to controls and single-drug treatments, the simultaneous administration of temporin L and β-lactams produced the highest antimicrobial activities and the strongest reduction in plasma endotoxin and TNF-α levels, resulting in the highest survival rates.

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DIAGNOSTIC LUNG PUNCTURE IN THE PNEUMONIAS OF INFANTS AND CHILDREN

PEDIATRICS ◽

10.1542/peds.44.4.486 ◽

1969 ◽

Vol 44 (4) ◽

pp. 486-492

Author(s):

Jerome O. Klein

Keyword(s):

Defense Mechanisms ◽

Underlying Disease ◽

Etiologic Agent ◽

Upper Respiratory Tract ◽

E Coli ◽

Pure Cultures ◽

Lung Puncture ◽

Lower Respiratory Disease ◽

And Staphylococcus Aureus ◽

Etiologic Diagnosis

Lung punctures were performed on 32 occasions in 28 infants with pneumonia to assist in specific bacteriologic diagnosis. The aspirates yielded pure cultures of Diplococcus pneumoniae and Staphylococcus aureus each in four patients and E. coli in two patients. The procedure is performed as for a thoracentesis and requires no special instruments. Three children had pneumothoraces and one had a small hemoptysis following the procedure, but only one child exhibited even minimal respiratory distress as a result of the tap. The literature on lung aspirates was reviewed with respect to the value and potential liability of the procedure. At present, diagnostic lung punctures should be considered in three groups of children with lower respiratory disease: (1) the critically ill child in whom a specific etiologic diagnosis is of major importance to guide antimicrobial therapy, (2) the child who has deteriorated while on therapy and in whom an etiologic agent is not available from the usual upper respiratory tract cultures, and (3) the child with pneumonia complicated by underlying disease or drugs limiting normal host defense mechanisms. In these three instances, the advantages of a specific etiologic diagnosis outweighs the small risk from the lung puncture.

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