scholarly journals 53. Incidence of Bloodstream Infections and Outcomes in Patients with Severe COVID-19 Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S156-S157
Author(s):  
Aikaterini Papamanoli ◽  
Jeanwoo Yoo ◽  
Azad Mojahedi ◽  
Robin Jacob ◽  
Prabhjot Grewal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Medical Records ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Blood Cultures ◽  
High Flow ◽  
University Hospital ◽  
Skin Microbiota ◽  
Prolonged Recovery ◽  
The Impact

Abstract Background Coronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies. Methods We reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-flow O2). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia. Results A total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8–6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P< 0.001) per additional day. Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469) All Microorganisms Isolated from Blood Cultures Conclusion The incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab. Disclosures All Authors: No reported disclosures

scholarly journals 382. Incidence of Hospital-Acquired and Ventilator-Associated Pneumonia in Patients with Severe COVID 19 on High Flow Oxygen

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S260-S261
Author(s):  
Aikaterini Papamanoli ◽  
Jacquelyn Nakamura ◽  
Jenny Fung ◽  
Joshua Abata ◽  
Nikitha Karkala ◽  
...  
Keyword(s):  
Length Of Stay ◽  
High Flow ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Systemic Corticosteroids ◽  
High Flow Oxygen ◽  
Venturi Mask ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
The Impact

Abstract Background Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) can be serious complications of coronavirus disease 19 (COVID-19). Co-infections may worsen outcomes and prolong hospitalization. This risk may be exacerbated by systemic corticosteroids (steroids) and other adjunctive therapies. Methods We reviewed the records of all adults admitted to Stony Brook University Hospital, NY, from 3/1 to 4/15, 2020 with severe COVID-19 pneumonia, requiring high-flow O2 (non-rebreather mask, Venturi mask with FiO2 >50%, or high-flow nasal cannula). We excluded patients who received mechanical ventilation (MV) or died within 24h. Patients were followed until death or hospital discharge. We reviewed positive sputum cultures (PSC) for pathogenic microorganisms and calculated the incidence of HAP and VAP (nosocomial pneumonia, [NP]), rates of MV and impact on mortality. Fungi isolated from sputum, were considered colonization unless associated with fungemia. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on HAP or VAP. Results A total of 469 patients were included (Table 1). Of these, 199 (42.4%) required intensive care and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 105 (22.4%) had PSC. Of these, 59 were considered true pathogens (HAP: 11, VAP: 48), with predominance of S. aureus (MSSA) 38.9%, Enterobacteriaceae 33.8% and Pseudomonas species 18.6%. 39 isolates were considered colonization (Table 2); Patients with PSC < 48h (N=7) from admission, were not considered NP. The incidence of NP was 7.0 per 1000 patient-days (95%CI 5.5–8.5). Of 11 patients with HAP, 9 needed MV. NP was more frequent among patients receiving steroids (9.0 vs 5.7 per 1000 patient-days; P=0.023). Use of tocilizumab was not associated with NP (6.2 vs 8.4 per 1000 patient-days; P=0.11). Mortality was nonsignificantly higher in patients with (20/59, 33.9%) vs. without (103/410, 25.1%) NP (P=0.16). Intubation and length of stay were the strongest predictors of NP in multivariable models. Cohort Characteristics of Patients with Severe COVID -19 Pneumonia on High Flow Oxygen (N= 469) All Microbes Isolated from Sputum Cultures Conclusion Among high risk COVID-19 patients, NP is a common complication. MSSA and Enterobacteriaceae were the most frequent isolates. The risk increases with intubation, longer hospital stay and use of steroids but not tocilizumab. Disclosures All Authors: No reported disclosures

scholarly journals Time to Grow Positive Blood Cultures and Its Impact on Clinical Outcomes in Patients with Bacteremia Admitted to Intensive Care Unit

2021 ◽  
pp. 1-6
Author(s):  
Rashid Nadeem ◽  
Ashraf M. Elhoufi ◽  
Lamiaa Salama ◽  
Mayada Mahmoud ◽  
Islam Bon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Clinical Outcomes ◽  
Severity Of Illness ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Comorbid Conditions ◽  
Mortality And Morbidity ◽  
Causes Of Mortality ◽  
The Impact

Introduction: Bloodstream infections are one of the leading causes of mortality and morbidity. Time to positive blood culture may be reflective of the severity of infection. We aim to study the impact of time to positivity (TTP) of blood culture upon clinical outcome. Methods: Data from blood cultures for 17 months duration reviewed. Outcome measures included in-hospital mortality and length of stay in ICU (LOSICU). TTP was determined for each sample. Demographics (age, gender, BMI, and nationality), APACHE-2 score for severity of illness, comorbid conditions, and other confounding factors were recorded. Results: One hundred and one patients with 346 positive blood cultures with mean age of 62 and mean APACHE-2 score of 18.9 + 9.7 (mean +SD) with overall observed mortality of 61%. Median TTP was 20.2 h with quartiles cutoff Q1 = 15.3, Q2 = 20.2, Q3 = 28, and range 8–104 h. Only APACHE-2 scores predict LOSICU. TTP is not a significant predictor for mortality or LOSICU. Discussion: Data on TTP of blood cultures have a complex interaction with clinical outcomes. Conclusion: TTP of blood cultures does not predict mortality or length of stay in ICU.

scholarly journals 2143. Attempting to Add Clarity to “Indeterminates” on a Deployed Rapid Diagnostic with Antimicrobial Stewardship Program (ASP) Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S726-S726
Author(s):  
Heather L Cox ◽  
April E Attai ◽  
Allison M Stilwell ◽  
Kasi B Vegesana ◽  
Frankie Brewster ◽  
...  
Keyword(s):  
Pasteurella Multocida ◽  
Diagnostic Testing ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Central Line ◽  
Blood Cultures ◽  
University Hospital ◽  
Salmonella Spp ◽  
Gram Negative ◽  
Stewardship Program

Abstract Background Rapid diagnostic testing paired with ASP intervention optimizes therapy and improves outcomes but few data guide ASP response in the absence of organism identification (ID). We describe the microbiology for organisms unidentified by Accelerate Pheno™ Gram-negative platform (AXDX) in order to inform ASP-provider team communication (PTC). Methods Consecutive, non-duplicate inpatient blood cultures with Gram-negative bacilli (GNB) following AXDX implementation at a single university hospital between April 2018 and March 2019 were included. Standard of care (SOC) ID and susceptibility followed AXDX. Clinical Microbiology emailed AXDX results to the ASP in real time; results were released into the EMR paired with telephone PTC or withheld after ASP review. Bloodstream Infections (BSIs) and patient outcomes for organisms labeled no/indeterminate ID by the AXDX were characterized. Results AXDX was performed on 351 blood cultures. Among 52 (15%) labeled no/indeterminate ID, SOC methods revealed: Enterobacteriaceae (40%; 9 monomicrobial with AXDX targets), anaerobes (21%), non-lactose fermenters (NLFs) other than Pseudomonas aeruginosa (21%), and fastidious GNB (10%). Frequent organisms without AXDX targets included: Raoultella planticola (4); Bacteroides fragilis, Cupriavidus spp., Haemophilus spp., Prevotella spp., Providencia spp., non-aeruginosa Pseudomonas spp., Salmonella spp. (3 each); Pasteurella multocida, Stenotrophomonas maltophilia (2 each). BSI sources were most commonly intra-abdominal (21%), central line-associated (17%), or unknown (17%). CLABSIs were associated with immune suppression and/or substance abuse in all but 1 case. BSIs without active empiric therapy included: NDM-producing Providencia stuartii SSSI; OXA-48-producing R. planticola intraabdominal infection (IAI); Pandoraea spp. CLABSI after liver transplant; enteric fever; B. fragilis, Leptotrichia wadei, and S. maltophilia, each of unknown source. In-hospital mortality occurred in 4 of these cases. Conclusion When AXDX yields no/indeterminate ID, ASP chart review for possible anaerobic/IAI, unique environmental exposures, and travel history may assist in guiding empiric therapy. GNB with AXDX targets are not excluded. Disclosures All authors: No reported disclosures.

Impact of Contaminated Blood Cultures on Children, Families, and the Health Care System

2020 ◽  
Vol 10 (10) ◽  
pp. 836-843
Author(s):  
Megan Farrell ◽  
Sarah Bram ◽  
Hongjie Gu ◽  
Shakila Mathew ◽  
Elizabeth Messer ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care System ◽  
Peripheral Blood ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Significant Difference ◽  
Contaminated Blood ◽  
The Impact ◽  
Care System

BACKGROUND: Contaminated blood cultures pose a significant burden. We sought to determine the impact of contaminated peripheral blood cultures on patients, families, and the health care system. METHODS: In this retrospective case-control study from January 1, 2014, to December 31, 2017, we compared the hospital course, return visits and/or admissions, charges, and length of stay of patients with contaminated peripheral blood cultures (case patients) with those of patients with negative cultures (controls). Patients were categorized into those evaluated and discharged from the emergency department (ED) (ED patients) and those who were hospitalized (inpatients). RESULTS: A total of 104 ED case patients were matched with 208 ED control patients. A total of 343 case inpatients were matched with 686 inpatient controls. There was no significant difference between case and control patient demographics, ED, or hospital course at presentation. Fifty-five percent of discharged ED patients returned to the hospital for evaluation and/or admission versus 4% of controls. There was a significant (P < .0001) increase in repeat blood cultures (43% vs 1%), consultations obtained (21% vs 2%), cerebrospinal fluid studies (10% vs 0%), and antibiotic administration (27% vs 1%) in ED patients compared with controls. Each ED patient requiring revisit to the hospital incurred, on average, $4660 in additional charges. There was a significant (P < .04) increase in repeat blood cultures (57% vs 7%), consultations obtained (35% vs 28%), broadening of antibiotic coverage (18% vs 11%), median length of stay (75 vs 64 hours), and median laboratory charges ($3723 vs $3296) in case inpatients compared with controls. CONCLUSIONS: Contaminated blood cultures result in increased readmissions, testing and/or procedures, length of stay, and hospital charges in children.

Nosocomial Bloodstream Infections in Patients Receiving Extracorporeal Life Support: Variability in Prevention Practices

2016 ◽  
Vol 31 (10) ◽  
pp. 654-669 ◽  
Author(s):  
Lily B. Glater-Welt ◽  
James B. Schneider ◽  
Marcia M. Zinger ◽  
Lisa Rosen ◽  
Todd M. Sweberg
Keyword(s):  
Infection Prevention ◽  
Life Support ◽  
Antimicrobial Prophylaxis ◽  
Blood Stream Infection ◽  
Extracorporeal Life Support ◽  
Bloodstream Infections ◽  
The United States ◽  
Blood Stream ◽  
Blood Cultures ◽  
Support Organization

Nosocomial blood stream infections (BSIs) increase both the morbidity and the mortality of patients receiving extracorporeal life support (ECLS). The aim of this study was to identify common practices for blood stream infection prevention among national Extracorporeal Membrane Oxygenation (ECMO) programs. An electronic survey that comprised of a 16-item questionnaire was sent out to all ECMO program directors and coordinators within the United States that are part of the Extracorporeal Life Support Organization (ELSO) registry. A total of 152 institutions in 40 states were surveyed, with 85 (55%) responses. One-quarter of the institutions responded that an ECMO infection-prevention bundle or checklist was used during the cannulation. Less than half responded that an ECMO infection-prevention bundle or checklist was used for cannula maintenance, although a majority (82.9%) of institutions responded that a “standard approach to cannula dressings” was used. Half of the respondents reported antimicrobial prophylaxis was routinely prescribed for patients on ECMO, although specific regimens varied widely. Of the institutions, 34.2% reported sending daily blood cultures as part of routine surveillance. Smaller programs were more likely to send daily surveillance blood cultures (58.8%, P < .01). We found no clear consensus on practices used to prevent BSI in patients receiving ECMO.

scholarly journals The Impact of Nighttime Intensivists on Medical Intensive Care Unit Infection-Related Indicators

2015 ◽  
Vol 37 (3) ◽  
pp. 352-354 ◽  
Author(s):  
Abhaya Trivedi ◽  
Kathleen M. McMullen ◽  
Hilary M. Babcock ◽  
Marin H. Kollef
Keyword(s):  
Intensive Care Unit ◽  
Length Of Stay ◽  
Intervention Study ◽  
Medical Intensive Care Unit ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Before And After ◽  
Medical Intensive Care ◽  
The Impact

In 2013, a before-and-after intervention study was conducted to evaluate the effect 24-hour intensivist coverage on length of stay and rates of catheter-associated urinary tract infection, central-line associated blood stream infection, and ventilator-associated events. Intensivist coverage for 24 hours did not decrease length of stay or result in a decrease in any specific infection rate.Infect. Control Hosp. Epidemiol. 2016;37(3):352–354

scholarly journals The Impact of the Introduction of Innovative REDS Scale for the Evaluation of Central Tunnelled Catheter (CTC) Exit Site on Infection Prevention in Long-Term Haemodialyzed Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Tomasz Porazko ◽  
Edyta Stasiak ◽  
Marian Klinger
Keyword(s):  
Blood Stream Infection ◽  
Bloodstream Infections ◽  
Cost Effective ◽  
Blood Stream ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
The Impact

Central tunneled catheter (CTC)-related infections are a leading cause of a catheter loss, thus being the source of significant morbidity and mortality. The study aims at evaluating the impact of the implementation of the innovative redness, edema, discharge and tenderness, symptoms (REDS) scale (devised by the authors) for the description of the tunnel condition on the frequency of infection in long-term catheter users. The same cohort of the 40 patients was observed for 4 years altogether: 2 years before and 2 years after REDS application. The results, as well as follow-up evaluation of participants, were compared. The 2-year cumulative incidence of the CTC exit site infection (ESI) dropped significantly (log-rank p &lt; 0.001) from 0.89 episode/1,000 catheter days (53.5%, 95% CI [35.9%; 66.2%]) in the period before REDS was used—to 0.26 episode/1,000 catheter days (18.6%, 95% CI [6.1%; 29.4%]) in the time of REDS application. There were also significantly fewer episodes of ESI complicated with catheter-related blood stream infection (CRBSI) requiring the CTC removal (0.6 episode/1,000 catheter days; 18.6%, 95% CI [6.1%; 29.4%] vs. 0.3 episode/1,000 catheter days; 4.7%, 95% CI [0.0; 10.7%]; log-rank p = 0.04, in pre-REDS and REDS time, respectively). The REDS scale appears to be a simple, cost-effective tool reducing the frequency of the tunneled CTC exit site infection and associated bloodstream infections.

scholarly journals Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic

2021 ◽  
Vol 58 ◽  
pp. 004695802110679
Author(s):  
Hela Ghali ◽  
Asma Ben Cheikh ◽  
Sana Bhiri ◽  
Selwa Khefacha ◽  
Houyem Said Latiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Protective Factor ◽  
Bloodstream Infections ◽  
Point Prevalence ◽  
University Hospital ◽  
Healthcare Associated Infection ◽  
Tract Infections ◽  
Healthcare Associated ◽  
The Impact

Background Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. Aim To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI. Methods The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors. Results Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% ( P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98). Conclusion Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

scholarly journals Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

2021 ◽  
Vol 14 ◽  
pp. 73-76
Author(s):  
Blake Buzard ◽  
Patrick Evans ◽  
Todd Schroeder
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Total Hospital Cost ◽  
Initial Specimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department.  Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained.  Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

scholarly journals Three-year study of health care-associated infections in a Turkish pediatric ward

2014 ◽  
Vol 8 (11) ◽  
pp. 1415-1420 ◽  
Author(s):  
Canan Kuzdan ◽  
Ahmet Soysal ◽  
Gulcan Çulha ◽  
Gulsen Altinkanat ◽  
Guner Soyletir ◽  
...  
Keyword(s):  
Health Care ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Pediatric Ward ◽  
Control Programmes ◽  
Resistance Patterns ◽  
Health Care Associated Infections ◽  
Tract Infections

Introduction: Health care-associated infections (HCAIs) can cause an increase in morbidity, mortality and costs, especially in developing countries. As information on the epidemiology of HCAIs in pediatric patientsinTurkey is limited, we decided to study the annual incidence and antibiotic resistance patterns in our pediatric ward at Marmara University Hospital. Methodology: All hospitalized patients in the pediatric ward were assessed with regard to HCAIs betweenJanuary 1, 2008 and December 31, 2010. Data was prospectively collected according to standard protocols of the National Nosocomial Infections Surveillance System (NosoLINE). Results: A total of 16.5% of all hospitalized patients developed HCAIs in the three years studied. The most frequent HCAIs were urinary tract infections (UTI) (29.3%), bloodstream infections (27%) and pneumonias (21%). While the most frequent agent isolatedfrom UTI was Escherichia coli (26%), the most common agent in blood stream infections was Staphylococcus epidermidis (30.4%). Vancomycin resistance was found in 73.3% of all Enterococcus faecium strains. Extended-spectrum β-lactamase was detected in 58.3% of Klebsiella pneumoniae and E. coli isolates. Conclusions: Continual HCAI surveillance is important to determineits rate. Knowledge of the HCAI incidence can influence people’s use of broad-spectrum antibiotics and encourage antibiotic rotation. Moreover, the knowledge of HCAI incidence may support the infection control programmes, including education and isolation methods which ultimately may help to reducethe rate of the HCAIs.

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