scholarly journals Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate

2021 ◽  
Vol 8 (7) ◽  
Author(s):  
Mohammod Jobayer Chisti ◽  
Jason B Harris ◽  
Ryan W Carroll ◽  
K M Shahunja ◽  
Abu S M S B Shahid ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Young Children ◽  
High Mortality ◽  
Diarrhoeal Disease ◽  
Salmonella Typhi ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Empiric Antibiotics ◽  
Risk Of Death ◽  
Gram Negative Bacteremia

Abstract Background Pneumonia is a leading cause of sepsis and mortality in children under 5 years. However, our understanding of the causes of bacteremia in children with pneumonia is limited. Methods We characterized risk factors for bacteremia and death in a cohort of children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between 2014 and 2017 with radiographically confirmed pneumonia. Results A total of 4007 young children were hospitalized with pneumonia over the study period. A total of 1814 (45%) had blood cultures obtained. Of those, 108 (6%) were positive. Gram-negative pathogens predominated, accounting for 83 (77%) of positive cultures. These included Pseudomonas (N = 22), Escherichia coli (N = 17), Salmonella enterica (N = 14, including 11 Salmonella Typhi), and Klebsiella pneumoniae (N = 11). Gram-positive pathogens included Pneumococcus (N = 7) and Staphylococcus aureus (N = 6). Resistance to all routinely used empiric antibiotics (ampicillin, gentamicin, ciprofloxacin, and ceftriaxone) for children with pneumonia at the icddr,b was observed in 20 of the 108 isolates. Thirty-one of 108 (29%) children with bacteremia died, compared to 124 of 1706 (7%) who underwent culture without bacteremia (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.3–8.1; P < .001). Children infected with bacteria resistant to all routinely used empiric antibiotics were at greater risk of death compared to children without bacteremia (OR, 17.3; 95% CI, 7.0–43.1; P < .001). Conclusions Antibiotic-resistant Gram-negative bacteremia in young children with pneumonia in Dhaka, Bangladesh was associated with a high mortality rate. The pandemic of antibiotic resistance is shortening the lives of young children in Bangladesh, and new approaches to prevent and treat these infections are desperately needed.

scholarly journals Bloodstream Infections Caused by Antibiotic-Resistant Gram-Negative Bacilli: Risk Factors for Mortality and Impact of Inappropriate Initial Antimicrobial Therapy on Outcome

2005 ◽  
Vol 49 (2) ◽  
pp. 760-766 ◽  
Author(s):  
Cheol-In Kang ◽  
Sung-Han Kim ◽  
Wan Beom Park ◽  
Ki-Deok Lee ◽  
Hong-Bin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Mortality Rate ◽  
Antimicrobial Therapy ◽  
Treated Group ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Initial Antimicrobial Therapy ◽  
Risk Source

ABSTRACT The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial antimicrobial therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with Escherichia coli bacteremia, 65 with Klebsiella pneumoniae bacteremia, 74 with Pseudomonas aeruginosa bacteremia, and 86 with Enterobacter bacteremia, were analyzed retrospectively. If a patient received at least one antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture collection, the initial antimicrobial therapy was considered to have been appropriate. High-risk sources of bacteremia were defined as the lung, peritoneum, or an unknown source. The main outcome measure was 30-day mortality. Of the 286 patients, 135 (47.2%) received appropriate initial empirical antimicrobial therapy, and the remaining 151 (52.8%) patients received inappropriate therapy. The adequately treated group had a 27.4% mortality rate, whereas the inadequately treated group had a 38.4% mortality rate (P = 0.049). Multivariate analysis showed that the significant independent risk factors of mortality were presentation with septic shock, a high-risk source of bacteremia, P. aeruginosa infection, and an increasing APACHE II score. In the subgroup of patients (n = 132) with a high-risk source of bacteremia, inappropriate initial antimicrobial therapy was independently associated with increased mortality (odds ratio, 3.64; 95% confidence interval, 1.13 to 11.72; P = 0.030). Our data suggest that inappropriate initial antimicrobial therapy is associated with adverse outcome in antibiotic-resistant gram-negative bacteremia, particularly in patients with a high-risk source of bacteremia.

scholarly journals Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients

2014 ◽  
Vol 79 (1) ◽  
pp. 73-76 ◽  
Author(s):  
Aaron S. Hess ◽  
Michael Kleinberg ◽  
John D. Sorkin ◽  
Giora Netzer ◽  
Jennifer K. Johnson ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Increased Risk ◽  
Gram Negative Bacteremia

scholarly journals High Frequency of Clinically Significant Bacteremia in Adults Hospitalized With Falciparum Malaria

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Phyo Pyae Nyein ◽  
Ne Myo Aung ◽  
Tint Tint Kyi ◽  
Zaw Win Htet ◽  
Nicholas M. Anstey ◽  
...  
Keyword(s):  
Falciparum Malaria ◽  
Severe Disease ◽  
Kidney Injury ◽  
Gram Negative ◽  
Low Transmission ◽  
Risk Of Death ◽  
Gram Negative Bacteremia ◽  
Referral Hospitals ◽  
Clinically Significant ◽  
Empirical Antibiotics

Abstract Background.  African children with severe falciparum malaria commonly have concomitant Gram-negative bacteremia, but co-infection has been thought to be relatively rare in adult malaria. Methods.  Adults with a diagnosis of falciparum malaria hospitalized at 4 tertiary referral hospitals in Myanmar had blood cultures collected at admission. The frequency of concomitant bacteremia and the clinical characteristics of the patients, with and without bacteremia, were explored. Results.  Of 67 adults hospitalized with falciparum malaria, 9 (13% [95% confidence interval, 5.3%–21.6%]) were also bacteremic on admission, 7 (78%) with Gram-negative enteric organisms (Escherichia coli [n = 3], typhoidal Salmonella species [n = 3], nontyphoidal Salmonella [n = 1]). Bacteremic adults had more severe disease (median Respiratory Coma Acidosis Malaria [RCAM] score 3; interquartile range [IQR], 1–4) than those without bacteremia (median RCAM score 1; IQR, 1–2) and had a higher frequency of acute kidney injury (50% vs 16%, P = .03). Although 35 (52%) were at high risk of death (RCAM score ≥2), all 67 patients in the study survived, 51 (76%) of whom received empirical antibiotics on admission. Conclusions.  Bacteremia was relatively frequent in adults hospitalized with falciparum malaria in Myanmar. Like children in high transmission settings, bacteremic adults in this low transmission setting were sicker than nonbacteremic adults, and were often difficult to identify at presentation. Empirical antibiotics may also be appropriate in adults hospitalized with falciparum malaria in low transmission settings, until bacterial infection is excluded.

Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia

2014 ◽  
Vol 69 (3) ◽  
pp. 216-225 ◽  
Author(s):  
Katherine K. Perez ◽  
Randall J. Olsen ◽  
William L. Musick ◽  
Patricia L. Cernoch ◽  
James R. Davis ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Rapid Diagnostics ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals Impact of Combination Antimicrobial Therapy on Mortality Risk for Critically Ill Patients with Carbapenem-Resistant Bacteremia

2015 ◽  
Vol 59 (7) ◽  
pp. 3748-3753 ◽  
Author(s):  
Stephanie N. Bass ◽  
Seth R. Bauer ◽  
Elizabeth A. Neuner ◽  
Simon W. Lam
Keyword(s):  
Blood Culture ◽  
Combination Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Survival Rates ◽  
Gram Negative ◽  
Risk Of Death ◽  
Carbapenem Resistant ◽  
Gram Negative Bacteremia

ABSTRACTThere are limited treatment options for carbapenem-resistant Gram-negative infections. Currently, there are suggestions in the literature that combination therapy should be used, which frequently includes antibiotics to which the causative pathogen demonstratesin vitroresistance. This case-control study evaluated risk factors associated with all-cause mortality rates for critically ill patients with carbapenem-resistant Gram-negative bacteremia. Adult patients who were admitted to an intensive care unit with sepsis and a blood culture positive for Gram-negative bacteria resistant to a carbapenem were included. Patients with polymicrobial, recurrent, or breakthrough infections were excluded. Included patients were classified as survivors (controls) or nonsurvivors (cases) at 30 days after the positive blood culture. Of 302 patients screened, 168 patients were included, of whom 90 patients died (53.6% [cases]) and 78 survived (46.4% [controls]) at 30 days. More survivors received appropriate antibiotics (antibiotics within vitroactivity) than did nonsurvivors (93.6% versus 53.3%;P< 0.01). Combination therapy, defined as multiple appropriate agents given for 48 h or more, was more common among survivors than nonsurvivors (32.1% versus 7.8%;P< 0.01); however, there was no difference in multiple-agent use whenin vitroactivity was not considered (including combinations with carbapenems) (87.2% versus 80%;P= 0.21). After adjustment for baseline factors with multivariable logistic regression, combination therapy was independently associated with decreased risk of death (odds ratio, 0.19 [95% confidence interval, 0.06 to 0.56];P< 0.01). These data suggest that combination therapy with multiple agents within vitroactivity is associated with improved survival rates for critically ill patients with carbapenem-resistant Gram-negative bacteremia. However, that association is lost ifin vitroactivity is not considered.

scholarly journals A Propensity Score Analysis Shows that Empirical Treatment with Linezolid Does Not Increase the Thirty-Day Mortality Rate in Patients with Gram-Negative Bacteremia

2014 ◽  
Vol 58 (12) ◽  
pp. 7025-7031 ◽  
Author(s):  
Hugo-Guillermo Ternavasio-de la Vega ◽  
Ana-María Mateos-Díaz ◽  
Jose-Antonio Martinez ◽  
Manel Almela ◽  
Nazaret Cobos-Trigueros ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Mortality Rate ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Propensity Score Analysis ◽  
Mortality Rates ◽  
Empirical Treatment ◽  
Gram Negative ◽  
Score Analysis ◽  
Gram Negative Bacteremia

ABSTRACTThe role of linezolid in empirical therapy of suspected bacteremia remains unclear. The aim of this study was to evaluate the influence of empirical use of linezolid or glycopeptides in addition to other antibiotics on the 30-day mortality rates in patients with Gram-negative bacteremia. For this purpose, 1,126 patients with Gram-negative bacteremia in the Hospital Clinic of Barcelona from 2000 to 2012 were included in this study. In order to compare the mortality rates between patients who received linezolid or glycopeptides, the propensity scores on baseline variables were used to balance the treatment groups, and both propensity score matching and propensity-adjusted logistic regression were used to compare the 30-day mortality rates between the groups. The overall 30-day mortality rate was 16.0% during the study period. Sixty-eight patients received empirical treatment with linezolid, and 1,058 received glycopeptides. The propensity score matching included 64 patients in each treatment group. After matching, the mortality rates were 14.1% (9/64) in patients who received glycopeptides and 21.9% (14/64) in those who received linezolid, and a nonsignificant association between empirical linezolid treatment and mortality rate (odds ratio [OR], 1.63; 95% confidence interval [CI], 0.69 to 3.82;P= 0.275, McNemar's test) was found. This association remained nonsignificant when variables that remained unbalanced after matching were included in a conditional logistic regression model. Further, the stratified propensity score analysis did not show any significant relationship between empirical linezolid treatment and the mortality rate after adjustment by propensity score quintiles or other variables potentially associated with mortality. In conclusion, the propensity score analysis showed that empirical treatment with linezolid compared with that with glycopeptides was not associated with 30-day mortality rates in patients with Gram-negative bacteremia.

scholarly journals 1163. Impact of Difficult-to-Treat Resistance on Survival in Gram-Negative Bacteremia: A Risk-Adjusted Analysis Using Electronic Health Record-based Clinical Data From 140 US Hospitals

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S350-S350
Author(s):  
Sameer S Kadri ◽  
Yi Ling Lai ◽  
Emily E Ricotta ◽  
Jeffrey Strich ◽  
Ahmed Babiker ◽  
...  
Keyword(s):  
Clinical Data ◽  
Risk Adjustment ◽  
First Line ◽  
Gram Negative ◽  
Risk Of Death ◽  
Gram Negative Bacteremia ◽  
Electronic Health ◽  
The Impact ◽  
To Receive

Abstract Background In Gram-negative bacteremia (GNB), administrative data suggest that “difficult-to-treat resistance” (DTR; i.e., co-resistance to all first-line antibiotics) increases mortality. However, adequate risk-adjustment for severity of illness (SOI) may require granular laboratory and physiologic data. Methods Adult inpatients with GNB were identified from electronic health records (EHRs) of 140 hospitals in the Cerner Healthfacts database between 2009 and 2015. Mortality from DTR (intermediate/resistant in vitro to β-lactams including carbapenems and fluoroquinolones) was compared with GNB phenotypes susceptible to at least one first-line agent, but otherwise resistant to carbapenems (CR), extended-spectrum cephalosporins (ECR), or fluoroquinolones (FQR) per US Centers for Disease Control and Prevention surveillance definitions. Relative risk of mortality was adjusted (aRR) for age, sex, baseline Sequential Organ Failure Assessment (SOFA) score, Elixhauser comorbidity index, GNB source, taxon, hospital vs. community onset, year, and hospital region, bed capacity, and urban and teaching status using Poisson regression. Results Of 25,448 unique GNB encounters, 207 (1%) met DTR criteria. DTR patients were 2-fold more likely to receive intravenous colistin and 5-fold more likely to receive tigecycline compared with CR cases susceptible to ≥1 first-line agent. Crude mortality varied considerably by taxon and resistance phenotype, but resistance per se was associated with only a minority of overall deaths (DTR = 3% of deaths; any of the four resistance phenotypes = 28% of deaths; Figure 1). Inclusion of EHR-derived, baseline SOFA scores in SOI adjustments decreased aRR effect estimates; nonetheless, all resistance phenotypes still significantly increased mortality (Figure 2A). Among resistance phenotypes, aRR of mortality was similar for DTR vs. CR (aRR = 1.18; 95% CI, 0.91–1.54; P = 0.2), but higher for DTR vs. ECR (aRR = 1.26 [1.01–1.58]; P = 0.04), and DTR vs. FQR (aRR = 1.36 [1.08–1.70]; P = 0.008), respectively (Figure 2B). Conclusion DTR is associated with nonsurvival and greater use of reserve antibiotics in GNB, but adds little to the risk of death associated with CR. The impact of resistance on survival is attenuated but still present even after risk adjustment using granular clinical data. Disclosures All authors: No reported disclosures.

scholarly journals Monotherapy versus beta-lactam-aminoglycoside combination treatment for gram-negative bacteremia: a prospective, observational study.

1997 ◽  
Vol 41 (5) ◽  
pp. 1127-1133 ◽  
Author(s):  
L Leibovici ◽  
M Paul ◽  
O Poznanski ◽  
M Drucker ◽  
Z Samra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antibiotic Treatment ◽  
Combination Treatment ◽  
Mortality Rates ◽  
Beta Lactam ◽  
Gram Negative ◽  
Empirical Antibiotic Treatment ◽  
Gram Negative Bacteremia ◽  
Neutropenic Patients

The aim of the present study was to test whether the combination of a beta-lactam drug plus an aminoglycoside has advantage over monotherapy for severe gram-negative infections. Of 2,124 patients with gram-negative bacteremia surveyed prospectively, 670 were given inappropriate empirical antibiotic treatment and the mortality rate in this group was 34%, whereas the mortality rate was 18% for 1,454 patients given appropriate empirical antibiotic treatment (P = 0.0001). The mortality rates for patients given appropriate empirical antibiotic treatment were 17% for 789 patients given a single beta-lactam drug, 19% for 327 patients given combination treatment, 24% for 249 patients given a single aminoglycoside, and 29% for 89 patients given other antibiotics (P = 0.0001). When patients were stratified according to risk factors for mortality other than antibiotic treatment, combination therapy showed no advantage over treatment with a single beta-lactam drug except for neutropenic patients (odds ratio [OR] for mortality, 0.5; 95% confidence interval [95% CI], 0.2 to 1.3) and patients with Pseudomonas aeruginosa bacteremia (OR, 0.7; 95% CI, 0.3 to 1.8). On multivariable logistic regression analysis including all risk factors for mortality, combination therapy had no advantage over therapy with a single beta-lactam drug. The mortality rate for patients treated with a single appropriate aminoglycoside was higher than that for patients given a beta-lactam drug in all strata except for patients with urinary tract infections. When the results of blood cultures were known, 1,878 patients were available for follow-up. Of these, 816 patients were given a single beta-lactam drug, 442 were given combination treatment, and 193 were given a single aminoglycoside. The mortality rates were 13, 15, and 23%, respectively (P = 0.0001). Both on stratified and on multivariable logistic regression analyses, combination treatment showed a benefit over treatment with a single beta-lactam drug only for neutropenic patients (OR, 0.2; 95% CI, 0.05 to 0.7). In summary, combination treatment showed no advantage over treatment with an appropriate beta-lactam drug in nonneutropenic patients with gram-negative bacteremia.

scholarly journals The Comparison of Widal Slide Examination Results between Tubex TF on Febrile Observation Patients Over 3 Days

2019 ◽  
Vol 5 (1) ◽  
pp. 54
Author(s):  
Nosa Ika Cahyariza ◽  
Rofiatu Sholihah
Keyword(s):  
Mortality Rate ◽  
Typhoid Fever ◽  
Diagnostic Test ◽  
High Mortality ◽  
Salmonella Enterica ◽  
Salmonella Typhi ◽  
Bacterial Disease ◽  
Serological Tests ◽  
Salmonella Enterica Serovar Typhi ◽  
The Difference

Typhoid fever is systematic bacterial disease usually occurs and has a high mortality rate each year, a disease transmitted from person to person due to contamination of feces, food, and water. The cause is bacterium Salmonella enterica serovar Typhi (S. Typhi) which is a natural host and reservoir for human. The limitations of the diagnostic test led to the increasing mortality rate due to typhoid fever. Besides ensuring infection in individuals, accurate serological tests are needed to ascertain the actual burden of the disease. Serological tests which are usually carried out in Puskesmas and hospital are Widal and Tubex Tf examinations. This study aims to determine whether there are differences in Widal and Tubex TF serological examinations in febrile patients over three days non-typhoid so patients can immediately find out whether they have typhoid fever or not. This study used a laboratory exploration method by examining 24 samples using Widal TYDAL and TUBEX® TF IDL Biotech. As many as 24 samples were examined by widal with antisera O, H, AH, and BH. Twenty-four of the same samples analyzed by TUBEX® TF. Results comparison of diagnostic from both methods will be compared using Mc Nemar test with significance = 0.05. Based on the examination which had done, it showed the difference in the results of Widal slide and lg M Anti Salmonella (Tubex Tf) in patients with febrile observation over three days. So, it can conclude that Tubex Tf examinations were better that widal slide examination because Tubex Tf uses Salmonella typhi anti-O9 antigen which can distinguish these organisms from >99% other Salmonella bacteria serotypes so that Tubex Tf examination is more specific.

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