Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals

Introduction: Bloodstream infections due to Candida species are becoming a major cause of morbidity and mortality in hospitalized patients. The spectrum of candidemia has changed with the emergence of non-albicans Candida species, especially among critically ill patients. Methodology: In a retrospective study (July 2009 to December 2009) on candidemia, various Candida species isolated from blood cultures were characterized and studied along with the determination of their antifungal susceptibility to amphotericin B, itraconazole, and fluconazole by Etest. Probable risk factors for patients in the intensive care unit (ICU) presenting with candidemia were also analyzed. Results: During the study period, a total of 4651 samples were received, out of which 468 samples (10.06%) were positive for growth of organisms: 441 (94.20%) aerobic bacterial pathogens and 27 (5.79%) Candida species. The most common Candida spp. isolate was C. tropicalis (40.8%) followed by C. albicans (29.6%), C. glabrata (18.5%) and others (11.1%). Out of the 27 Candida strains, 24 (88.9%) were isolated from patients treated in the ICU. Among these, association of previous use of broad-spectrum antibiotics in 22 patients (91.6%) and central line catheter insertion in 20 patients (83.3%) were found to be statistically significant as compared to non-candidemia patients (p <0.05). Antifungal susceptibility testing of the isolates revealed a lower level of drug resistance to amphotericin B (18.5% of the isolates) versus 77.8% resistance to fluconazole. Conclusion: Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious bloodstream fungal infection.

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A Ten‐year Surveillance of P. aeruginosa Bloodstream Infections in a Tertiary Care Hospital: Trends and Risk Factors for Mortality

International Journal of Clinical Practice ◽

10.1111/ijcp.14409 ◽

2021 ◽

Author(s):

Mera A. Ababneh ◽

Abeer M Rababa'h ◽

Basima A. Almomani ◽

Abeer M. Ayoub ◽

Sayer I. Al‐Azzam¹

Keyword(s):

Risk Factors ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Bloodstream Infections ◽

Care Hospital

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Incidence rate and risk factors of central line-associated bloodstream infections among neonates and children admitted to a tertiary care university hospital

American Journal of Infection Control ◽

10.1016/j.ajic.2021.07.016 ◽

2021 ◽

Author(s):

Kanyarat Khieosanuk ◽

Sawalak Fupinwong ◽

Anchana Tosilakul ◽

Natthanidnan Sricharoen ◽

Tavitiya Sudjaritruk

Keyword(s):

Risk Factors ◽

Incidence Rate ◽

Tertiary Care ◽

Bloodstream Infections ◽

Central Line ◽

University Hospital

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Central line associated bloodstream infections in cohort of abdominal surgical patients

Acta chirurgica iugoslavica ◽

10.2298/aci1304023m ◽

2013 ◽

Vol 60 (4) ◽

pp. 23-30

Author(s):

Vesna Mioljevic ◽

Miroslav Milicevic ◽

Vesna Bumbasirevic ◽

Vesna Suljagic

Keyword(s):

Risk Factors ◽

Amino Acids ◽

Intensive Care ◽

Bloodstream Infections ◽

Central Line ◽

Aseptic Technique ◽

Candida Spp ◽

Anatomic Site ◽

Study Results ◽

Significant Difference

INTRODUCTION: Central venous catheter (CVC) placement is an unavoidable part of the everyday medical practice. At the same time CVC application is associated with high risk of development of central line-associated bloodstream infections (CLABSIs). These infections are cause of icreased morbidity and mortality rates as well as higer costs of the inpatient treatment2. Risk factors for onset of CLABSIs include duration of catheterization, length of hospital stay before catheterization, anatomic site of placement, CVC placement at the intensive care units (ICU), parenteral nutrition (PN) and ommisions diring CVC placement, use and care. CLABSI incidence rates vary depending on distribution of different risk factors associated with CVC and patient him/herself. The most significant causative organisms of CLABSIs are coagulase-negative Staphylococcocae, Staphylococcus aureus (S.aures), Enterococcus spp. i Candida spp. CLABSIs prevention measures include compliance with the rules of the aseptic technique upon placement, use and care of CVCs, which, based on the study results, may enable prevention of 65% to 70% of cases of CLABSIs. METHODS: A prospective cohort study included 200 patients hospitalized at the intensive care and therapy units of the CCS Clinic of Digestive Surgery in the period November 30th, 2006-November 31st, 2007 in whom CVC was placed for more than 48 hours. All the data necessary for the study were obtained based on the review of the case histories and they were recorded into the individual questionnaires for each patient. The questionnarire included patient information (age, gender, underlying disease, presence of other infections), information related to diagnostic and therapeutic procedures to which the patient was exposed. The incidence of CRBSIs in ICU patients, Institute of Digestive Diseases, CCS over the study period was 10.08 per 1,000 catheter-days. During the study CLABSI more often present in the females. Additionally, application of albumin and amino acids, ICU stay longer that 7 days and CVC application longer than 15 days, significantly more often present in patients with CRBSIs than in the group of patients without CRBSIs. Independent factors for development of CRBSI are gender, administration of albumin and amino acids. The most common microorganisms isolated from hemocultures and CVC were S. aureus and Klebsiella spp., with 31,8% of isolates each. Statistically significant difference was evidenced in frequency of resistance of S. aureus isolates to methicillin in the group of patients with CRBSI in comparison to the group of patients without CLABSIs. CLABSIs prevention measurs include compliance with the rules of the aseptic technique upon placement, use and care of CVCs.

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Risk Factors Associated with Ischemic Heart Diseases in Different Age Groups Patients of Tertiary Care Hospitals of Peshawar

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.1-2.64 ◽

2015 ◽

Vol 1 (2) ◽

pp. 3-9

Author(s):

Riaz Gul ◽

Sumaira Naz

Keyword(s):

Risk Factors ◽

Heart Diseases ◽

Tertiary Care ◽

Age Groups ◽

Ischemic Heart ◽

P Value ◽

Age Group ◽

Ischemic Heart Diseases ◽

Sedentary Life ◽

Tertiary Care Hospitals

Objectives:To determine different risk factors associated with ischemic heart diseases in different age group patients of tertiary care hospitals of Peshawar.Methodology:A cross sectional study conducted on 350 patients of different age groups presented with ischemic heart diseases in tertiary care hospitals of Peshawar. Study was conducted for duration of 3 months from December 2013 to February 2014. Non probability convenient sampling technique was used. Sample size was calculated using standard sample size calculator. Semi structured questionnaire was used as data collection tool. Patient’s record and investigations were used as adding tools. Standard definition was made for ischemic heart disease. Different modifiable and non-modifiable factors were assessed and were analyzed using SPSS version 16.Results:This study contains 350 patients in which female patients were 133(38%) and male were 217(62%).The mean age was 57.23±11.36 years. The age of the patients ranges from 22 to 80 years. The frequencies of risk factors were stress (73.1%) followed by hypertension (65.7%), sedentary life style (59.4%), family history (57.1%), smoking (50.6%), over weight and obese (39.1%), below normal HDL (30.3%), high LDL (29.1%), hypertriglyceridemia (28%), hypercholesterolemia (23.7%). 64.3% patients were presenting with acute IHD and 35.7% were with chronic IHD. Stress, HTN, DM and sedentary life style were found to be significantly associated with male gender (p- value <0.05). Age was divided into two groups, <45 years and >45 years. Stress, HTN, DM and hypercholesterolemia had a significant association with >45 years of age group. (P-value <0.05).Conclusion:Stress, HTN, DM, sedentary life styles were the major risk factors. And they were found to be more in male gender and in equal to more than 45 years of age group.

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ASSESSMENT OF POTENTIAL DRUG INTERACTIONS AMONG HOSPITALIZED PATIENTS IN NEUROLOGY DEPARTMENT IN TERTIARY CARE HOSPITALS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2019.v12i3.29484 ◽

2019 ◽

pp. 173-176

Author(s):

DIJO DAIS ◽

RANJEET AVIS CHERUVATHOOR ◽

KAMESWARAN R ◽

SHANMUGA SUNDARAM RAJAGOPAL

Keyword(s):

Risk Factors ◽

Drug Interactions ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Daily Basis ◽

Potential Drug ◽

Potential Ddis ◽

Patient History ◽

Therapeutic Advantage ◽

Tertiary Care Hospitals

Objective: This research was instigated to determine and assess the prevalence, severity, type, and the total number of potential drug interactions in the neurology department of two hospitals in India. Methods: The data were collected from the prescriptions and by patient history interview on a daily basis. The drug-drug interactions (DDIs) were identified using Micromedex® database-2.7 and drugs.com. Results: The drug interactions were influenced by a plethora of risk factors: Gender, age, comorbidities, length of hospital stay, and the neurological condition. The study was comprised 320 patients, among 196 patients were identified with potential DDIs (PDDIs), and a total of 450 PDDIs were observed. The prevalence of PDDIs according to the severity was major (42.6%), moderate (45.11%), and minor (12.22%). Conclusion: To lessen PDDIs, the range of medications for the patients must be properly managed, and it is encouraged to remove all medicines without therapeutic advantage, intention, and an indication.

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2288. Role of Β Lactam-Β Lactamase Inhibitors in Indian Tertiary Care Hospitals: Results from a Nationwide Survey

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1966 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S784-S784

Author(s):

Shweta Kamat ◽

Pankaj Gupta ◽

Akshata Mane

Keyword(s):

Clinical Experience ◽

Online Survey ◽

Tertiary Care ◽

Bloodstream Infections ◽

Nationwide Survey ◽

Third Generation ◽

Tract Infections ◽

Abdominal Infections ◽

Tertiary Care Hospitals ◽

Third Generation Cephalosporins

Abstract Background Broad-spectrum antibiotics, particularly third-generation cephalosporins, are routinely used in the treatment of nosocomial infections. The emergence of Extended Spectrum Β-Lactamase (ESBL)-producing pathogens in Indian tertiary care hospitals warrants the need to reassess β-lactam–β-lactamase inhibitors (BL-BLIs) as better alternative treatments. Methods An online survey was conducted by Pfizer India to understand the usage of BL-BLIs across Indian hospitals. The survey was administered to 334 clinicians across multiple specialties out of which 195 were from tertiary care hospitals. Results were analyzed using MS-Excel statistical tools. Results One-hundred ninety-five (195) clinicians from tertiary care hospitals completed the survey. About 78% of HCPs revealed the resistance to third-generation cephalosporins (e.g., ceftriaxone, ceftazidime) to be between 10–60% in their clinical settings. BL-BLIs were mostly preferred for treatment based on hospital antibiograms (64%) and used as first-line options for hospitalized adults with mild-moderate severe infections caused by ESBL-producing organisms (71%) and in mild-moderate infections caused by susceptible Gram-negative bacteria such as Enterobacteriaceae (54%). The average duration of IV BL-BLI treatment was 5–7 days (66%). The HCPs considerations while choosing BL-BLIs were mainly based on anti-microbial spectrum (81%), and rationality of BL/BLI combination (63%) and clinical experience with the BL-BLI molecule (63%). Cefoperazone-Sulbactam (CS) and Piperacillin–tazobactam (PT) were most commonly prescribed BL-BLIs and HCPs preferred the latter for pneumonia (67%), skin and soft-tissue infections (57%), bloodstream infections (67%) and cancer-associated febrile neutropenia (64%); while they preferred former for urinary tract infections (64%). CS and PT were preferred for intra-abdominal infections (57% and 64% respectively) and post-surgical infections (56% and 53% respectively). Conclusion CS and PT were the most commonly prescribed BL-BLIs probably due to their wide antimicrobial spectrum, rationality of the BL/BLI combination and the clinical experience with the molecules. BL-BLIs are still a mainstay of treatment for infections due to ESBL producing organisms. Disclosures All authors: No reported disclosures.

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Risk Factors and Outcomes for Vancomycin-ResistantEnterococcusBloodstream Infection in Children

Infection Control and Hospital Epidemiology ◽

10.1086/655464 ◽

2010 ◽

Vol 31 (10) ◽

pp. 1038-1042 ◽

Cited By ~ 14

Author(s):

Eric J. Haas ◽

Theoklis E. Zaoutis ◽

Priya Prasad ◽

Mingyao Li ◽

Susan E. Coffin

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Length Of Stay ◽

Tertiary Care ◽

Bloodstream Infections ◽

Older Age ◽

The Difference ◽

Nested Case Control ◽

Epidemiological Characteristics

Background and Objective.Enterococcal bloodstream infections (BSIs) cause morbidity and mortality in children. This study aims to describe the epidemiological characteristics of enterococcal BSI, to determine the risk factors for vancomycin-resistantEnterococcus(VRE) BSI, and to compare outcomes of VRE BSI and vancomycin-susceptibleEnterococcus(VSE) BSI in this population.Methods.A retrospective cohort study at a 418-bed tertiary care children's hospital in Philadelphia, Pennsylvania, examined the epidemiological characteristics of children hospitalized with enterococcal BSI during the period from 2001 through 2006. A nested case-control study compared patients with VRE BSI with control patients with VSE BSI. Analysis included regression modeling to identify independent risk factors for VRE BSI.Results.We identified 339 patients with enterococcal BSI during the study period, including 39 patients with VRE infection. Fifty-three patients (16%) died before hospital discharge. Risk factors for VRE included long-term receipt of mechanical ventilation (adjusted odds ratio [OR], 5.40 [95% confidence interval {CI}, 1.28-6.48]), receipt of immunosuppressive medications during the preceding 30 days (adjusted OR, 2.88 [95% CI, 1.40-20.78]), use of vancomycin during the 2 weeks before onset of bacteremia (adjusted OR per day of vancomycin use, 1.25 [95% CI, 1.14-1.38]), and older age (adjusted OR, 1.08 [95% CI, 1.03-1.14]). VRE BSI was not associated with an increased length of stay after onset of bacteremia (0.77 days [95% CI, 0.55-1.07 days]). Mortality was higher for VRE BSI, but the difference was not statistically significant (adjusted OR, 1.94 [95% CI, 0.78-4.8]).Conclusion.Most enterococcal BSI in children was caused by VSE. Risk factors for VRE BSI included receipt of vancomycin, long-term receipt of mechanical ventilation, immunosuppression, and older age. Differences in length of stay and mortality were not detected.

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Impact of Baseline Characteristics on Future Episodes of Bloodstream Infections: Multistate Model in Septic Patients With Bloodstream Infections

Clinical Infectious Diseases ◽

10.1093/cid/ciz1206 ◽

2019 ◽

Author(s):

M Cristina Vazquez Guillamet ◽

Rodrigo Vazquez ◽

Jonas Noe ◽

Scott T Micek ◽

Victoria J Fraser ◽

...

Keyword(s):

Risk Factors ◽

Blood Culture ◽

Bloodstream Infections ◽

Baseline Risk ◽

Resistant Bacteria ◽

Beta Lactam ◽

Candida Spp ◽

Patients At Risk ◽

Baseline Characteristics ◽

Inappropriate Antibiotics

Abstract Background Looking only at the index infection, studies have described risk factors for infections caused by resistant bacteria. We hypothesized that septic patients with bloodstream infections may transition across states characterized by different microbiology and that their trajectory is not uniform. We also hypothesized that baseline risk factors may influence subsequent blood culture results. Methods All adult septic patients with positive blood cultures over a 7-year period were included in the study. Baseline risk factors were recorded. We followed all survivors longitudinally and recorded subsequent blood culture results. We separated states into bacteremia caused by gram-positive cocci, susceptible gram-negative bacilli (sGNB), resistant GNB (rGNB), and Candida spp. Detrimental transitions were considered when transitioning to a culture with a higher mortality risk (rGNB and Candida spp.). A multistate Markov-like model was used to determine risk factors associated with detrimental transitions. Results A total of 990 patients survived and experienced at least 1 transition, with a total of 4282 transitions. Inappropriate antibiotics, previous antibiotic exposure, and index bloodstream infection caused by either rGNB or Candida spp. were associated with detrimental transitions. Double antibiotic therapy (beta-lactam plus either an aminoglycoside or a fluoroquinolone) protected against detrimental transitions. Conclusion Baseline characteristics that include prescribed antibiotics can identify patients at risk for subsequent bloodstream infections caused by resistant bacteria. By altering the initial treatment, we could potentially influence future bacteremic states.

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