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

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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Health Care–Associated Infections

Mayo Clinic Infectious Diseases Board Review ◽

10.1093/med/9780199827626.003.0040 ◽

2012 ◽

pp. 458-463

Author(s):

Rodney L Thompson ◽

Priya Sampathkumar

Keyword(s):

Health Care ◽

Home Health Care ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Infectious Complications ◽

Health Care Associated Infections ◽

Health Care Associated Infection ◽

Tract Infections ◽

And Control ◽

And Training

Health care–associated infection (HAI) is an infection that occurs in hospitals, nursing homes, clinics, or home health care programs. Infection control departments have been constituted to prevent and control infectious complications in health care settings. Prevention and control require combinations of education and training, procedures and policies, surveillance and reporting, and interventions that include isolation and teamwork. Common HAIs (nosocomial infections) include urinary tract infections, surgical site infections, bloodstream infections, and ventilator-associated pneumonia. Diagnosis and treatment of each type of infection are reviewed.

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

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.045 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S15-S15

Author(s):

E Sánchez-Medina ◽

A Reyes-Hernández ◽

A Severiano-Tellez

Keyword(s):

Septic Shock ◽

Defense Mechanisms ◽

Antibiotic Use ◽

Infectious Complications ◽

E Coli ◽

Pediatric Cancer Patients ◽

Leukemia Treatment ◽

Criteria For Diagnosis ◽

Healthcare Associated ◽

Epidemiologic Characteristics

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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TANGGUNG JAWAB HUKUM RUMAH SAKIT TERHADAP PASIEN HEALTH CARE-ASSOCIATED INFECTIONS (HAIS)

HERMENEUTIKA : Jurnal Ilmu Hukum ◽

10.33603/hermeneutika.v4i1.3277 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Endang Sutrisno ◽

MC Inge Hartini ◽

Mustopo Mustopo ◽

Nanang Ruhyana

Keyword(s):

Health Care ◽

Health Care Associated Infections ◽

Health Care Associated Infection

Rumah Sakit memiliki peran penting dalam mewujudkan derajat kesehatan masyarakat secara optimal, untuk itu dituntut agar mampu mengelola secara professional dan bertanggung jawab, mengusung arus keutamaan tanggung jawab profesi pada aspek kesehatan, khususnya tenaga medis dan tenaga keperawatan dalam menjalankan tugas dan wewenangnya. Â Health-Care Associated Infection (HAIs) penyebabnya terkait dengan proses dan sistem kesehatan. Aspek pertanggungjawaban hukum Rumah Sakit terhadap pasien yang terkena Health care-associated Infections (HAIs) menjadi fokus kajian, dengan pendekatan penelitian yuridis normatif, pada perspektif hukum sebagai kaidah tertulis yang tertuang dalam produk perundang-undangan yang berlaku. Rumah Sakit bertanggung jawab atas tindakan kelalaian tenaga kesehatan di Rumah Sakit, yang menyebabkan kerugian pada pasien, dibutuhkan adanya perlindungan hukum yang memadai sebagaimana tertuang dalam peraturan hukum secara normatif. Dalam hal perlindungan pasien, sebelum pelaksanaan pelayanan medis yang berkaitan dengan tindakan medis, tenaga kesehatan memberikan edukasi terhadap pasien terlebih dahulu, berupa penjelasan mengenai informasi, risiko yang terjadi, serta bentuk penanganannya. Apabila pasien merasa dirugikan dalam hal materiil maupun imateriil, pasien dapat mengajukan gugatan kepada Rumah Sakit yang melakukan kelalaian dan kesalahan, sebagai salah satu bentuk tanggung jawab hukum yang timbul.

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Antibiotic Exposure and Risk for Hospital-Associated Clostridioides difficile Infection

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02169-19 ◽

2020 ◽

Vol 64 (4) ◽

Cited By ~ 3

Author(s):

Brandon J. Webb ◽

Aruna Subramanian ◽

Bert Lopansri ◽

Bruce Goodman ◽

Peter Bjorn Jones ◽

...

Keyword(s):

Health Care ◽

Care Facility ◽

Health Care Facility ◽

Antibiotic Use ◽

Antibiotic Exposure ◽

Content Type ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Intermountain Healthcare ◽

Health Care Associated Infection

ABSTRACT Clostridioides difficile infection (CDI) is a health care-associated infection associated with significant morbidity and cost, with highly varied risk across populations. More effective, risk-based prevention strategies are needed. Here, we investigate risk factors for hospital-associated CDI in a large integrated health system. In a retrospective cohort of all adult admissions to 21 Intermountain Healthcare hospitals from 2006 to 2012, we identified all symptomatic (i) hospital-onset and (ii) health care-facility-associated, community-onset CDI. We then evaluated the risk associated with antibiotic exposure, including that of specific agents, using multivariable logistic regression. A total of 2,356 cases of CDI among 506,068 admissions were identified (incidence, 46.6 per 10,000). Prior antibiotic use was the dominant risk factor, where for every antibiotic day of therapy prior to the index admission, the odds of subsequent CDI increased by 12.8% (95% confidence interval [CI], 12.2 to 13.4%; P < 0.0001). This was a much stronger association than was inpatient antibiotic exposure (odds ratio [OR], 1.007 [95% CI, 1.005 to 1.009]; P < 0.0001). The highest-risk antibiotics included second-generation and later cephalosporins (especially oral), carbapenems, fluoroquinolones, and clindamycin, while doxycycline and daptomycin were associated with a lower CDI risk. We concluded that cumulative antibiotic exposure prior to admission is the greatest contributor to the risk of subsequent CDI. Most classes of antibiotics carry some risk, which varies by drug and route. This information may be useful for antimicrobial stewardship efforts.

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Molecular Characterization and Epidemiology of Extended-Spectrum- β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates Causing Health Care-Associated Infection in Thailand, Where the CTX-M Family Is Endemic

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00171-08 ◽

2008 ◽

Vol 52 (8) ◽

pp. 2818-2824 ◽

Cited By ~ 123

Author(s):

Pattarachai Kiratisin ◽

Anucha Apisarnthanarak ◽

Chaitat Laesripa ◽

Piyawan Saifon

Keyword(s):

Escherichia Coli ◽

Health Care ◽

Klebsiella Pneumoniae ◽

Antimicrobial Agents ◽

Upstream Region ◽

University Hospitals ◽

E Coli ◽

Extended Spectrum ◽

Genes Encoding ◽

Health Care Associated Infection

ABSTRACT Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae have rapidly spread worldwide and pose a serious threat for health care-associated (HA) infection. We conducted molecular detection and characterization of ESBL-related bla genes, including bla TEM, bla SHV, bla CTX-M, bla VEB, bla OXA, bla PER, and bla GES, among 362 isolates of ESBL-producing E. coli (n = 235) and ESBL-producing K. pneumoniae (n = 127) collected from patients who met the definition of HA infection at two major university hospitals in Thailand from December 2004 to May 2005. The prevalence of ESBL-producing E. coli and ESBL-producing K. pneumoniae, patient demographics and the susceptibilities of these bacteria to various antimicrobial agents were described. A total of 87.3% of isolates carried several bla genes. The prevalence of bla CTX-M was strikingly high: 99.6% for ESBL-producing E. coli (CTX-M-14, -15, -27, -40, and -55) and 99.2% for ESBL-producing K. pneumoniae (CTX-M-3, -14, -15, -27, and -55). ISEcp1 was found in the upstream region of bla CTX-M in most isolates. Up to 77.0% and 71.7% of ESBL-producing E. coli and ESBL-producing K. pneumoniae, respectively, carried bla TEM; all of them encoded TEM-1. ESBL-producing K. pneumoniae carried bla SHV at 87.4% (SHV-1, -2a, -11, -12, -27, -71, and -75) but only at 3.8% for ESBL-producing E. coli (SHV-11 and -12). bla genes encoding VEB-1 and OXA-10 were found in both ESBL-producing E. coli (8.5% and 8.1%, respectively) and ESBL-producing K. pneumoniae (10.2% and 11.8%, respectively). None of the isolates were positive for bla PER and bla GES. Pulsed-field gel electrophoresis analysis demonstrated that there was no major clonal relationship among these ESBL producers. This is the first study to report CTX-M-3, CTX-M-27, CTX-M-40, SHV-27, SHV-71, and SHV-75 in Thailand and to show that CTX-M ESBL is highly endemic in the country.

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