scholarly journals Socioeconomic Burden of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacteriaceae

2021 ◽  
Vol Volume 14 ◽  
pp. 5385-5393
Author(s):  
Yunying Zhu ◽  
Tingting Xiao ◽  
Yuan Wang ◽  
Kai Yang ◽  
Yanzi Zhou ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Carbapenem Resistant ◽  
Socioeconomic Burden ◽  
Carbapenem Resistant Enterobacteriaceae

Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation

2022 ◽  
pp. 1-6
Author(s):  
Robert J. Clifford ◽  
Donna Newhart ◽  
Maryrose R. Laguio-Vila ◽  
Jennifer L. Gutowski ◽  
Melissa Z. Bronstein ◽  
...  
Keyword(s):  
Control Charts ◽  
Bloodstream Infections ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Full Time ◽  
Staffing Levels ◽  
Clostridioides Difficile ◽  
Carbapenem Resistant ◽  
Healthcare Associated ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Objective: To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). Design and setting: An ambidirectional observation in a 528-bed teaching hospital. Patients: All inpatients from July 1, 2012, to February 1, 2021. Methods: Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2–3 FTE), below recommended IP levels (4–6 FTE), and at recommended IP levels (7–8 FTE). Results: The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7–8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line–associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. Conclusions: Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.

Emergence of carbapenem-resistant Enterobacteriaceae as causes of bloodstream infections in patients with hematologic malignancies

2012 ◽  
Vol 54 (4) ◽  
pp. 799-806 ◽  
Author(s):  
Michael J. Satlin ◽  
David P. Calfee ◽  
Liang Chen ◽  
Kathy A. Fauntleroy ◽  
Stephen J. Wilson ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals Appropriate Treatment for Bloodstream Infections Due to Carbapenem-Resistant Klebsiella pneumoniae and Escherichia coli: A Nationwide Multicenter Study in Taiwan

2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Yi-Tsung Lin ◽  
Chin-Fang Su ◽  
Chien Chuang ◽  
Jung-Chung Lin ◽  
Po-Liang Lu ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multivariate Analysis ◽  
Klebsiella Pneumoniae ◽  
Multicenter Study ◽  
Bloodstream Infections ◽  
Carbapenem Resistant ◽  
Appropriate Treatment ◽  
Comorbidity Index ◽  
Enterobacteriaceae Infections ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background In a multicenter study from Taiwan, we aimed to investigate the outcome of patients who received different antimicrobial therapy in carbapenem-resistant Enterobacteriaceae bloodstream infections and proposed a new definition for tigecycline use. Methods Patients from 16 hospitals in Taiwan who received appropriate therapy for bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae and Escherichia coli were enrolled in the study between January 2012 and June 2015. We used a cox proportional regression model for multivariate analysis to identify independent risk factors of 14-day mortality. Tigecycline was defined as appropriate when the isolates had a minimum inhibitory concentration (MIC) ≤0.5 mg/L, and we investigated whether tigecycline was associated with mortality among patients with monotherapy. Results Sixty-four cases with carbapenem-resistant K pneumoniae (n = 50) and E coli (n = 14) bloodstream infections were analyzed. Of the 64 isolates, 17 (26.6%) had genes that encoded carbapenemases. The 14-day mortality of these cases was 31.3%. In the multivariate analysis, Charlson Comorbidity Index (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03–1.42; P = .022) and colistin monotherapy (HR, 5.57; 95% CI, 2.13–14.61; P < .001) were independently associated with 14-day mortality. Among the 55 patients with monotherapy, the 14-day mortality was 30.9% (n = 17). Tigecycline use was not associated with mortality in the multivariate analysis. Conclusions Tigecycline monotherapy was a choice if the strains exhibited MIC ≤0.5 mg/L, and colistin monotherapy was not suitable. Our findings can initiate additional clinical studies regarding the efficacy of tigecycline in carbapenem-resistant Enterobacteriaceae infections.

Carbapenem-resistant Enterobacteriaceae in pediatric bloodstream infections in rural Southern India

2017 ◽  
Vol 54 (12) ◽  
pp. 1021-1024 ◽  
Author(s):  
Ramalingam Sekar ◽  
Manoharan Mythreyee ◽  
Seetharaman Srivani ◽  
Dharmaraj Sivakumaran ◽  
Sivathanu Lallitha ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Southern India ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals Clinical and Mortality Risk Factors in Bloodstream Infections with Carbapenem-Resistant Enterobacteriaceae

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Xiaopeng Li ◽  
Huan Ye
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Medical Information ◽  
Central Venous Catheterization ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Central Venous ◽  
Carbapenem Resistant ◽  
Venous Catheterization ◽  
Carbapenem Resistant Enterobacteriaceae

Objective. To investigate the risk factors underlying the occurrence and mortality of bloodstream infections (BSIs) with carbapenem-resistant Enterobacteriaceae (CRE). Methods. Medical information was retrospectively analyzed from 148 cases of patients with Enterobacteriaceae BSIs at a medical center in China, between 2013 and 2015. Results. The 30-day mortality rate in the CRE group was 65.4%. Indwelling urethral catheterization, admission to the ICU, use of antibiotics within 30 days, and BSIs from the respiratory system were associated with CRE BSIs. Lung infection, abdominal infection, central venous catheterization, and use of hormones within 30 days were associated with mortality. Conclusion. The 30-day mortality rate of CRE BSIs was high. Lung infections, abdominal infections, central venous catheterization, and use of hormones within 30 days increased the mortality rate of Enterobacteriaceae BSIs.

scholarly journals Ceftazidime-avibactam use for KPC-Kp infections: a retrospective observational multicenter study

2021 ◽  
Author(s):  
Mario Tumbarello ◽  
Francesca Raffaelli ◽  
Maddalena Giannella ◽  
Elisabetta Mantengoli ◽  
Alessandra Mularoni ◽  
...  
Keyword(s):  
Propensity Score ◽  
Multivariate Regression ◽  
Bloodstream Infections ◽  
Multivariate Regression Analysis ◽  
Carbapenem Resistant ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Propensity Score Adjustment ◽  
Combination Regimens ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background A growing body of observational evidence supports the value of ceftazidime-avibactam (CAZ-AVI) in managing infections caused by carbapenem-resistant Enterobacteriaceae (CRE). Methods We retrospectively analyzed observational data on the use and outcomes of CAZ-AVI therapy for infections caused by KPC-producing K. pneumoniae (KPC-Kp) strains. Multivariate regression analysis was used to identify variables independently associated with 30-day mortality. Results were adjusted for propensity score for receipt of CAZ-AVI combination regimens vs. CAZ-AVI monotherapy. Results The cohort comprised 577 adults with bloodstream infections (BSIs) (n=391) or non-bacteremic infections (nBSIs) involving mainly the urinary tract, lower respiratory tract, intra-abdominal structures. All received treatment with CAZ-AVI alone (n=165) or with one or more other active antimicrobials (n=412). The all-cause mortality rate 30 days after infection onset was 25% (146/577). There was no statistically significant difference in mortality between patients managed with CAZ-AVI alone and those treated with combination regimens (26.1% vs. 25.0%, P=0.79). In multivariate analysis, mortality was positively associated with the presence at infection onset of septic shock (P=0.002), neutropenia (P <0.001), or an INCREMENT score >8 (P=0.01); with LRTI (P=0.04); and with CAZ-AVI dose adjustment for renal function (P=0.01). Mortality was negatively associated with CAZ-AVI administration by prolonged infusion (P=0.006). All associations remained significant after propensity score adjustment. Conclusions CAZ-AVI is an important option for treating serious KPC-Kp infections, even when used alone. Further study is needed to explore the drug’s seemingly more limited efficacy in LRTIs and the potential survival benefits of prolonging CAZ-AVI infusions to 3 hours or more.

scholarly journals Bloodstream Infections caused by Klebsiella pneumoniae and Serratia marcescens isolates co-harboring NDM-1 and KPC-2.

2020 ◽  
Author(s):  
Taniela Bes ◽  
Debora Nagano ◽  
Roberta Martins ◽  
Ana Paula Marchi ◽  
Lauro Perdigão Neto ◽  
...  
Keyword(s):  
Serratia Marcescens ◽  
Low Income ◽  
Case Series ◽  
Bloodstream Infections ◽  
Surgical Patient ◽  
Hematopoietic Stem ◽  
Travel History ◽  
Molecular Tests ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Carbapenem-resistant Enterobacteriaceae is a worldwide health problem, however isolates carrying both blaKPC-2 and blaNDM-1 are unusual. Here we describe microbiological and clinical characteristics of five cases of bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae and Serratia marcescens co-harboring blaKPC-2 and blaNDM-1.Of the five blood culture isolates, three from are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a soft tissue surgical patient. All patients lived in low-income neighborhoods and had no travel history. Despite antibiotic treatment, four of five patients died. The phenotypic assays showed that Meropenem added with either EDTA, PA or both showed increased zone of inhibition in comparison to Meropenem alone. Molecular tests confirmed blaKPC-2 and blaNDM-1 genes, the K. pneumoniae were assigned as ST258 and ST340 by Whole Genome Sequencing.This case-series showed high mortality of BSI caused by Enterobacteria coproducing KPC-2 and NDM-1. The detection of samples co-harboring blaKPC-2 and blaNDM-1 remains unsatisfactory with phenotypic assay. Routine microbiology laboratories must be on alert for samples co-harboring these mechanisms.

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