scholarly journals How to prevent transmission of MRSA in the open community?

2004 ◽  
Vol 9 (11) ◽  
pp. 1-2 ◽  
Author(s):  
F Vandenesch ◽  
J Etienne
Keyword(s):  
Methicillin Resistance ◽  
Past History ◽  
The United States ◽  
Hospital Acquired Infection ◽  
History Of ◽  
Mrsa Strains ◽  
Healthcare Associated ◽  
Resistance Rates ◽  
Low Prevalence ◽  
Hospital Acquired

In the past 20 to 30 years, methicillin-resistant Staphylococcus aureus (MRSA) strains have been present in hospitals and have become a major cause of hospital-acquired infection. Methicillin resistance rates of S. aureus vary considerably between countries, with a high prevalence in the United States, and southern Europe (>20%) and a low prevalence in northern Europe (< or =5%). Community-acquired MRSA emerged worldwide in the late 1990s. There has been great confusion in the literature between healthcare-associated MRSA infections occurring in the community in patients who are at risk of acquiring hospital MRSA (such as those with past history of hospital admission, immunocompromised status, etc.), and true CA-MRSA infections due to strains that are present in the community only.

Healthcare-AssociatedStaphylococcus aureusBacteremia and the Risk for Methicillin Resistance: Is the Centers for Disease Control and Prevention Definition for Community-Acquired Bacteremia Still Appropriate?

2005 ◽  
Vol 26 (2) ◽  
pp. 204-209 ◽  
Author(s):  
Olivier Lesens ◽  
Yves Hansmann ◽  
Eimar Brannigan ◽  
Susan Hopkins ◽  
Pierre Meyer ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Disease Control ◽  
Methicillin Resistance ◽  
Blood Cultures ◽  
New Classification ◽  
Control And Prevention ◽  
Centers For Disease Control ◽  
Mrsa Strains ◽  
Healthcare Associated ◽  
Hospital Acquired

AbstractObjective:To evaluate a new classification for bloodstream infections that differentiates hospital acquired, healthcare associated, and community acquired in patients with blood cultures positive forStaphylococcus aureus.Design:Prospective, observational study.Setting:Three tertiary-care, university-affiliated hospitals in Dublin, Ireland, and Strasbourg, France.Patients:Two hundred thirty consecutive patients older than 18 years with blood cultures positive forS. aureus.Methods:S. aureusbacteremia (SAB) was defined as hospital acquired if the first positive blood culture was performed more than 48 hours after admission. Other SABs were classified as healthcare associated or community acquired according to the definition proposed by Friedman et al. When available, strains of methicillin-resistantStaphylococcus aureus(MRSA) were analyzed by pulsed-field gel electrophoresis (PFGE).Results:Eighty-two patients were considered as having community-acquired bacteremia according to the Centers for Disease Control and Prevention (CDC) classification. Of these 82 patients, 56% (46) had healthcare-associated SAB. MRSA prevalence was similar in patients with hospital-acquired and healthcare-associated SAB (41% vs 33%;P> .05), but significantly lower in the group with community-acquired SAB (11%;P< .03). PFGE of MRSA strains showed that most community-acquired and healthcare-associated MRSA strains were similar to hospital-acquired MRSA strains. On multivariate analysis, Friedman's classification was more effective than the CDC classification for predicting MRSA.Conclusion:These results support the call for a new classification for community-acquired bacteremia that would account for healthcare received outside the hospital by patients with SAB.

scholarly journals Genetic Diversity of Methicillin-Resistant Staphylococcus Aureus Among Japanese Inpatients in the Early 1980s

2020 ◽  
Author(s):  
Hui Zuo ◽  
Yuki Uehara ◽  
Yujie Lu ◽  
Takashi Sasaki ◽  
Keiichi Hiramatsu
Keyword(s):  
Staphylococcus Aureus ◽  
Population Structure ◽  
Methicillin Resistance ◽  
The United States ◽  
Type I ◽  
Methicillin Resistant ◽  
Global Pandemic ◽  
Mrsa Strains ◽  
Healthcare Associated ◽  
Genotypic Characteristics

Abstract Background: Methicillin-resistant Staphylococcus aureus (MRSA) was recognized as a serious nosocomial pathogen in Japan starting in the early 1980s. Limited genotypic characteristics on healthcare-associated MRSA (HA-MRSA) associated with “hospital MRSA panics” in Japan in this era. Therefore, this study aimed to determine the characteristics of Japanese HA-MRSA strains in the early 1980s and their linkage with current MRSA strains.Methods: For 194 S. aureus strains isolated in the early 1980s, we determined methicillin resistance phenotypically and genotypically and performed multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec) typing, and whole-genome sequencing. Results: Twenty mecA-positive MRSA (10.3%), 8 mecA-negative MRSA (4.1%) and 3 mecA-positive methicillin-susceptible S. aureus (MSSA) (1.5%) strains were identified. The frequent sequence type (ST) was ST30 (n=11), followed by ST5 (n=8), ST81 (n=4), and ST247 (n=3). Rates of SCCmec types I, II, and IV were 65.2%, 13.0%, and 17.4%, respectively. ST30-SCCmec I (n=7) and ST5-SCCmec I (n=5) were predominant genotypes. Only two strains exhibited tst-positive ST5-SCCmec II, which is the current Japanese HA-MRSA genotype. Moreover, 73.3% of SCCmec type I strains were susceptible to imipenem compared with SCCmec type II strains (0%). All ST30 strains shared a common ancestor with strain 55/2053, which resulted in a global pandemic of Panto-Valentine leukocidin (PVL)-positive and penicillin-resistant MSSA spread in Europe and the United States in the 1950s. Conclusions: Our results demonstrated the heterogeneous population structure of Japanese HA-MRSA during the early 1980s, which comprised diverse clones that are mostly rare in recent years. The shift to the current homogenous population structure of HA-MRSA strains consisting of tst-positive ST5-SCCmec II might result from the clinical introduction of new antimicrobials including imipenem.

scholarly journals Global Fluoroquinolone Resistance Epidemiology and Implictions for Clinical Use

2012 ◽  
Vol 2012 ◽  
pp. 1-37 ◽  
Author(s):  
Axel Dalhoff
Keyword(s):  
Urinary Tract ◽  
Rural Areas ◽  
Methicillin Resistance ◽  
Bacterial Species ◽  
Fluoroquinolone Resistance ◽  
Sexually Transmitted ◽  
Tract Infections ◽  
Almost All ◽  
Healthcare Associated ◽  
Resistance Rates

This paper on the fluoroquinolone resistance epidemiology stratifies the data according to the different prescription patterns by either primary or tertiary caregivers and by indication. Global surveillance studies demonstrate that fluoroquinolone resistance rates increased in the past years in almost all bacterial species exceptS. pneumoniaeandH. influenzae, causing community-acquired respiratory tract infections. However, 10 to 30% of these isolates harbored first-step mutations conferring low level fluoroquinolone resistance. Fluoroquinolone resistance increased in Enterobacteriaceae causing community acquired or healthcare associated urinary tract infections and intraabdominal infections, exceeding 50% in some parts of the world, particularly in Asia. One to two-thirds of Enterobacteriaceae producing extended spectrum -lactamases were fluoroquinolone resistant too. Furthermore, fluoroquinolones select for methicillin resistance inStaphylococci.Neisseria gonorrhoeaeacquired fluoroquinolone resistance rapidly; actual resistance rates are highly variable and can be as high as almost 100%, particularly in Asia, whereas resistance rates in Europe and North America range from <10% in rural areas to >30% in established sexual networks. In general, the continued increase in fluoroquinolone resistance affects patient management and necessitates changes in some guidelines, for example, treatment of urinary tract, intra-abdominal, skin and skin structure infections, and traveller’s diarrhea, or even precludes the use in indications like sexually transmitted diseases and enteric fever.

Nosocomial Methicillin-ResistantStaphylococcus aureusBacteremia: Is It Any Worse Than Nosocomial Methicillin-SensitiveStaphylococcus aureusBacteremia?

2000 ◽  
Vol 21 (10) ◽  
pp. 645-648 ◽  
Author(s):  
Linda A. Selvey ◽  
Michael Whitby ◽  
Barbara Johnson
Keyword(s):  
Past History ◽  
Healthcare Setting ◽  
Underlying Disease ◽  
Tertiary Referral Hospital ◽  
Historical Cohort ◽  
General Consensus ◽  
Risk Of Death ◽  
History Of ◽  
Mrsa Strains ◽  
Overall Mortality

AbstractObjective:To determine the comparative virulence of methicillin-resistantStaphylococcus aureus(MRSA) and methicillin-sensitiveS aureus(MSSA) by consideration of predisposing factors and outcomes in patients infected with these organisms in the healthcare setting.Design:Analysis of an historical cohort of 504 bacteremic patients (316 MSSA and 188 MRSA), examining factors associated with mortality.Setting:A 916-bed, university-affiliated, tertiary referral hospital.Results:Risk factors for the development of MRSA include male gender, admission due to trauma, immunosuppression, presence of a central vascular line or an indwelling urinary catheter, and a past history of MRSA infection. Overall mortality was 22%. Death due to bacteremia was significantly greater in the MRSA group (risk ratio, 1.68;P<.05), although these patients were not found to be more likely to die due to underlying disease during treatment of bacteremia. In those patients who recovered from bacteremia, no significant differences for the outcome of death could be determined between the MRSA and MSSA groups.Conclusions:There is a general consensus in the published literature that MRSA bacteremia is more likely to be associated with death, and we confirm this conclusion. However, in contrast to other studies, our MRSA cohort does not appear to be more at risk of death due to underlying disease during treatment for bacteremia. Similarly, the general consensus that MRSA patients have an increased overall mortality was not confirmed in our study. Differences in comorbidities of patients may provide some explanation of these conflicting results, while an alternate explanation is that MRSA strains are more virulent than MSSA in some centers. Perhaps the most plausible explanation is that treatment is provided earlier and in a more aggressive fashion in some centers, leading to an overall lower mortality rate in all staphylococcal bacteremias in these institutions.

scholarly journals 972. Asymptomatic Carriage of Clostridiodes difficile and Risk of Subsequent Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S38-S38
Author(s):  
Katrina Espiritu ◽  
Michael Vernon ◽  
Donna Schora ◽  
Lance Peterson ◽  
Kamaljit Singh
Keyword(s):  
Care Facility ◽  
The United States ◽  
Term Care ◽  
Asymptomatic Carriers ◽  
Long Term Care Facility ◽  
Patient Demographics ◽  
Asymptomatic Carriage ◽  
Admission Screening ◽  
History Of ◽  
Healthcare Associated

Abstract Background C. difficile is one of the most common healthcare-associated infections in the United States. Studies of patients with asymptomatic carriage of toxigenic C. difficile have reported conflicting results on the risk of subsequent C. difficile infection (CDI). Older studies suggest that the risk was low and colonization may be protective. Subsequent studies indicate that asymptomatic carriers have a 6-fold greater risk of developing CDI. The aims of our study were to assess the burden of asymptomatic C. difficile carriage and risk of subsequent CDI. Methods Adult inpatients at NorthShore University HealthSystem, Illinois hospitals between August 1, 2017 and February 28, 2018 were eligible for the study. Focused admission screening of patients at high risk of C. difficile carriage was performed: (1) history of CDI or colonization, (2) prior hospitalization past 2 months, or (3) admission from a long-term care facility. A rectal swab was collected and tested using the cobas® Cdif Test (Roche) real-time PCR. The development of hospital onset CDI (HO-CDI) in colonized patients was monitored prospectively for at least 2 months. HO-CDI testing of colonized patients was performed using the Cepheid GeneXpert RT-PCR. HO-CDI was defined as patients hospitalized for at least 72 hours with 3 or more episodes of diarrhea/24 hours, in the absence of other potential causes of diarrhea. Patient demographics were collected using a standardized form and data analyzed using VassarStats. Results There were 6,104 patients enrolled in the study and 528 (8.7%) were positive on admission for toxigenic C. difficile carriage. The mean age of colonized patients was 75.5 years (range 24–103) and 56.4% (298 patients) were females. Of 528 colonized patients, 21 (4%) had a positive CDI test. A total of 7 patients (1.3%) developed HO-CDI. Mean time to positive HO-CDI was 46.1 days (range 5–120 days). Of 5,576 patients that were negative for C difficile carriage on admission, 14 (0.3%) patients developed HO-CDI. The relative risk of HO-CDI was 5.28 (95% CI: 2.14–13.03, P = 0.05). Conclusion We found that 8.7% of at-risk admissions were asymptomatic toxigenic C. difficile carriers. While only 1.3% developed HO-CDI, asymptomatic carriers had a 5 times higher risk of subsequent CDI compared with non-carriers. Disclosures All authors: No reported disclosures.

scholarly journals Comparative Genomics of Vancomycin-Resistant Staphylococcus aureus Strains and Their Positions within the Clade Most Commonly Associated with Methicillin-Resistant S. aureus Hospital-Acquired Infection in the United States

mBio ◽  
2012 ◽  
Vol 3 (3) ◽  
Author(s):  
Veronica N. Kos ◽  
Christopher A. Desjardins ◽  
Allison Griggs ◽  
Gustavo Cerqueira ◽  
Andries Van Tonder ◽  
...  
Keyword(s):  
United States ◽  
Staphylococcus Aureus ◽  
The United States ◽  
Methicillin Resistant ◽  
Content Type ◽  
Mrsa Infection ◽  
Vancomycin Resistant ◽  
Foreign Dna ◽  
Mrsa Strains ◽  
Hospital Acquired

ABSTRACTMethicillin-resistantStaphylococcus aureus(MRSA) strains are leading causes of hospital-acquired infections in the United States, and clonal cluster 5 (CC5) is the predominant lineage responsible for these infections. Since 2002, there have been 12 cases of vancomycin-resistantS. aureus(VRSA) infection in the United States—all CC5 strains. To understand this genetic background and what distinguishes it from other lineages, we generated and analyzed high-quality draft genome sequences for all available VRSA strains. Sequence comparisons show unambiguously that each strain independently acquired Tn1546and that all VRSA strains last shared a common ancestor over 50 years ago, well before the occurrence of vancomycin resistance in this species. In contrast to existing hypotheses on what predisposes this lineage to acquire Tn1546, the barrier posed by restriction systems appears to be intact in most VRSA strains. However, VRSA (and other CC5) strains were found to possess a constellation of traits that appears to be optimized for proliferation in precisely the types of polymicrobic infection where transfer could occur. They lack a bacteriocin operon that would be predicted to limit the occurrence of non-CC5 strains in mixed infection and harbor a cluster of unique superantigens and lipoproteins to confound host immunity. A frameshift indprA, which in other microbes influences uptake of foreign DNA, may also make this lineage conducive to foreign DNA acquisition.IMPORTANCEInvasive methicillin-resistantStaphylococcus aureus(MRSA) infection now ranks among the leading causes of death in the United States. Vancomycin is a key last-line bactericidal drug for treating these infections. However, since 2002, vancomycin resistance has entered this species. Of the now 12 cases of vancomycin-resistantS. aureus(VRSA), each was believed to represent a new acquisition of the vancomycin-resistant transposon Tn1546from enterococcal donors. All acquisitions of Tn1546so far have occurred in MRSA strains of the clonal cluster 5 genetic background, the most common hospital lineage causing hospital-acquired MRSA infection. To understand the nature of these strains, we determined and examined the nucleotide sequences of the genomes of all available VRSA. Genome comparison identified candidate features that position strains of this lineage well for acquiring resistance to antibiotics in mixed infection.

scholarly journals Critical Care Workers Have Lower Seroprevalence of SARS-CoV-2 IgG Compared with Non-patient Facing Staff in First Wave of COVID19

2021 ◽  
Vol 7 (3) ◽  
pp. 199-210
Author(s):  
Helen E. Baxendale ◽  
David Wells ◽  
Jessica Gronlund ◽  
Angalee Nadesalingham ◽  
Mina Paloniemi ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Symptoms ◽  
Infection Frequency ◽  
Hospital Acquired Infection ◽  
Care Workers ◽  
Increased Risk ◽  
Symptom Severity Score ◽  
History Of ◽  
Viral Surveillance ◽  
Hospital Acquired

Abstract Introduction: In early 2020, at first surge of the coronavirus disease 2019 (COVID-19) pandemic, many health care workers (HCW) were re-deployed to critical care environments to support intensive care teams looking after patients with severe COVID-19. There was considerable anxiety of increased risk of COVID-19 for these staff. To determine whether critical care HCW were at increased risk of hospital acquired infection, we explored the relationship between workplace, patient facing role and evidence of immune exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a quaternary hospital providing a regional critical care response. Routine viral surveillance was not available at this time. Methods: We screened over 500 HCW (25% of the total workforce) for history of clinical symptoms of possible COVID19, assigning a symptom severity score, and quantified SARS-CoV-2 serum antibodies as evidence of immune exposure to the virus. Results: Whilst 45% of the cohort reported symptoms that they consider may have represented COVID-19, 14% had evidence of immune exposure. Staffs in patient facing critical care roles were least likely to be seropositive (9%) and staff working in non-patient facing roles most likely to be seropositive (22%). Anosmia and fever were the most discriminating symptoms for seropositive status. Older males presented with more severe symptoms. Of the 12 staff screened positive by nasal swab (10 symptomatic), 3 showed no evidence of seroconversion in convalescence. Conclusions: Patient facing staff working in critical care do not appear to be at increased risk of hospital acquired infection however the risk of nosocomial infection from non-patient facing staff may be more significant than previous recognised. Most symptoms ascribed to possible COVID-19 were found to have no evidence of immune exposure however seroprevalence may underrepresent infection frequency. Older male staff were at the greatest risk of more severe symptoms.

scholarly journals COVID-19 and Ventilator-Associated Event Discordance

2021 ◽  
Vol 1 (S1) ◽  
pp. s45-s45
Author(s):  
Kelly Cawcutt ◽  
Mark Rupp ◽  
Lauren Musil
Keyword(s):  
Chart Review ◽  
Respiratory Illness ◽  
The United States ◽  
Healthcare Facilities ◽  
Mechanically Ventilated ◽  
Viral Shedding ◽  
History Of ◽  
Healthcare Acquired Infections ◽  
Hospital Acquired ◽  
Present On Admission

Background: The COVID-19 pandemic has challenged healthcare facilities since its discovery in late 2019. Notably, the subsequent COVID-19 pandemic has led to an increase in healthcare-acquired infections such as ventilator associated events (VAEs). Many hospitals in the United States perform surveillance for the NHSN for VAEs by monitoring mechanically ventilated patients for metrics that are generally considered to be objective and preventable and that lead to poor patient outcomes. The VAE definition is met in a stepwise manner. Initially, a ventilator-associated condition (VAC) is met when there an increase in ventilator requirements after a period of stability or improvement. An IVAC is then met when there is evidence of an infectious process such as leukocytosis or fever and a new antimicrobial agent is started. Finally, possible ventilator-associated pneumonia (PVAP) is met when there is evidence of microbial growth or viral detection. Since the beginning of the COVID-19 pandemic, our hospital has seen an increase in VAEs, which is, perhaps, not unexpected during a respiratory illness pandemic. However, the NSHN definitions of VAE, and PVAP in particular, do not account for the novelty and nuances of COVID-19. Methods: We performed a chart review of 144 patients who had a VAE reported to the NHSN between March 1 and December 31, 2020. Results: Of the 144 patients with a VAE reported to NHSN, 39 were SARS-CoV-2 positive. Of the 39 patients, 4 patients (10.25%) met the NHSN PVAP definition due to a positive SARS-CoV-2 PCR that was collected in the prolonged viral shedding period of their illness (< 90 days). One of the four patients also had a bacterial infection in addition to their subsequent positive COVID-19 result. All these patients were admitted to the hospital with a COVID-19 diagnosis and their initial PCR swab was performed upon admission. Conclusions: We believe that the PVAP definition was inappropriately triggered by patients who were decompensating on the ventilator due to a novel respiratory virus that was present on admission. Early in the pandemic, frequent swabbing of these patients was performed to try and understand the duration of viral shedding and to determine when it would be safe to transfer patients from isolation after prolonged hospitalization. The NSHN definition should take into consideration the prolonged viral shedding period of COVID-19 and natural history of the illness, and subsequent COVID-19 testing within 90 days of an initial positive should not require classification as a hospital-acquired PVAP.Funding: NoDisclosures: None

scholarly journals Combination Therapy with Aminoglycoside in Bacteremiasdue to ESBL-Producing Enterobacteriaceae in ICU

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 777
Author(s):  
Lucie Benetazzo ◽  
Pierre-Yves Delannoy ◽  
Marion Houard ◽  
Frederic Wallet ◽  
Fabien Lambiotte ◽  
...  
Keyword(s):  
Death Rate ◽  
Distress Syndrome ◽  
Bloodstream Infections ◽  
Observational Cohort Study ◽  
Icu Patients ◽  
Hospital Acquired Infection ◽  
History Of ◽  
Observational Cohort ◽  
Hospital Acquired ◽  
Retrospective Observational Cohort Study

Objectives: Evaluation of the efficacy of empirical aminoglycoside in critically ill patients with bloodstream infections caused by extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E BSI). Methods: Patients treated between 2011 and 2018 for ESBL-E BSI in the ICU of six French hospitals were included in a retrospective observational cohort study. The primary endpoint was mortality on day 30. Results: Among 307 patients, 169 (55%) were treated with empirical aminoglycoside. Death rate was 40% (43% with vs. 39% without aminoglycoside, p = 0.55). Factors independently associated with death were age ≥70 years (OR: 2.67; 95% CI: 1.09–6.54, p = 0.03), history of transplantation (OR 5.2; 95% CI: 1.4–19.35, p = 0.01), hospital acquired infection (OR 8.67; 95% CI: 1.74–43.08, p = 0.008), vasoactive drugs >48 h after BSI onset (OR 3.61; 95% CI: 1.62–8.02, p = 0.001), occurrence of acute respiratory distress syndrome (OR 2.42; 95% CI: 1.14–5.16, p = 0.02), or acute renal failure (OR 2.49; 95% CI: 1.14–5.47, p = 0.02). Antibiotherapy appropriateness was more frequent in the aminoglycoside group (91.7% vs. 77%, p = 0.001). Rate of renal impairment was similar in both groups (21% vs. 24%, p = 0.59). Conclusions: In intensive care unit (ICU) patients with ESBL-E BSI, empirical treatment with aminoglycoside was frequent. It demonstrated no impact on mortality, despite increasing treatment appropriateness.

scholarly journals Impact on mortality of a bundle for the management of enterococcal bloodstream infection

2019 ◽  
Author(s):  
Michele Bartoletti ◽  
Sara Tedeschi ◽  
Luigia Scudeller ◽  
Renato Pascale ◽  
Elena Rosselli Del Turco ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Blood Cultures ◽  
Healthcare Associated Infections ◽  
Hospital Acquired Infection ◽  
Enterococcus Spp ◽  
Quasi Experimental ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
Post Period

Abstract BACKGROUND In this study we evaluated the effectiveness of a management bundle for Enterococcus spp BSI (E-BSI). METHODS This was a single-center quasi-experimental (pre/post) study. In the “pre” phase (January 2014 to December 2015) patients with monomicrobial E-BSI were retrospectively enrolled. During the “post” or “intervention” phase (January 2016 to December 2017), all patients with incident E-BSI were prospectively enrolled in a non-mandatory intervention arm consisting in infectious disease consultation, echocardiography, follow-up blood cultures and early targeted antibiotic treatment. Patients were followed-up to 1 year after E-BSI. The primary outcome was 30-day mortality. RESULTS Overall, 368 patients were enrolled, 173 in the “pre” phase and 195 in the “post” phase. The entire bundle was applied in 15% and 61% patients during the “pre” and “post” phase, respectively (P<0.001). Patients enrolled in the post-phase had a significant lower 30-day mortality rate (20% vs 32%, P=0.0042). At multivariate analysis, factors independently associated to mortality were age [HR 1.03 (95%CI 1.00-1.05)], ICU admission [HR 2.51 (95%CI 1.18-3.89)] healthcare associated [HR 2.32 (95%CI 1.05-5.16)] and hospital-acquired infection [HR 2.85 (95%CI 1.34-4.76)] whereas being enrolled in the “post” period [HR 0.49 (95%CI 0.32-0.75)] was associated with improved survival. Results were consistent also in the subgroups with severe sepsis [HR 0.37 (95%CI 0.16-0.90)] or healthcare-associated infections [HR 0.53 (95%CI 0.31-0.93)]. A significative lower 1-year mortality was observed in patients enrolled in the “post” period (50% vs 68%,p<0.001). CONCLUSION The introduction of a bundle for the management of E-BSI was associated with improved 30-day and 1-year survival.

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