scholarly journals Risk Factors for Same Pathogen Sepsis Readmission Following Hospitalization for Septic Shock

2019 ◽  
Vol 8 (2) ◽  
pp. 181 ◽  
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Seung Ryoo ◽  
Chang Sohn ◽  
Shin Ahn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Site Infection ◽  
Gram Negative ◽  
Tertiary Center ◽  
Gram Negative Bacteremia ◽  
Previous Hospitalization ◽  
Using Data ◽  
Culture Negative ◽  
Resuscitation Bundle

(1) Background: Septic shock survivors frequently readmit because of subsequent infection. This study aimed to determine the rate and risk factors for same pathogen sepsis readmissions following hospitalization for septic shock. (2) Methods: We performed this retrospective study using data from a prospective septic shock registry at a single urban tertiary center. All the patients were treated with a protocol-driven resuscitation bundle therapy between 2011 and 2016. We collected data from adult (older than 18 years) patients readmitted with sepsis within 90 days of discharge following hospitalization for septic shock. (3) Results: Among 2062 septic shock patients, 690 were readmitted within 90 days of discharge. After excluding scheduled and non-sepsis admissions, we analyzed the data from 274 (13.3%) patients readmitted for sepsis. Most of the readmissions following septic shock were new infections rather than relapses of the initial infection. The culture-negative rate was 51.4% (141/274), while the same pathogen was isolated in 25% of cases (69/274). Multivariate analysis revealed that previous gram-negative bacteremia (OR, 9.902; 95% CI, 2.843–34.489), urinary tract infection (OR, 4.331; 95% CI, 1.723–10.882) and same site infection (OR, 6.894; 95% CI, 2.390–19.886) were significantly associated with readmission for sepsis caused by the same pathogen. (4) Conclusions: The sepsis readmission rate following the previous hospitalization for septic shock was 13.3% and one-quarter of those patients had the same pathogen isolated. Previous gram-negative bacteremia, and/or same site infection are predisposing factors for recurrent same-pathogen sepsis.

#15: Risk Factors of Infection related mortality in Pediatric Acute Myeloid Leukemia- Single Institute Experience: 2016–2018

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S1-S1
Author(s):  
Ahmed Bayoumi
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Infectious Complications ◽  
P Value ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Febrile Episodes ◽  
Acute Myeloid

Abstract Children with acute myeloid leukemia (AML) are at a particularly high risk for infectious complications related to the highly intensive chemotherapy. Infections leads to mortality and prolong hospitalization. The aim of the study is to evaluate the risk factors, infectious complications and assess outcome of febrile episodes during induction and consolidation chemotherapy courses in children with AML at the Pediatric Oncology Department, National Cancer Institute, Cairo University from January 2016 to December 2018. Infectious complications were evaluated retrospectively in 621 febrile episodes. Mortality from gram negative bacteremia was 29.9%, in febrile episodes with multidrug resistant gram negative bacteremia: Mortality was 39.2 % in febrile episodes with multidrug resistant gram negative bacteremia and septic shock. Mortality was 71.8 % (p value <0.001). Mortality was high in early chemotherapy phase (intensive timing). Infection related mortality was 39%. In our institute there is epidemiological shift towards gram negative organisms. Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of pediatric Acute myeloid leukemia. It is Important to trace the risk factors that may affect the outcome of febrile episodes. Summary of Significant laboratory and clinical predictors of mortality Risk Factor Mortality p value Septic shock 55% <0.001 Septic shock with MDRO 72% Cardiac impairment/inotropic support 65.60% Presence Of Central venous line 18.30% Episode duration >18 days 20.50% Start of antimicrobial in relation to start of chemotherapy < 16 days 33% Episodes: Not in remission 15.60% Risk factor Mortality p value CRP more than or equals 90 mg/l 24.4% Not significant ANC LESS THAN 500 29.9% 0.003 Hgb less than or equals to 7 g/dl 19.9% 0.633 Platelets less than 20000/cc 29.9% 0.299 Liver impairment (grades 3 and 4) 42.2% 0.025 Electrolyte imbalance (grades 3 and 4) 24.1% 0.003 Renal impairment 56.8% 0.025 Coagulopathy 41% <0.001

Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia

2011 ◽  
Vol 62 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Cheol-In Kang ◽  
Jae-Hoon Song ◽  
Doo Ryeon Chung ◽  
Kyong Ran Peck ◽  
Kwan Soo Ko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Sepsis And Septic Shock

Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

2021 ◽  
Author(s):  
Mariana Chumbita ◽  
Pedro Puerta-Alcalde ◽  
Carlota Gudiol ◽  
Nicole Garcia-Pouton ◽  
Júlia Laporte-Amargós ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Kidney Injury ◽  
Bloodstream Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Prospective Cohorts ◽  
Independent Risk Factors ◽  
The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

scholarly journals The Effect of Exit-Site Antibacterial Honey versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial

2015 ◽  
Vol 35 (7) ◽  
pp. 712-721 ◽  
Author(s):  
Lei Zhang ◽  
Sunil V. Badve ◽  
Elaine M. Pascoe ◽  
Elaine Beller ◽  
Alan Cass ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Site Infection ◽  
Control Groups ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Nasal Mupirocin ◽  
And Control ◽  
Technique Failure ◽  
Culture Negative

Background The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. Methods A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care ( N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis-and infection-associated hospitalization, and technique failure (PD withdrawal). Results The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32 – 0.50) and 0.41 (95% CI 0.33 – 0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75 – 1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66 – 1.49), gram-negative (IRR 0.71, 95% CI 0.39 – 1.29), culture-negative (IRR 2.01, 95% CI 0.91 – 4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36 – 3.20). Exit-site infection rates were 0.37 (95% CI 0.28 – 0.45) and 0.33 (95% CI 0.26 – 0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81 – 1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70 – 1.72), gram-negative (IRR: 0.85, 95% CI 0.46 – 1.58), culture-negative (IRR 1.88, 95% CI 0.67 – 5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40 – 2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. Conclusion Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.

scholarly journals 116. Risk Factors and Clinical Outcomes of Carbapenem Non-Susceptible Gram-Negative Bacteremia in Patients with Acute Myelogenous Leukemia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S89-S89
Author(s):  
Dong Hoon Shin ◽  
Kang Il Jun ◽  
Song Mi Moon ◽  
Wan Beom Park ◽  
Ji Hwan Bang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Resistant Organism ◽  
Time Interval ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Acute Myelogenous ◽  
Independent Risk Factors

Abstract Background Early administration of susceptible antibiotics is crucial in Gram-negative bacteremia (GNB), especially in immunocompromised patients. We aimed to explore risk factors and clinical outcomes of carbapenem non-susceptible (Carba-NS) GNB in patients with acute myelogenous leukemia (AML). Methods Cases of all GNB during induction or consolidation chemotherapy for AML in a 15-year period in a tertiary hospital were retrospectively reviewed. Independent risk factors for Carba-NS GNB were sought and its clinical outcomes were compared with those of carbapenem susceptible (Carba-S) GNB. Results Among 485 GNB cases from 930 patients, 440 (91%) were Carba-S and 45 (9%) were Carba-NS GNB. Frequent Carba-NS isolates were Stenotrophomonas maltophilia (n = 23), Pseudomonas aeruginosa (n = 11), and Acinetobacter baumannii (n = 10). Independent risk factors for Carba-NS GNB were carbapenem use at the onset of GNB (aOR [95% CI], 78.6 [24.4–252.8]; P < 0.001), the isolation of imipenem-resistant A. baumannii in the prior 1 year (aOR [95% CI], 14.6 [2.7–79.9]; P = 0.002), time interval from chemotherapy to GNB ≥20 days (aOR [95% CI], 4.7 [1.7–13.1]; P = 0.003), and length of hospital stay ≥30 days (aOR [95% CI], 3.4 [1.3–9.1]; P = 0.013). Except breakthrough GNBs which occurred during carbapenem treatment, the frequency of Carba-NS GNB was 48% (19/40) in cases having ≥2 risk factors other than carbapenem use. 30-day overall mortality (Carba-NS, 36% vs. Carba-S, 6%; P < 0.001) and in-hospital mortality (Carba-NS, 47% vs. Carba-S, 9%; P < 0.001) were significantly higher in Carba-NS GNB. Conclusion Carba-NS GNB in AML patients was independently associated with the use of carbapenem, the past isolation of resistant organism, and late onset of GNB, and its clinical outcomes were poorer than those of Carba-S GNB. Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors. Disclosures All authors: No reported disclosures.

Risk Factors for Mortality in Patients with Nosocomial Gram-Negative Bacteremia

2012 ◽  
Vol 32 (6) ◽  
pp. 1641-1647 ◽  
Author(s):  
M. Gökhan GÖZEL ◽  
Ayşe ERBAY ◽  
Hürrem BODUR ◽  
Selim Sırrı EREN ◽  
Neriman BALABAN
Keyword(s):  
Risk Factors ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

2016 ◽  
Vol 60 (11) ◽  
pp. 6673-6678 ◽  
Author(s):  
Ji-Yong Lee ◽  
Cheol-In Kang ◽  
Jae-Hoon Ko ◽  
Woo Joo Lee ◽  
Hye-Ri Seok ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Respiratory Infections ◽  
Hematologic Malignancy ◽  
Tertiary Hospital ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Content Type ◽  
Gram Negative Bacteremia ◽  
Infection Types

ABSTRACTWith the increasing use of carbapenems, carbapenem-resistant Gram-negative bacteria have become a major concern in health care-associated infections. The present study was performed to evaluate the clinical and microbiological features of breakthrough Gram-negative bacteremia (GNB) during carbapenem therapy and to assess risk factors for development of breakthrough GNB. A case-control study was performed at a tertiary hospital from 2005 to 2014. Case patients were defined as individuals whose blood cultures grew Gram-negative bacteria while the patients were receiving carbapenems for at least 48 h before breakthrough GNB. Age-, sex-, and date-matched controls were selected from patients who received carbapenem for at least 48 h and did not develop breakthrough GNB during carbapenem treatment. A total of 101 cases of breakthrough GNB were identified and compared to 100 controls. The causative microorganisms for breakthrough GNB wereStenotrophomonas maltophilia(n= 33),Acinetobacter baumannii(n= 32),Pseudomonas aeruginosa(n= 21), and others (n= 15). Approximately 90% ofS. maltophiliaisolates were susceptible to levofloxacin and trimethoprim-sulfamethoxazole. The most common infection types were primary bacteremia (38.6%) and respiratory infections (35.6%). More than half of the patients died within a week after bacteremia, and the 30-day mortality rate was 70.3%. In a multivariate analysis, a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization by causative microorganisms were significantly associated with breakthrough GNB. Our data suggest thatS. maltophilia,A. baumannii, andP. aeruginosaare the major pathogens of breakthrough GNB during carbapenem therapy, in association with a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization.

Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients

2013 ◽  
Vol 39 (7) ◽  
pp. 1253-1261 ◽  
Author(s):  
Christina Routsi ◽  
Maria Pratikaki ◽  
Evangelia Platsouka ◽  
Christina Sotiropoulou ◽  
Vasileios Papas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Gram Negative Bacteremia
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