scholarly journals Infections Due to Multidrug-Resistant Bacteria in Oncological Patients: Insights from a Five-Year Epidemiological and Clinical Analysis

2019 ◽  
Vol 7 (9) ◽  
pp. 277 ◽  
Author(s):  
Eleni Isidora A. Perdikouri ◽  
Kostoula Arvaniti ◽  
Dimitrios Lathyris ◽  
Fani Apostolidou Kiouti ◽  
Eleni Siskou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Protective Factor ◽  
Current Knowledge ◽  
Significant Risk ◽  
Multidrug Resistant ◽  
Adverse Outcomes ◽  
Resistant Bacteria ◽  
Carbapenem Resistant ◽  
Oncological Patients

Bacterial infections are frequent complications in cancer patients. Among them, those caused by multidrug-resistant (MDR) bacteria increase morbidity and mortality mainly because of limited therapeutic options. Current knowledge regarding MDR infections in patients with solid tumors is limited. We assessed the epidemiology and risk factors of increased mortality in these patients. In this retrospective five-year single cohort observational study, we included all oncological patients with MDR infections. Cancer-related parameters, comorbidities, prior use of antibiotics, previous surgical interventions and hospitalization, as well as the use of invasive procedures were investigated as potential risk factors causing adverse outcomes. Seventy-three patients with MDR infection were included: 37% with carbapenem-resistant Klebsiella pneumoniae, 24% with oxacillin-resistant Staphylococcus aureus (MRSA) and 21% with carbapenem-resistant Acinetobacter baumanni. Previous colonization with MDR bacteria was detected in 14% patients, while 20% of the patients presented MDR colonization or infection at ward admission. Mortality during the infection episode was 32%. Duration of hospitalization and CRP were statistically significant risk factors of mortality, whereas administration of guided antibiotics was a protective factor. Knowledge of local epidemiology of MDR bacteria can help physicians promptly identify cancer patients at risk of MDR infections and initiate timely effective empirical antibiotic treatment that can eventually improve the overall therapeutic management.

scholarly journals Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

2018 ◽  
Vol 62 (9) ◽  
Author(s):  
Maristela P. Freire ◽  
Ligia C. Pierrotti ◽  
Antonio E. Zerati ◽  
Luciana Benites ◽  
Joaquim Mauricio da Motta-Leal Filho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Palliative Care ◽  
Cancer Patients ◽  
Sofa Score ◽  
Protective Factor ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Lock Therapy ◽  
The Impact

ABSTRACT The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus. Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.

scholarly journals Risk factors for tuberculous empyema in pleural tuberculosis patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Peng Wen ◽  
Min Wei ◽  
Chao Han ◽  
Yu He ◽  
Mao-Shui Wang
Keyword(s):  
Risk Factors ◽  
Protective Factor ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Multidrug Resistant ◽  
Mortality And Morbidity ◽  
Pulmonary Tb ◽  
Pleural Tuberculosis

AbstractTuberculous empyema (TE) is associated with high mortality and morbidity. In the retrospective cohort study, we aimed to find risk factors for TE among pleural tuberculosis (TB) patients. Between July 2011 and September 2015, all culture-confirmed pleural TB patients (474 cases) were enrolled in our study. Empyema was defined as grossly purulent pleural fluid. Demographic and epidemiological data were collected for further analysis. Multivariate logistic regression analysis was used to evaluate risk factors of TE in pleural TB, age–adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to show the risk. The mean age was 35.7 ± 18.1 years old, males comprised 79.1% of the participants (375 cases). Forty-seven patients (9.9%) were multidrug-resistant TB (MDR-TB), 29 (6.1%) had retreatment TB, 26 (5.5%) had diabetes mellitus. The percentage of empyema patients was 8.9% (42 cases). Multivariate analysis revealed that male (adjusted OR = 4.431, 95% CI: 1.411, 13.919), pleural adenosine deaminase (ADA, >88 U/L) (adjusted OR = 3.367, 95% CI: 1.533, 7.395) and white blood cell (WBC, >9.52 109/L) (adjusted OR = 5.763, 95% CI: 2.473, 13.431) were significant risk factors for empyema in pleural TB, while pulmonary TB (adjusted OR = 0.155, 95% CI: 0.072, 0.336) was the protective factor for the patients. TE remains a serious threat to public health in China. Male sex is a significant risk factor for TE while the presence of pulmonary TB is protective, and high levels of pleural ADA and WBC count could aid in early diagnosis of TE. This finding would help towards reducing the mortality and morbidity associated with TE.

scholarly journals Prevalence and Risk Factors of Metallo β-lactamase Producing Pseudomonas aeruginosa and Acinetobacter species in Burns and Surgical Wards in a Tertiary Care Hospital

2012 ◽  
Vol 4 (01) ◽  
pp. 039-042 ◽  
Author(s):  
Simit H Kumar ◽  
Anuradha S De ◽  
Sujata M Baveja ◽  
Madhuri A Gore
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Care Hospital ◽  
Acinetobacter Species ◽  
Carbapenem Resistant

ABSTRACT Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

scholarly journals Nosocomial Infections Due to Multidrug-Resistant Bacteria in Cancer Patients: A Seven-Year Experience of an Oncology Center in Western China

2020 ◽  
Author(s):  
Ai-Min Jiang ◽  
Xin Shi ◽  
Na Liu ◽  
Huan Gao ◽  
Meng-Di Ren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Cancer Patients ◽  
Nosocomial Infections ◽  
Multidrug Resistant ◽  
Western China ◽  
Resistant Bacteria ◽  
Klebsiella Pneumonia ◽  
Multidrug Resistant Bacteria ◽  
Antibiotic Resistant

Abstract Background: Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. This study aimed to evaluate characteristics, antibiotic-resistant patterns, and prognosis of nosocomial infections caused by multidrug-resistant bacteria (MDR) in cancer patients. Methods: This retrospectively analyzed cancer patients with MDR bacteria caused nosocomial infections from August 2013 to May 2019 and was conducted to explore the risk factors, clinical features, outcomes, and antibiotic-resistant patterns of these infections. Results: Overall, 257 cancer patients developed nosocomial infections caused by MDR bacteria. Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae was the most frequently isolated multidrug-resistant Gram-negative bacteria (MDRGNB), followed by ESBL-producing Klebsiella pneumonia, and Acinetobacter baumannii. Cancer patients with liver disease, received intrapleural/abdominal infusion within 30 days, length of hospitalization, hemoglobin, and albumin were independent factors for 30-day mortality in the study population. The isolated MDR bacteria were highly sensitive to amikacin, meropenem, imipenem, tigecycline, and piperacillin/tazobactam. Conclusions: Cancer patients with prolonged hospitalization was an independent predictor of a favorable outcome. However, cancer patients with liver disease, received intrapleural/abdominal infusion within 30 days, anemia, and hypoproteinemia were independent risk factors of 30-day mortality.

scholarly journals It's a risky business: use of the QCovid risk calculator in a psychiatric rehabilitation population to enhance prevention

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S46-S46
Author(s):  
Jinal Patel ◽  
Fraser Scott ◽  
Rajesh Mohan
Keyword(s):  
Risk Factors ◽  
Current Knowledge ◽  
Significant Risk ◽  
Inpatient Rehabilitation ◽  
Adverse Outcomes ◽  
Vulnerable Groups ◽  
Subjective Perception ◽  
Risk Calculator ◽  
Risk Of Death ◽  
Feedback Questionnaire

AimsSerious mental illness (SMI) is now accepted as a significant risk factor for contracting COVID-19, increasing the rates of adverse outcomes, including hospitalisation and mortality. Risk assessments are the cornerstone of protecting vulnerable groups of individuals. The QCovid risk calculator is a newly developed tool to predict the risk of death or hospitalisation from COVID-19. It has not been applied in SMI populations. We aimed to use the QCovid risk calculator in an inpatient rehabilitation setting to identify and mitigate risk for people with SMI with personalised COVID-19 prevention plans.MethodClinical and sociodemographic characteristics were obtained for 22 inpatients. Firstly, the QCovid risk calculator was used to ascertain the absolute and relative risks to patients (Odds Ratios (OR) of mortality and/or hospitalisation) from COVID-19. Patients were stratified as high (OR > 10), moderate (OR 5-10) and low (OR < 5) risk. Secondly, personalised COVID-19 prevention plans were coproduced by patients and clinicians addressing 1) risk factors contributing to increased QCovid risk, 2) patient's personal goals, concerns, and preferences 3) maximizing patient engagement in COVID-19 infection prevention strategies. Finally, uptake of personalised COVID-19 prevention plans was evaluated after four weeks using a customised patient feedback questionnaire.ResultOf the 22 inpatients (68% male), 14 patients (64%) had schizophrenia and 3 patients (14%) had schizoaffective disorder as primary diagnosis. 13 (59%) patients were prescribed clozapine. QCovid risk stratification showed 10% of patients as high risk, 29% as moderate risk, and 61% as low risk. Apart from SMI in all 22 inpatients, the most common QCovid risk factors were increased body mass index (64%, n = 14; 23% overweight and 41% obese), diabetes mellitus type 1 or 2 (27%, n = 6) and epilepsy (n = 4, 18%). 19 of the 22 patients provided feedback on their personalised COVID-19 prevention plans. Most patients (79%) felt they had “contributed significantly” to their COVID-19 prevention plans, and their individual goals and concerns were valued. 79% were “satisfied” with their COVID-19 prevention plans. Subjective perception of safety from COVID-19 was high, with 95% of patients feeling “safe and well-protected from COVID-19”.ConclusionComprehensive assessment of COVID-19 risks in vulnerable groups enables personalised risk mitigation, both at an individual and service level. Our findings show the importance of applying current knowledge to protect vulnerable patients with SMI through personalised prevention plans. This approach can be scaled up to understand risks for services and teams, while allowing clinicians to adapt their use for individualised COVID-19 prevention.

scholarly journals Multidrug-resistant organism infections and mortality: estimates from a large Italian hospital

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Moro ◽  
G P Vigezzi ◽  
E Callari ◽  
A Biancardi ◽  
P Nizzero ◽  
...  
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Outcome Variable ◽  
Resistant Bacteria ◽  
Risk Of Death ◽  
Carbapenem Resistant

Abstract Background Multidrug-resistant organisms (MDRO) are one of the most critical public health concerns, particularly in hospital settings. Nearly 8% of hospitalized patients develop healthcare-associated infections (HAI), 20% of which is caused by MDRO. Aim of the study was to estimate nosocomial infection-associated in-hospital mortality, by different MDRO, in a large Italian teaching hospital. Methods We conducted a retrospective cohort study on patients hospitalized at San Raffaele Hospital, Milan, from 2016 to 2018. Two existing datasets were merged: hospital discharge records and MDRO surveillance data. Exposure was defined as any HAI caused by MDRO, and main outcome variable was in-hospital mortality from all causes. Results A total of 78,795 patients were studied (mean age 59.3 y, age range 18-105 y). 1,345 patients with at least one MDRO had mean age of 68 y, mean length of stay (LOS) of 32.8 days and mean DRG weight of 3.8. 77,450 patients without MDRO isolation had mean age of 59 y, mean LOS of 7.2 days and mean DRG weight of 1.6. Risk of in-hospital mortality is 3.4 times higher in patients with at least one MDRO isolation (OR 3.4; 95% CI 2.8-4.2). Enterococci (OR 2.6; 95% CI 1.1-6.3), A. baumannii (OR 3.5; 95% CI 1.4-8.6), P. aeruginosa (OR 1.8; 95% CI 0.8-4.2), MRSA (OR 3.4; 95% CI 2.1-5.4), ESBL-producing (OR 1.9; 95% CI 1.4-2.7) and carbapenem-resistant bacteria (OR 3.8; 95% CI 2.5-5.7), and carbapenem-resistant K. pneumoniae (OR 5.5; 95% CI 3.2-9.2) isolations were risk factors for nosocomial mortality. Conclusions Patients with MDRO isolations were older, more complex and had 5 times longer LOS than ones without MDRO. Deceased patients were 18% among MDRO cohort against only 2% among others. Bacteria included in WHO list of priority pathogens with antibiotic resistance were associated with a significantly higher risk of death. These results prove the urgency of controlling MDROs' spread that threatens global public health and available treatments of infections. Key messages Nosocomial MDRO isolation is a significant risk factor for in-hospital mortality from all causes. Infection prevention and control measures, and antibiotic stewardship are key strategies in order to prevent MDRO transmission and HAI, AR spreading and their burden of related deaths.

Risk Factors of Multidrug-resistant Klebsiella spp. in Hospitalized Cancer Patients in Erbil Governate, Iraq

2020 ◽  
Vol 51 (3) ◽  
pp. 123-140
Author(s):  
FATTMA A. ALI ◽  
SUSAN F. KHADHEM AL-SUDANI ◽  
GAILAN CHWAIS HASSAN ◽  
SEVAN HASSAN BAKIR
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Multidrug Resistant ◽  
Klebsiella Spp

Distribution of Pathogens Involved in Infections in Oncological Patients and their Antibiotic Resistance Profile

2020 ◽  
Vol 70 (12) ◽  
pp. 4287-4294
Keyword(s):  
Antibiotic Resistance ◽  
Cancer Patients ◽  
Bacterial Pathogen ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Antibiotic Resistance Profile ◽  
Oncological Patients ◽  
Eastern European Countries ◽  
Klebsiella Spp

Cancer is the second leading cause of death in Romania and worldwide. Cancer patients are at increasing risk of acquiring bacterial infection with multi-resistant germs, including multidrug-resistant (MDR) strains of Gram-negative bacteria involved in nosocomial infection. Romania is one of the South-Eastern European countries with one of the highest prevalence rates of MDR pathogens. To determine the resistance pattern of bacterial profile and antibiotic resistance pattern in cancer patients admitted at the County Emergency Clinical Hospital Craiova, Romania. A retrospective study of bacterial pathogens was carried out on 90 adult cancer patients admitted from January to December 2018. The analysis of the resistance patterns for the action of the appropriate antibiotics was performed using Vitek 2 Compact system and diffusion method. In this study there were analysed 92 samples from 90 oncological patients (37-86 years). A total of 157 bacterial isolates were obtained, of which 37 strains of Staphylococcus aureus (23.56%), followed by Streptococcus pneumoniae (23- 14.64%), Klebsiella spp. and Escherichia coli (22 - 14,01%). The most common isolates were from respiratory tract (86 isolates - 54.77%). High rates of MDR were found for E. coli (63.63%), MRSA (61,11%) and Klebsiella spp. (54,54%), while one third of the isolated strains of Pseudomonas aeruginosa, Acinetobacter spp. and Proteus spp. were MDR. The findings of this study may be the basis for further more extensive studies highlighting the germs involved in the infectious pathology of cancer patients, in order to determine the antimicrobial resistance and to improve the methods of prophylaxis and treatment. Keywords: multidrug resistance (MDR), cancer patients, bacterial pathogen

The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

2021 ◽  
pp. 1-11
Author(s):  
Yini Wang ◽  
Xueqin Gao ◽  
Zhenjuan Zhao ◽  
Ling Li ◽  
Guojie Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Significant Risk ◽  
Type D Personality ◽  
Adverse Outcomes ◽  
Combined Effect ◽  
Continuous Variables ◽  
Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

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