#Strategies for increasing #diagnostic yield of #community-onset #bacteraemia within the #emergency department: A retrospective study (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study

Kathrin Rothe , Christoph D. Spinner, Armin Ott, Christiane Querbach, Michael Dommasch, Cassandra Aldrich, Friedemann Gebhardt, Jochen Schneider, Roland M. Schmid, Dirk H. Busch, Juri Katchanov

Published: September 12, 2019 / DOI: https://doi.org/10.1371/journal.pone.0222545

 

Abstract

Bloodstream infections (BSI) are associated with high mortality. Therefore, reliable methods of detection are of paramount importance. Efficient strategies to improve diagnostic yield of bacteraemia within the emergency department (ED) are needed. We conducted a retrospective analysis of all ED encounters in a high-volume, city-centre university hospital within Germany during a five-year study period from October 2013 to September 2018. A time-series analysis was conducted for all ED encounters in which blood cultures (BCs) were collected. BC detection rates and diagnostic yield of community-onset bacteraemia were compared during the study period (which included 45 months prior to the start of a new diagnostic Antibiotic Stewardship (ABS) bundle and 15 months following its implementation). BCs were obtained from 5,191 out of 66,879 ED admissions (7.8%). Bacteraemia was detected in 1,013 encounters (19.5% of encounters where BCs were obtained). The overall yield of true bacteraemia (defined as yielding clinically relevant pathogens) was 14.4%. The new ABS-related diagnostic protocol resulted in an increased number of hospitalised patients with BCs collected in the ED (18% compared to 12.3%) and a significant increase in patients with two or more BC sets taken (59% compared to 25.4%), which resulted in an improved detection rate of true bacteraemia (2.5% versus 1.8% of hospital admissions) without any decrease in diagnostic yield. This simultaneous increase in BC rates without degradation of yield was a valuable finding that indicated success of this strategy. Thus, implementation of the new diagnostic ABS bundle within the ED, which included the presence of a skilled infectious disease (ID) team focused on obtaining BCs, appeared to be a valuable tool for the accurate and timely detection of community-onset bacteraemia.

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Citation: Rothe K, Spinner CD, Ott A, Querbach C, Dommasch M, Aldrich C, et al. (2019) Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study. PLoS ONE 14(9): e0222545. https://doi.org/10.1371/journal.pone.0222545

Editor: Wisit Cheungpasitporn, University of Mississippi Medical Center, UNITED STATES

Received: June 24, 2019; Accepted: August 31, 2019; Published: September 12, 2019

Copyright: © 2019 Rothe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Bacteremia; Antibiotics.

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#Toxic #shock #syndrome toxin 1-producing #MRSA of clonal complex 5, the #NY / #Japan #epidemic #clone, causing a high early #mortality rate in patients with #bloodstream infections (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Toxic shock syndrome toxin 1-producing methicillin-resistant Staphylococcus aureus of clonal complex 5, the New York/Japan epidemic clone, causing a high early mortality rate in patients with bloodstream infections

Dokyun Kim, Jun Sung Hong, Eun-Jeong Yoon, Hyukmin Lee, Young Ah Kim, Kyeong Seob Shin, Jeong Hwan Shin, Young Uh, Jong Hee Shin, Yoon Soo Park, Seok Hoon Jeong

DOI: 10.1128/AAC.01362-19

 

ABSTRACT

Introduction:

This study was performed to evaluate the clinical impacts of putative risk factors in patients with Staphylococcus aureus bloodstream infections (BSIs) through a prospective, multicenter, observational study.

Methods:

All 576 patients with S. aureus BSIs that occurred during a one-year period in six general hospitals were included in this study. Host- and pathogsen-related variables were investigated to determine risk factors for the early mortality of patients with S. aureus BSIs.

Results:

The all-cause mortality rate was 14.8% (85/576) during the four-week follow-up period from the initial blood culture, and 76.5% (65/85) of the mortality cases occurred within the first two weeks. One-quarter (26.8%, 152/567) of the S. aureus blood isolates carried the tst-1 gene, and most (86.2%, 131/152) of them were identified as clonal complex 5-agr type 2-methicillin-resistant S. aureus (MRSA) strains harboring staphylococcal cassette chromosome mec type II, belonging to the New York/Japan epidemic clone. A multivariable logistic regression showed that tst-1-positivity of causative S. aureus isolates was associated with an increased two-week mortality rate both in patients with S. aureus BSIs [adjusted odds ratio (aOR), 1.62; 95% confidence interval (CI), 0.90-2.88] and in patients with MRSA BSIs (aOR, 2.61; 95% CI, 1.19-6.03).

Conclusions:

Both host-related factors, increased Pitt bacteremia score and advanced age, as well as a pathogen-related factor, carriage of tst-1 by causative MRSA isolates, were risk factors for two-week mortality in patients with BSIs, and careful management of patients with BSIs caused by the New York/Japan epidemic clone is needed to improve clinical outcomes.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; MRSA; Bacteremia; Staphylococcus aureus.

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#Flavobacteriaceae #Bacteremia in #Children: A Multicenter Study (Pediatr Infect Dis J., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pediatr Infect Dis J. 2019 Aug 28. doi: 10.1097/INF.0000000000002449. [Epub ahead of print]

Flavobacteriaceae Bacteremia in Children: A Multicenter Study.

Cooper S1,2, Levy I2,3, Ben-Zvi H4, Ashkenazi-Hoffnung L1,2,3, Ben-Shimol S5,6, Shachor-Meyouhas Y7,8, Grisaru-Soen G2,9, Kriger O2,10, Yahav D2,11, Scheuerman O1,2,3.

Author information: 1 From the Department of Pediatrics B, Schneider Children’s Medical Center, Petach Tikva, Israel. 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv. 3 Department of Pediatric Infectious Disease Unit, Schneider Children’s Medical Center. 4 Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. 5 Pediatric Infectious Disease Unit, Soroka Medical Center. 6 Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel. 7 Pediatric Infectious Disease Unit, Rambam Medical Center. 8 Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. 9 Pediatric Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 10 Pediatric Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel. 11 Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.

 

Abstract

BACKGROUND:

The Flavobacteriaceae family includes rare pathogens in children; Chryseobacterium indologenes and Elizabethkingia meningosepticum are the most common pathogenic species, with a wide range of clinical presentations and high mortality rate. Although rare, diagnosis is important due to inherent resistance to multiple antibiotics, especially those typically prescribed for empiric treatment of aerobic Gram-negative bacterial infections.

METHODS:

A multicenter retrospective study conducted in 5 Israeli hospitals, describing Flavobacteriaceae bacteremia confirmed by positive blood culture from 1998 to 2018.

RESULTS:

Thirteen cases were included; 9 isolates were C. indologenes. Bacteremia was nosocomial or healthcare-associated in all cases. Bacteremia was associated with young age (median, 1 year, range 24 days-17 years), with only 2 (15.4%) cases in neonates, Central line-associated bloodstream infection as a source (5/13, 38%) and malignancy (7/13, 54.8%). Thirty-day all-cause mortality was 23% (3/13). Ninety-one percent of isolates were susceptible to trimethoprim-sulfamethoxazole, 82% to piperacillin-tazobactam and 92% to ciprofloxacin.

CONCLUSIONS:

C. indologenes and E. meningosepticum are rare, nosocomial- or healthcare-associated pediatric bacteremia pathogens. Bacteremia was associated with young age, but in contrast to the literature, the majority of our cases were older than the neonatal age period. In addition, they were associated with central line-associated bloodstream infection and malignancy. The most adequate antibiotics according to resistance patterns were ciprofloxacin, trimethoprim-sulfamethoxazole and piperacillin-tazobactam.

PMID: 31469778 DOI: 10.1097/INF.0000000000002449

Keywords: Flavobacteriaceae; Chryseobacterium indologenes; Elizabethkingia meningosepticum; Bacteremia; Pediatrics.

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#Enterococcal #bacteremia in febrile #neutropenic #children and adolescents with underlying #malignancies, and clinical #impact of #vancomycin resistance (Infection, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infection. 2019 Jun;47(3):417-424. doi: 10.1007/s15010-018-1260-z. Epub 2018 Dec 19.

Enterococcal bacteremia in febrile neutropenic children and adolescents with underlying malignancies, and clinical impact of vancomycin resistance.

Bae KS1,2, Shin JA1, Kim SK1,3, Han SB4,5, Lee JW1,3, Lee DG2,3,6, Chung NG1,3, Cho B1,3, Jeong DC1,2, Kang JH1,2.

Author information: 1 Department of Pediatrics, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. 2 The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 3 The Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 4 Department of Pediatrics, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. beomsid@catholic.ac.kr. 5 The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. beomsid@catholic.ac.kr. 6 Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

 

Abstract

PURPOSE:

Enterococci are a common cause of bacteremia in immunocompromised patients. Although the increase of vancomycin-resistant enterococci (VRE) makes appropriate antibiotic therapy difficult, clinical characteristics of enterococcal bacteremia and the impact of VRE infection on outcomes have rarely been reported in immunocompromised children.

METHODS:

We enrolled children and adolescents (< 19 years of age) with underlying malignancies who were diagnosed with enterococcal bacteremia during febrile neutropenia between 2010 and 2017. Medical records of the enrolled children were retrospectively reviewed to evaluate the clinical characteristics of enterococcal bacteremia and impact of VRE infection on outcomes.

RESULTS:

Thirty-six episodes of enterococcal bacteremia were identified in 30 patients. VRE infection was identified in 11 episodes (30.6%); the 7- and 30-day mortalities were 27.8% and 44.4%, respectively. Acute lymphoblastic leukemia (50.0%) and acute myeloid leukemia (30.6%) were the most common underlying disorders. Three (8.3%) of the patients were in complete remission, and palliative and reinduction chemotherapies were administered in 47.2% and 36.1% of episodes, respectively. Empirical antibiotic therapy was appropriate in 64.0% of patients with vancomycin-susceptible enterococcal infection and in none of the VRE-infected patients (p = 0.001). However, the 30-day mortality was not significantly different between the two patient groups (44.0% vs. 45.5%, p = 1.000).

CONCLUSIONS:

Most episodes of enterococcal bacteremia occurred in advanced stages of underlying malignancies, and still showed high mortality. The prognosis seemed to be related to the underlying disease condition rather than vancomycin resistance of the isolated enterococci, although the number of enrolled patients was small.

KEYWORDS: Child; Enterococcus; Neutropenia; Vancomycin resistance

PMID: 30565009 DOI: 10.1007/s15010-018-1260-z [Indexed for MEDLINE]

Keywords: Enterococci; Bacteremia; Cancer; Antibiotics; Drugs Resistance; Vancomycin.

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Strong #correlation between the rates of intrinsically #antibiotic #resistant species and the rates of acquired resistance in Gram-negative species causing #bacteraemia, #EU/EEA, 2016 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016

Vincent Jarlier 1,2, Liselotte Diaz Högberg 3, Ole E Heuer 3, José Campos 4, Tim Eckmanns 5, Christian G Giske 6,7, Hajo Grundmann 8,Alan P Johnson 9, Gunnar Kahlmeter 10, Jos Monen 11, Annalisa Pantosti 12, Gian Maria Rossolini 13,14, Nienke van de Sande-Bruinsma 15,Alkiviadis Vatopoulos 16, Dorota Żabicka 17, Helena Žemličková 18,19, Dominique L Monnet 3, Gunnar Skov Simonsen 20,21, EARS-Net participants 22

Affiliations: 1 Sorbonne Universités (Paris 06) Inserm Centre d’Immunologie et des Maladies Infectieuses (CIMI), UMR 1135, Paris, France; 2 Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière hospital, Laboratoire de Bactériologie-Hygiène, Paris, France; 3 European Centre for Disease Prevention and Control, Solna, Sweden; 4 Reference and Research Laboratory on Antimicrobial Resistance, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain; 5 Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany; 6 Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; 7 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; 8 Medical Center – University of Freiburg, Department for Infection Prevention and Hospital Epidemiology, Freiburg, Germany; 9 National Infection Service, Public Health England, London, United Kingdom; 10 Clinical Microbiology, Central Hospital, Växjö, Sweden; 11 National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 12 Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; 13 Department of Experimental and Clinical Medicine, University of Florence, Italy; 14 Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy; 15 Pan American Health Organization/World Health Organization (PAHO/ WHO), Washington DC, United States; 16 Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece; 17 Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland; 18 National Institute of Public Health, National Reference Laboratory for Antibiotics, Prague, Czech Republic; 19 Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czech Republic; 20 Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway; 21 Research Group for Host-Microbe Interaction, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway; 22 The members of the group are listed at the end of the article

Correspondence:  Liselotte Diaz Högberg

Citation style for this article: Jarlier Vincent, Diaz Högberg Liselotte, Heuer Ole E, Campos José, Eckmanns Tim, Giske Christian G, Grundmann Hajo, Johnson Alan P,Kahlmeter Gunnar, Monen Jos, Pantosti Annalisa, Rossolini Gian Maria, van de Sande-Bruinsma Nienke, Vatopoulos Alkiviadis, Żabicka Dorota, Žemličková Helena,Monnet Dominique L, Simonsen Gunnar Skov, EARS-Net participants. Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016. Euro Surveill. 2019;24(33):pii=1800538. https://doi.org/10.2807/1560-7917.ES.2019.24.33.1800538

Received: 03 Oct 2018;   Accepted: 01 Apr 2019

 

Abstract

Background

Antibiotic resistance, either intrinsic or acquired, is a major obstacle for treating bacterial infections.

Aim

Our objective was to compare the country-specific species distribution of the four Gram-negative species Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species and the proportions of selected acquired resistance traits within these species.

Method

We used data reported for 2016 to the European Antimicrobial Resistance Surveillance Network (EARS-Net) by 30 countries in the European Union and European Economic Area.

Results

The country-specific species distribution varied considerably. While E. coli accounted for 31.9% to 81.0% (median: 69.0%) of all reported isolates, the two most common intrinsically resistant species P. aeruginosa and Acinetobacterspp. combined (PSEACI) accounted for 5.5% to 39.2% of isolates (median: 10.1%). Similarly, large national differences were noted for the percentages of acquired non-susceptibility to third-generation cephalosporins, carbapenems and fluoroquinolones. There was a strong positive rank correlation between the country-specific percentages of PSEACI and the percentages of non-susceptibility to the above antibiotics in all four species (rho > 0.75 for 10 of the 11 pairs of variables tested).

Conclusion

Countries with the highest proportion of P. aeruginosa and Acinetobacter spp. were also those where the rates of acquired non-susceptibility in all four studied species were highest. The differences are probably related to national differences in antibiotic consumption and infection prevention and control routines.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; Bacteremia; EU.

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#Shock and Early #Death in #Hematologic Patients with Febrile #Neutropenia (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Shock and Early Death in Hematologic Patients with Febrile Neutropenia

Mariana Guarana, Marcio Nucci, Simone A. Nouér

DOI: 10.1128/AAC.01250-19

 

ABSTRACT

Empiric antibiotic therapy with a betalactam is standard of care in febrile neutropenia (FN), and is given to prevent early death. The addition of vancomycin is recommended in certain circumstances but the quality of evidence is low, reflecting the lack of clinical data. In order to characterize the epidemiology of early death and shock in FN, we reviewed all episodes of FN from 2003 to 2017 at University Hospital, Federal University of Rio de Janeiro, and looked at factors associated with shock at first fever and early death (within 3 days from first fever) by univariate and multivariate analyses. Among 1305 episodes of FN, shock occurred in 42 episodes (3.2%) and early death in 15 (1.1%). Predictors of shock were bacteremia due to Escherichia coli (odds ratio [OR] 8.47, 95% confidence interval [95% CI] 4.08 – 17.55, p<0.001), Enterobacter sp. (OR 7.53, 95% CI 1.60 – 35.33, p=0.01), and Acinetobacter sp. (OR 6.95, 95% CI 1.49 – 32.36, p=0.01). Factors associated with early death were non-Hodgkin lymphoma (OR 3.57, 95% CI 1.18-10.73, p=0.02), pneumonia (OR 21.36, 95% CI 5.72-79.72, p<0.001), shock (OR 11.64, 95% CI 2.77-48.86, p=0.01) and bacteremia due to Klebsiella pneumoniae (OR 5.91, 95% CI 1.11-31.47, p=0.03). Adequate empiric antibiotic therapy was protective (OR 0.23, 95% CI 0.07 – 0.81, p=0.02). Shock or early death was not associated with Gram-positive bacteremia, catheter-related, skin or soft tissue infection, or inadequate Gram-positive coverage. These data challenge guidelines recommendations for the empiric use of vancomycin at first fever in neutropenic patients.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Vancomycin; Sepsis; Bacteremia; Enterobacteriaceae.

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Oral #antibiotics for the #treatment of gram negative #bloodstream #infections: a retrospective comparison of three classes (J Glob Antimicrob Resist., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Glob Antimicrob Resist. 2019 Aug 4. pii: S2213-7165(19)30192-4. doi: 10.1016/j.jgar.2019.07.026. [Epub ahead of print]

Oral antibiotics for the treatment of gram negative blood stream infections: a retrospective comparison of three classes.

Nisly SA1, McClain DL2, Fillius AG3, Davis KA4.

Author information: 1 School of Pharmacy, Wingate University, Clinical Pharmacist, Internal Medicine, Wake Forest Baptist Health, 515 N. Main St, Wingate, NC 28174. Electronic address: s.nisly@wingate.edu. 2 School of Pharmacy Alumna, Wingate University, 515 N. Main St, Wingate, NC 28174. Electronic address: do.mcclain@wingate.edu. 3 School of Pharmacy Alumna, Wingate University, 515 N. Main St, Wingate, NC 28174. Electronic address: am.fillius@wingate.edu. 4 Clinical Pharmacist, Internal Medicine, Department of Pharmacy, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston Salem, NC 27157. Electronic address: kydavis@wakehealth.edu.

 

Abstract

BACKGROUND:

Treatment of bacteremia with oral antibiotics has the potential to reduce hospital length of stay, treatment costs, and line related complications. To date, small trials have supported use of specific classes of antibiotics, primarily fluoroquinolones (FQ), in the treatment of gram-negative blood stream infections (GNBSI). At present, limited data exists evaluating treatment with beta-lactams (BL) or trimethoprim-sulfamethoxazole (TMP-SMX).

OBJECTIVE:

The purpose of this study was to compare the treatment of GNBSI across three different oral antibiotic classes.

METHODS:

A retrospective cohort of hospitalized patients with a GNBSI receiving initial intravenous antibiotic therapy followed by step-down oral therapy was conducted. Patients were divided into one of three oral antibiotic treatment groups: FQ, BL, or TMP-SMX. The composite primary endpoint was treatment failure, comprised of 30-day mortality, clinical relapse, or transition back to intravenous antibiotics. Additional endpoints included secondary infections and individual components within the primary endpoint. Categorical endpoints were analyzed using X2 or Fisher’s exact while continuous variables were assessed with a one-way ANOVA.

RESULTS:

A total of 204 patients were included in the analysis. The majority of patients received FQ (n=136; 67%), followed by BL (n=46; 22%) and TMP-SMX (n=22;11%). Treatment failure occurred in 15 (7%) patients with no significance found between groups. Likewise, individual composite outcomes and secondary outcomes demonstrated no statistical significance.

CONCLUSION AND RELEVANCE:

Transitioning to oral antibiotics to complete GNBSI treatment can offer many advantages. As FQ resistance increases, data supporting use of BL or TMP-SMX in treatment of GNBSI will become essential.

Copyright © 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Antibiotics; Bacteremia; Gram-negative; Oral

PMID: 31390537 DOI: 10.1016/j.jgar.2019.07.026

Keywords: Antibiotics; Drugs Resistance; Bacteremia.

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