#Predictors of #Mortality in #Bloodstream #Infections Caused by #Pseudomonas aeruginosa: Impact of #Antimicrobial #Resistance and Bacterial Virulence (Antimicrob Agents Chemother., abstract)

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

Predictors of Mortality in Bloodstream Infections Caused by Pseudomonas aeruginosa: Impact of Antimicrobial Resistance and Bacterial Virulence

Raúl Recio, Mikel Mancheño, Esther Viedma, Jennifer Villa, María Ángeles Orellana, Jaime Lora-Tamayo, Fernando Chaves

DOI: 10.1128/AAC.01759-19

 

ABSTRACT

Whether multidrug-resistance (MDR) is associated with mortality in patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) remains controversial. Here, we explored the prognostic factors of PA BSI with emphasis on antimicrobial resistance and virulence. All PA BSI episodes in a 5-year period were retrospectively analyzed. The impact in early (5-day) and late (30-day) crude mortality of host, antibiotic treatment and pathogen factors was assessed by multivariate logistic regression analysis. Of 243 episodes, 93 (38.3%) were caused by MDR-PA. Crude 5-day (20%) and 30-day (33%) mortality was more frequent in patients with MDR-PA (34.4% vs. 11.3%, p<0.001 and 52.7% vs. 21.3%, p<0.001, respectively). Early mortality was associated with neutropenia (adjusted odds ratio [aOR], 9.21; 95% confidence interval [95% CI], 3.40-24.9; p<0.001), increased Pitt score (aOR, 2.42; 95% CI, 1.34-4.36; p=0.003), respiratory source (aOR, 3.23; 95% CI, 2.01-5.16; p<0.001), inadequate empirical therapy (aOR, 4.57; 95% CI, 1.59-13.1; p=0.005), shorter time to positivity of blood culture (aOR, 0.88; 95% CI, 0.80-0.97; p=0.010), exoU-positive genotype (aOR, 3.58; 95% CI, 1.31-9.79; p=0.013), and O11 serotype (aOR, 3.64; 95% CI, 1.20-11.1; p=0.022). These risk factors were also identified for late mortality, as well as MDR phenotype (aOR, 2.18; 95% CI, 1.04-4.58; p=0.040). Moreover, O11 serotype (15.2%, 37/243) was common among MDR (78.4%, 29/37) and exoU-positive (89.2%, 33/37) strains. Besides relevant clinical variables and inadequate empirical therapy, pathogen factors such as MDR phenotype, exoU-positive genotype, and O11 serotype adversely affect the outcome of PA BSI.

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

Keywords: Antibiotics; Drugs Resistance; Pseudomonas aeruginosa; Bacteremia.

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#Prevalence and outcome of #bloodstream #infections due to third-generation #cephalosporin-resistant #Enterobacteriaceae in sub-Saharan #Africa: a systematic review (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Prevalence and outcome of bloodstream infections due to third-generation cephalosporin-resistant Enterobacteriaceae in sub-Saharan Africa: a systematic review

Rebecca Lester, Patrick Musicha, Nadja van Ginneken, Angela Dramowski, Davidson H Hamer, Paul Garner, Nicholas A Feasey

Journal of Antimicrobial Chemotherapy, dkz464, https://doi.org/10.1093/jac/dkz464

Published: 19 November 2019

 

Abstract

Background

The prevalence of bacterial bloodstream infections (BSIs) in sub-Saharan Africa (sSA) is high and antimicrobial resistance is likely to increase mortality from these infections. Third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae are of particular concern, given the widespread reliance on ceftriaxone for management of sepsis in Africa.

Objectives

Reviewing studies from sSA, we aimed to describe the prevalence of 3GC resistance in Escherichia coli, Klebsiella and Salmonella BSIs and the in-hospital mortality from 3GC-R BSIs.

Methods

We systematically reviewed studies reporting 3GC susceptibility testing of E. coli, Klebsiella and Salmonella BSI. We searched PubMed and Scopus from January 1990 to September 2019 for primary data reporting 3GC susceptibility testing of Enterobacteriaceae associated with BSI in sSA and studies reporting mortality from 3GC-R BSI. 3GC-R was defined as phenotypic resistance to ceftriaxone, cefotaxime or ceftazidime. Outcomes were reported as median prevalence of 3GC resistance for each pathogen.

Results

We identified 40 articles, including 7 reporting mortality. Median prevalence of 3GC resistance in E. coli was 18.4% (IQR 10.5 to 35.2) from 20 studies and in Klebsiella spp. was 54.4% (IQR 24.3 to 81.2) from 28 studies. Amongst non-typhoidal salmonellae, 3GC resistance was 1.9% (IQR 0 to 6.1) from 12 studies. A pooled mortality estimate was prohibited by heterogeneity.

Conclusions

Levels of 3GC resistance amongst bloodstream Enterobacteriaceae in sSA are high, yet the mortality burden is unknown. The lack of clinical outcome data from drug-resistant infections in Africa represents a major knowledge gap and future work must link laboratory surveillance to clinical data.

Keywords: Antibiotics; Drugs Resistance; Cephalosporins; Enterobacteriaceae; Bacteremia; Africa region.

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A ten-year review of #ESBL and non-ESBL #Escherichia coli #bloodstream #infections among #children at a tertiary referral #hospital in South Africa [#ZA] (PLoS One, abstract)

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

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa

Oliver Ombeva Malande , James Nuttall, Vashini Pillay, Colleen Bamford, Brian Eley

Published: September 24, 2019 / DOI: https://doi.org/10.1371/journal.pone.0222675

 

Abstract

Introduction

There are few studies describing Escherichia coli (E. coli) bloodstream infection (BSI) among children in Africa, yet E.coli is increasing in importance as a cause of antibiotic resistant infection in paediatric settings.

Methods

In this retrospective, descriptive study aspects of E. coli BSI epidemiology are described over a 10-year period including incidence risk, risk factors for extended-spectrum β-lactamase (ESBL)-producing E. coli BSI, antibiotic susceptibility of the bacterial isolates and outcome including risk factors for severe disease.

Results

There were 583 new E. coli BSI episodes among 217,483 admissions, an overall incidence risk of 2.7 events/1,000 hospital admissions. Of 455 of these E. coli BSI episodes that were analysed, 136 (29.9%) were caused by ESBL-producing isolates. Risk factors for ESBL-producing E. coli BSI included hospitalization in the 28-day period preceding E. coli BSI episodes, having an underlying chronic illness other than HIV infection at the time of the E. coli BSI and having a temperature of 38° Celsius or higher at the time of the E. coli BSI. None of the E. coli isolates were resistant to carbapenems or colistin. The mortality rate was 5.9% and admission to the intensive care unit was required in 12.3% of BSI episodes. Predictors of severe disease included age less than 1 month, hospitalization in the 28-day period preceding E. coli BSI and BSI without a definable focus.

Conclusions

These findings extend our understanding of E. coli BSI in a sub-Saharan African setting, provide useful information that can guide empiric treatment choices for community- and hospital-acquired BSI and help inform prevention strategies.

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Citation: Malande OO, Nuttall J, Pillay V, Bamford C, Eley B (2019) A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa. PLoS ONE 14(9): e0222675. https://doi.org/10.1371/journal.pone.0222675

Editor: Surbhi Leekha, University of Maryland School of Medicine, UNITED STATES

Received: April 30, 2019; Accepted: September 3, 2019; Published: September 24, 2019

Copyright: © 2019 Malande 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 paper and its Supporting Information files.

Funding: There was no special funding for this work, except patient folders and clinical records and staff input from the Red Cross Hospital Children’s Hospital – Paediatric infectious Diseases unit and University of Cape Town.

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

Keywords: Antibiotics; Drugs Resistance; E. Coli; Carbapenem; Colistin; Beta-lactams; Bacteremia; Pediatrics; South Africa.

——

#Cost-effectiveness of #ceftazidime – #avibactam for #treatment of #carbapenem – resistant #Enterobacteriaceae  #bacteremia and #pneumonia (Antimicrob Agents Chemother., abstract)

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

Cost-effectiveness of ceftazidime-avibactam for treatment of carbapenem-resistant Enterobacteriaceae bacteremia and pneumonia

Matthew S. Simon [MD, MS], Maroun M. Sfeir [MD, MPH], David P. Calfee [MD, MS], Michael J. Satlin [MD, MS]

DOI: 10.1128/AAC.00897-19

 

ABSTRACT

Background:

Ceftazidime/avibactam (CAZ-AVI) may improve outcomes among patients with carbapenem-resistant Enterobacteriaceae (CRE) infections compared to conventional therapies. However, CAZ-AVI’s cost-effectiveness is unknown.

Methods:

We used a decision analytic model to estimate the health and economic consequences of CAZ-AVI-based therapy compared to colistin-based therapy (COL) for a hypothetical cohort of patients with CRE pneumonia or bacteremia over a 5-year horizon. Model inputs were from published sources and included CRE mortality with COL (41%), CAZ-AVI’s absolute risk reduction in CRE mortality (23%), daily cost of CAZ-AVI ($926), risk of nephrotoxicity with COL (42%) and probability of discharge to long-term care (LTC) following CRE infection (56%). Outcomes included quality adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICER; $/QALY). 1-way and probabilistic sensitivity analyses were performed and ICERs were compared to willingness to pay standards of $100,000/QALY and $150,000/QALY.

Results:

In the base case, CAZ-AVI had an ICER of $95,000/QALY. At a $100,000/QALY threshold, results were sensitive to a number of variables including: the probability and cost of LTC, quality of life following CRE infection, CAZ-AVI’s absolute risk reduction in mortality, all-cause mortality, daily cost of CAZ-AVI, and healthcare costs after CRE infection. The ICER did not exceed $150,000/QALY after varying all model inputs across a wide range of plausible values. In probabilistic sensitivity analysis, CAZ-AVI was the optimal strategy in 59% and 99% of simulations at $100,000/QALY and $150,000/QALY threshold, respectively.

Conclusion:

CAZ-AVI is a cost-effective treatment for CRE bacteremia and pneumonia based on accepted willingness to pay standards in the US.

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

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Enterobacteriaceae; Ceftazidime; Avibactam; Bacteremia; Pneumonia; USA.

——

#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.

——

#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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