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Background
Bloodstream infections (BSIs) are one of the most critical illnesses requiring intensive care unit (ICU) admission. Antimicrobial therapy (AMT) is one of the vital management strategies for the treatment of BSIs; it should be chosen appropriately to reduce mortality.
Objectives
This is the first study to investigate the types of antimic...
Contexts in source publication
Context 1
... mortality at 30-days, many of the risk factors identified for 14-days mortality were identified in the univariate analysis as shown in Table 5. ...Citations
... BSIs caused by PA represent a significant clinical challenge due to their association with high morbidity and mortality rates. Despite advances in antimicrobial therapies and supportive care, the management of PA BSIs remains complicated by the pathogen's ability to rapidly develop resistance and its propensity for causing severe systemic infections [7,8]. ...
Pseudomonas aeruginosa bloodstream infections (PA BSIs) in adults, especially those complicated by sepsis, are associated with high rates of morbidity and mortality. Early identification of risk factors for both mortality and sepsis-induced coagulopathy (SIC) is critical to optimizing patient management and improving outcomes. We conducted a retrospective analysis of 118 adult patients diagnosed with PA BSIs at the Affiliated Hospital of Xuzhou Medical University from January 2022 to February 2024. Univariate analysis was employed to identify significant clinical factors, followed by multivariate stepwise logistic regression to determine independent predictors of mortality and SIC. Based on these findings, nomogram models were constructed and evaluated using the area under the receiver operating characteristic curve (AUC), Bootstrap resampling, and calibration plots to assess model performance. Empiric sensitive antibiotic therapy (ESAT) (OR = 0.039, P < 0.001), coronary artery disease (CAD) (OR = 10.315, P = 0.010), and invasive mechanical ventilation (OR = 3.926, P = 0.020) emerged as significant predictors of mortality. In contrast, elevated C-reactive protein (CRP) (OR = 1.011, P = 0.003), procalcitonin (PCT) (OR = 1.030, P = 0.005), and lower hemoglobin levels (OR = 0.963, P = 0.004) were independently associated with SIC. The AUC of mortality prediction model is 0.908, while the SIC prediction model yielded an AUC of 0.817. The predictive models developed in this study demonstrate early identification of mortality rates and SIC risk in PA BSI patients, which may have the potential to guide timely therapeutic interventions and improve clinical outcomes in this high-risk population.
... Sequential organ failure assessment score (> 5) was closely related to 28-day mortality of nosocomial BSIs (Jiang et al., 2019). Among ICU patients, the independent risk factor for 30-day death involved solid tumors, septic shock and renal failure (Zhao et al., 2020;Ababneh et al., 2022). The 30-day mortality with renal failure in ICU patients was 10.0%. ...
Background
Bloodstream infections (BSIs) are one of the leading causes of death in cancer patients. Nevertheless, the risk factors of BSIs in solid tumors have rarely been ascertained adequately.
Methods
We conducted a single-center case-controlled retrospective study from 2017 to 2021 among adults with solid tumors in a tertiary-level hospital. The BSIs and control group were matched by the propensity score matching method. We found independent risk factors of occurrence and death of BSIs using univariate and multivariate regression analysis. Additionally, a nomogram was constructed to predict the risk of mortality in BSIs.
Results
Of 602 patients with solid tumors in the study period, 186 had BSIs and 416 had non-BSIs. The incidence of BSIs was 2.0/1,000 admissions (206/102,704), and the 30-day mortality rate was 18.8% (35/186). Compared to the control group, the BSIs had longer hospital stays (24.5 days vs. 20.0 days), and higher frequency complicating with organ failure (10.5% vs. 2.4%), nephropathy (19.6% vs. 3.8%), comorbidities≥3 (35.5% vs. 20.0%), and liver-biliary-pancreatic infections (15.6% vs. 5.3%) (all P<0.001). Among the 186 patients with BSIs, 35 died within 30 days after BSIs. Gram-negative bacteria were the most frequent microorganisms (124/192, 64.6%). Liver cancer, organ failure, a high level of lactate dehydrogenase and septic shock were the independent hazardous factors for death of BSIs. What’s more, a nomogram was constructed to predict the 30-day survival rate of BSIs, which was proved to have good accuracy (AUC: 0.854; 95% confidence interval: 0.785~0923) and consistency.
Conclusion
Being aware of the risk factors of BSIs redounds to take preventive measures to reduce the incidence and death of BSIs.
... Antimicrobial susceptibility testing of blood cultures in the survival rate of a patient with septic shock [3]. Moreover, early identification of pathogens and selection of the right antimicrobials for the treatment of BSI plays an important role in the reduction of mortality rate [4]. The Surviving Sepsis Campaign guidelines also recommend starting antimicrobial therapy within an hour of the detection of septic shock [5]. ...
Bloodstream infections (BSI) are associated with high mortality rates, especially in immunocompromised patients. Identifying pathogens early and selecting appropriate antimicrobials to treat BSI is integral in reducing the mortality rate. There is a need to reduce the turnaround time (TAT) of pathogen identification as well as to accelerate the antimicrobial susceptibility testing (AST) of blood cultures, which can be achieved by following relevant identification methods and performing the direct AST (DAST) by the disk diffusion method.
In this study, blood samples were collected from patients with suspected bacteremia/septicemia, and aseptic precautions were taken to prevent contamination. Samples containing gram-negative bacilli (GNB) were then analyzed by DAST and conventional AST (CAST). We tested 118 GNB-positive isolates in total to compare the results of DAST and CAST. DAST and CAST showed good categorical agreement (CA) for various groups of microorganisms: 98.9% and 99.6% for Enterobacterales and Pseudomonas spp., respectively. Early detection of pathogens in blood along with the determination of their antibiotic susceptibility patterns is a need of the hour. By performing DAST on positive blood culture broth, clinical teams can obtain the information necessary for switching from empirical therapy to definitive treatment one day faster. This rapid identification of the pathogen, along with corresponding AST results, will help clinicians to accelerate targeted antimicrobial therapy for critical patients and, thus, reduce mortality and morbidity rates in patients with bloodstream infections.
... Early identification of the pathogen in severe infections resulting in sepsis and septic shock can guide precise treatment (Zhou et al., 2019). Ineffective or inappropriate antibiotic therapy can lead to the generation of multi-drug resistant bacteria, resulting in longer hospital stay, ICU stay, and higher mortality rate (Kumar et al., 2006;Andersson et al., 2019;Raad et al., 2021;Ababneh et al., 2022;Kanj et al., 2022). ...
Objective
To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) in sepsis and bloodstream infection (BSI).
Methods
A retrospective analysis of patients diagnosed with sepsis and BSI at the First Affiliated Hospital of Zhengzhou University from January 2020 to February 2022 was conducted. All the patients underwent blood culture and were divided into mNGS group and non-mNGS group according to whether mNGS was performed or not. The mNGS group was further divided into early group (< 1 day), intermediate group (1–3 days), and late group (> 3 days) according to the time of mNGS inspection.
Results
In 194 patients with sepsis and BSI, the positive rate of mNGS for identifying pathogens was significantly higher than that of blood culture (77.7% vs. 47.9%), and the detection period was shorter (1.41 ± 1.01 days vs. 4.82 ± 0.73 days); the difference was statistically significant (p < 0.05). The 28-day mortality rate of the mNGS group (n = 112) was significantly lower than that of the non-mNGS group (n = 82) (47.32% vs. 62.20%, p = 0.043). The total hospitalization time for the mNGS group was longer than that for the non-mNGS group (18 (9, 33) days vs. 13 (6, 23) days, p = 0.005). There was no significant difference in the ICU hospitalization time, mechanical ventilation time, vasoactive drug use time, and 90-day mortality between the two groups (p > 0.05). Sub-group analysis of patients in the mNGS group showed that the total hospitalization time and the ICU hospitalization time in the late group were longer than those in the early group (30 (18, 43) days vs. 10 (6, 26) days, 17 (6, 31) days vs. 6 (2, 10) days), and the ICU hospitalization time in the intermediate group was longer than that in the early group (6 (3, 15) days vs. 6 (2, 10) days); the differences were statistically significant (p < 0.05). The 28-day mortality rate of the early group was higher than that of the late group (70.21% vs. 30.00%), and the difference was statistically significant (p = 0.001).
Conclusions
mNGS has the advantages of a short detection period and a high positive rate in the diagnosis of pathogens causing BSI and, eventually, sepsis. Routine blood culture combined with mNGS can significantly reduce the mortality of septic patients with BSI. Early detection using mNGS can shorten the total hospitalization time and the ICU hospitalization time of patients with sepsis and BSI.
Background: Currently, EUCAST have issued guidelines for direct rapid antimicrobial susceptibility testing (RAST) on blood cultures. There were few reports on total laboratory automation (TLA) for RAST in China. Additionally, certain antibiotic discs used in China with specific concentrations lack EUCAST breakpoints. The purpose of this study is to use TLA to evaluate EUCAST RAST methods in Enterobacterales -containing blood cultures and to investigate the optimal breakpoints for a selection of antibiotics, including cefepime (EFP), cefotaxime (CTX), ceftazidime (CAZ), piperacillin-tazobactam (TZP), and cefoperazone/sulbactam (CSL). Methods: From April to August 2022, blood cultures positive for Enterobacterales (54 Escherichia coli and 60 Klebsiella pneumoniae ) were analyzed. EUCAST RAST (4h, 6h, 8h) were performed using TLA and compared with Vitek 2 results. Results: EUCAST RAST's readable inhibition zone increased over time, with high categorical agreement with Vitek 2 (97.1%, 96.2%, 96.1% for E. coli , and 96.1%, 97.1%, 97.9% for K. pneumoniae ) and low error rates. Based on the optimal breakpoints we defined, the categorical agreement for EFP, CTX, CAZ, and TZP against E. coli was greater than 90% at both 6 and 8 hours. However, the categorical agreement for CSL was 57.1% at 6 hours and 74.3% at 8 hours, primarily due to a higher proportion of minor errors (42.9% and 25.7%, respectively). For K. pneumoniae , the categorical agreement for all five antibiotics was greater than 90% at both time points. Conclusion: According to the CLSI-M52 standards, the detection performance of EUCAST RAST at 4h, 6h, and 8h was equivalent to that of Vitek 2. Except for ciprofloxacin in E. coli , the readable rates and categorical agreement of all antibiotics are good at 6h. For the optimal breakpoints we have established, all antibiotics except for CSL against E. coli achieve a categorical agreement of over 90%.
