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CDC definitions of nosocomial infections
... This includes bloodstream infection, respiratory tract infection, urinary tract infection, and skin and soft tissue infection, as defined by the Centers for Disease Control and Prevention. [18,19] Colonization was defined as the isolation of P. aeruginosa from any clinical specimens in the absence of signs or symptoms of infections. [20] Microbiological responses were defined as follows: (a) successful (negative culture on repeat culture after 72 hours on therapy); (b) failure (persistent isolation at the site of infection); (c) new infection (found new organism at the site of infection); and (d) indeterminate (absence of subsequent culture to assess microbiological response). ...
... [28] Previously, studies had identified a few risk factors, including comorbidities (such as COPD and diabetes mellitus), ICU stays, prior hospitalizations, lengthy hospital stays, use of devices (such as central venous catheters and mechanical ventilators), and prior antipseudomonal exposure (e.g., cephalosporins, carbapenems, quinolones), that are linked to the development of MDR-PA. [10,19] Based on our findings, the independent risk factors that contribute to MDR-PA include age, genitourinary disorder and central venous catheter. Our study showed an independent association between age and MDR-PA, in concordance with a case-control study conducted in France. ...
... Antimicrobial treatment failure was observed in MDR-PA, which was similar to that observed in a previous study conducted in Bangkok, Thailand. [19] The low rates of microbiological clearance in this study could also be attributed to the small number of repeat cultures taken to determine successful eradication. In MDR, one of the main consequences is inadequate empirical antibiotic therapy resulting in the persistence of MDR-PA infection. ...
Background
Increasing trend and spread of multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical settings is a great challenge in managing patients with infections caused by this pathogen.
Objective
To determine the risk factors and outcomes of MDR-PA acquisition in the northeastern state of Malaysia. In addition, this study also reported on the susceptibility pattern and common resistant genes among MDR-PA.
Materials and Methods
MDR-PA isolates obtained between March 2021 and February 2022 from all four major hospitals in the state of Kelantan, Malaysia, were submitted for susceptibility and resistant genes identification. The clinical data of the patients with MDR-PA were retrospectively reviewed. The risk factors and outcomes of MDR-PA acquired patients were analyzed by comparing with patients who acquired susceptible-PA while admitted to the same hospital during the study time.
Results
A total of 100 MDR-PA and 100 susceptible-PA cases were included. Ceftolozane–tazobactam was susceptible in 41.3% of MDR-PA compared to only 4%–8% with other β-lactams. About half (46%) of the MDR-PA isolates harbored the bla -NDM-1 gene, but none had the bla -OXA-48 gene. Factors independently associated with MDR-PA acquisitions were age (OR: 1.02; P = 0.028), genitourinary disorder (OR: 6.89; P = 0.001), and central venous catheter (OR: 3.18; P = 0.001). In addition, MDR-PA acquisitions were found to be associated with antimicrobial treatment failure (41.1% vs. 25.0%; P = 0.001) and mortality (40.0% versus 6.0%; P <0.001).
Conclusion
Most of the MDR-PA strains in Kelantan tertiary hospitals harbored the bla -NDM-1 gene, which is easily transmissible and can lead to an outbreak. Nonetheless, a significant number of the MDR-PA isolates were still susceptible to ceftolozane–tazobactam.
... ARMs were classified according to the definition provided by the Krickenbeck classification [7]. SSI was diagnosed according to the definitions of the Centers for Disease Control and Prevention guidelines [8,9]. Cases involving reoperations in the anal region, cloaca, and those in which only a colostomy was performed without reconstruction of the anus, even during the initial surgery for an ARM, were excluded from the study. ...
... Similarly, perioperative factors listed in Table 1, such as intestinal preparation, American Society of Anesthesiologists classification, intraoperative blood loss, postoperative lower limb immobilization, timing of bougie use, and initiation of oral intake, were not found to influence the incidence of SSIs. However, age at surgery tended to be associated with SSIs (2 [0-6] vs 11 [6][7][8][9][10][11][12][13][14][15][16][17][18] months, p = 0.05) (Fig. 1). ...
Purpose
This study aimed to identify surgical site infection (SSI) risk factors after anal reconstruction surgery in patients with anorectal malformations (ARMs).
Methods
This retrospective analysis from January 2013 to December 2022, including all pediatric surgical facilities in Hokkaido, Japan, examined consecutive patients with ARMs, excluding cloacal cases, regarding perioperative and SSI factors during their initial anal reconstruction surgeries.
Results
This study involved 157 cases of major clinical groups and 7 cases of rare/regional variants, among whom 4% developed SSIs. SSIs occurrence varied by type and was primarily observed from the neo-anus to the perineal region. Organ/space SSIs occurred in rectourethral fistula (prostatic/bulbar) and perineal (cutaneous) fistula type. Surgical procedures were abdominal sacroperineal rectoplasty, posterior sagittal anorectoplasty, laparoscopic-assisted anorectal pull-through, cutback anoplasty, and Pott’s anoplasty, varied based on the ARM type and facility. In perineal (cutaneous) fistula, vestibular fistula, and anal stenosis cases, a significant association was observed between perianal muscle division and SSIs in patients aged > 4 months (p = 0.04). No significant SSI factors were found in other ARM types.
Conclusion
The choice of procedure as an interventional perioperative factor is suggested to be associated with SSIs. These findings may contribute to making informed decisions regarding surgical procedures in such cases.
... Variables related to the BSI episode included the source of the BSI (e.g., primary, catheter, respiratory, gastrointestinal, as defined by the primary team. 16 ), hospital-or communityacquired infections (i.e., cultures obtained <48 or >48 h after admission, respectively [16][17][18][19], mechanical ventilation (yes/no), and antibiotic usage measured in daily defined doses (DDD per 1000 hospital bed-days) per antibiotic family adhering to WHO ATC/DDD index standards and adjusted for frequency and dosage. 20 We used antibiotic usage for descriptive statistics and costs. ...
... We adopted a widely used threshold of 48 h for consistency and comparability with prior research. [16][17][18][19] Our study revealed a substantial health and economic burden associated with ARB BSIs in Chile, highlighting the need for enhanced infection prevention and control measures. Strengthening antibiotic stewardship programs and integrating surveillance systems are crucial in addressing this challenge. ...
Background
Antibiotic-resistant bloodstream infections (ARB BSI) cause an enormous disease and economic burden. We assessed the impact of ARB BSI caused by high- and critical-priority pathogens in hospitalised Chilean patients compared to BSI caused by susceptible bacteria.
Methods
We conducted a retrospective cohort study from 2018 to 2022 in three Chilean hospitals and measured the association of ARB BSI with in-hospital mortality, length of hospitalisation (LOS), and intensive care unit (ICU) admission. We focused on BSI caused by Acinetobacter baumannii, Enterobacterales, Staphylococcus aureus, Enterococcus species, and Pseudomonas aeruginosa. We addressed confounding using propensity scores, inverse probability weighting, and multivariate regressions. We stratified by community- and hospital-acquired BSI and assessed total hospital and productivity costs.
Findings
We studied 1218 adult patients experiencing 1349 BSI episodes, with 47.3% attributed to ARB. Predominant pathogens were Staphylococcus aureus (33% Methicillin-resistant ‘MRSA’), Enterobacterales (50% Carbapenem-resistant ‘CRE’), and Pseudomonas aeruginosa (65% Carbapenem-resistant ‘CRPA’). Approximately 80% of BSI were hospital-acquired. ARB was associated with extended LOS (incidence risk ratio IRR = 1.14, 95% CI = 1.05–1.24), increased ICU admissions (odds ratio OR = 1.25; 1.07–1.46), and higher mortality (OR = 1.42, 1.20–1.68) following index blood culture across all BSI episodes. In-hospital mortality risk, adjusted for time-varying and fixed confounders, was 1.35-fold higher (1.16–1.58) for ARB patients, with higher hazard ratios for hospital-acquired MRSA and CRE at 1.37 and 1.48, respectively. Using a societal perspective and a 5% discount rate, we estimated excess costs for ARB at 9.6 (5.0–16.4) million.
Interpretation
It is urgent to develop and implement interventions to reduce the burden of ARB BSIs, particularly from MRSA and CRE.
... We defined the occurrence of ventriculitis as previously described [17,18]. In short, we defined ventriculitis as (i) the presence of pathogens in CSF culture or (ii) the presence of at least one of the following clinical findings and one of the following CSF findings: headache, meningism or cranial nerve signs, and increase in CSF white blood cell (WBC) count or TP, decreased serum-to-CSF glucose ratio or evidence of pathogen in the CSF either by positive culture, positive antigen test or an increased specific antibody titer. ...
... Of 411 patients with SAH, a total of 183 met the inclusion criteria and were included in the study ( Figure 1). Demographic, clinical, laboratory and imaging characteristics are given in Table 1 Inherently to our study design (i.e., necessity for CSF sampling), included patients were clinically more affected (Hunt & Hess Score at ICU admission: 4 [3][4][5] vs. 2 [1][2][3]; p < 0.001) and had higher Hijdra ventricle (5 [2][3][4][5][6] vs. 1 [0-3]; p < 0.001) and Hijdra sum (18 [12][13][14][15][16][17][18][19][20][21][22][23] vs. 10 [5][6][7][8][9][10][11][12][13][14][15][16][17]; p < 0.001) and modified Fisher scores (4 [3][4] vs. 3 [2][3][4]; p < 0.001) than excluded patients. Furthermore, included patients had higher mRS scores at ICU discharge (4 [3][4][5] vs. 1 [1][2][3][4][5]; ...
Background and Purpose
Prognostication in patients with spontaneous subarachnoid hemorrhage (SAH) can be challenging. The aim of this study was to assess whether cerebrospinal fluid (CSF) red blood cell (RBC) count and total protein (TP) concentration are associated with SAH prognosis.
Methods
Patients with SAH treated at the neurological intensive care unit (ICU) in Innsbruck were included in this real‐world, observational study. Longitudinal CSF samples were collected as part of routine diagnostics. RBC count and CSF TP at the time of admission (RBCfirst, TPfirst), in Week 1 (RBCDays1–7, TPDays1–7), Week 2 (RBCDays8–14, TPDays8–14), and Week 3 or thereafter (RBCDay>14, TPDay>14), the highest detected value (RBChighest, TPhighest), as well as the RBC count adjusted for disease duration (RBCadjusted) were assessed. Primary outcomes were good functional outcome after 3 months, defined as modified Rankin scale score ≤2 and ICU survival.
Results
A total of 183 SAH patients with a female predominance (69%), a median (interquartile range [IQR]) age of 60 (50–70) years and median (IQR) Hunt and Hess score of 4 (3–5) were included. Multivariable analyses revealed that lower values of RBCfirst, RBCadjusted, RBChighest, TPfirst and TPhighest were associated with good functional outcome and hospital survival. Lower TP concentrations in Weeks 1, 2 and 3 were associated with good functional outcome, and in Weeks 1 and 2 with ICU survival. Early RBC measurements (Week 1) were associated with good functional outcome and ICU survival.
Conclusions
Low CSF RBC counts and TP concentrations were associated with good functional outcome and ICU survival in a real‐world cohort of SAH patients requiring external ventricular drainage.
... Major bleeding was defined as requiring at least 2 units of packed red blood cells due to an obvious hemorrhagic event, necessitating a surgical or interventional procedure, resulting in an intracerebral hemorrhage, or causing a fatal outcome. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) stages 1 or 2. Nosocomial infection definitions were consistent with those of the Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance System [10]. ...
... Details of patient characteristics at the time of ICU admission and before the initiation of ECMO are summarized in Table 1 and eFile 2. The SOFA score before ECMO initiation was 12 (10)(11)(12)(13)(14)(15). VV-ECMO was used in 86% of cases, with a median partial pressure of arterial oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 ) ratio of 69 (IQR 55-82) and a median plateau pressure of 30 cmH 2 O (IQR 29-34 cmH 2 O). ...
Objective
To report the outcomes of patients with severe tuberculosis (TB)-related acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO), including predictors of 90-day mortality and associated complications.
Methods
An international multicenter retrospective study was conducted in 20 ECMO centers across 13 countries between 2002 and 2022.
Results
We collected demographic data, clinical details, ECMO-related complications, and 90-day survival status for 79 patients (median APACHE II score of 20 [25th to 75th percentile, 16 to 28], median age 39 [28 to 48] years, PaO2/FiO2 ratio of 69 [55 to 82] mmHg before ECMO) who met the inclusion criteria. Thoracic computed tomography showed that 61 patients (77%) had cavitary TB, while 18 patients (23%) had miliary TB. ECMO-related complications included major bleeding (23%), ventilator-associated pneumonia (41%), and bloodstream infections (32%). The overall 90-day survival rate was 51%, with a median ECMO duration of 20 days [10 to 34] and a median ICU stay of 42 days [24 to 65]. Among patients on VV ECMO, those with miliary TB had a higher 90-day survival rate than those with cavitary TB (90-day survival rates of 81% vs. 46%, respectively; log-rank P = 0.02). Multivariable analyses identified older age, drug-resistant TB, and pre-ECMO SOFA scores as independent predictors of 90-day mortality.
Conclusion
The use of ECMO for TB-related ARDS appears to be justifiable. Patients with miliary TB have a much better prognosis compared to those with cavitary TB on VV ECMO.
Supplementary Information
The online version contains supplementary material available at 10.1186/s13054-024-05110-y.
... Repeated episodes were excluded and only a first bacteremic episode for each patient was included. Hospital-acquired infection was defined as a bacteremia with S. aureus more than 48 hours after hospital admission 15 . S. aureus bacteremia that developed in patients who did not receive healthcare recently were defined as community-acquired bacteremia 16 . ...
... The median time between SARS-CoV-2 PCR results and positive bacterial culture was 13 (5-30) days. The median time from obtaining blood culture to time of positive signal was 11.5 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) hours. The median time from blood culture to empiric antibiotic initiation (IQR) was 6 (3-12) hours. ...
Aim:
In this study, we aimed to determine associated factors for mortality in patients with S. aureus bacteremia and to explore the impact of prior COVID-19. Design and setting: In this retrospective and single-center study, all adult patients (≥ 18 years old) with S. aureus bacteremia between March 2020 and February 2022 were included.
Methods:
The outcomes of our study were 14-day and 28-day hospital mortality after the first positive blood culture was obtained. Univariate and Cox regression analyses were performed.
Results:
A total of 140 patients with S. aureus bacteremia were included in the study. The median age was 64.5 (48.5-76) and 82 (58.5%) of the patients were male. 14-day and 28-day mortality rates were 28.6% and 37.1% respectively. Among patients with S. aureus bacteremia and previous COVID-19 history, 14-day and 28-day mortality rates were 33.9% (n = 21) and 41.9% (n = 26), respectively. Cox regression analysis revealed that Pitt bacteremia score, AST, urea, and previous antibiotic use were associated factors for 14-day mortality and 28-day mortality due to S. aureus bacteremia.
Conclusions:
This study justified the remarkable fatality of S. aureus bacteremia during the COVID-19 pandemic period and revealed that a high Pitt bacteremia score, increased levels of AST and urea, and previous antibiotic exposure were associated factors for mortality in patients with S. aureus bacteremia.
... One RCT [48] employed a definition with CDC/NHSN-recommended clinical signs for patients ≤ 1 years of age, despite excluding patients < 18 years of age [34,66]. Other articles [16,42] cited an outdated version of the CDC definition [71] as the source for their employed definition, despite more recent versions [34,66,72] being available to them at the time of their writing. Nevertheless, arguments for or against any specific definition inevitably remains based on expert opinion because trials comparing the performance of different definitions [9,28] are limited by having to choose a definition to serve as a "true positive". ...
Despite being a common, well-recognized and important complication to External Ventricular Drainage (EVD), a consensus definition for Ventriculostomy Related Infections (VRI) has not yet been established. We conducted a review to qualitatively assess definition heterogeneity and objectivity among Randomized Controlled Trials (RCTs); and investigated systematic reviews, meta-analyses, and reviews of the literature for definition citation accuracy and common methodological approaches and points of discussion related to VRI definitions. RCTs were grouped into arbitrarily chosen infection rate brackets to examine the hypothesized correlation between broader definitions and higher infection rates in RCTs. A literature search was conducted via Ovid in the Embase, MedLine and Cochrane databases from all years until the 8th of January 2025. Using Covidence, two authors (MH, AA) independently evaluated records, including studies that had ≥ 1 VRI definitions and numerical VRI rates. We identified 12 definitions in 13 RCTs, documenting pronounced disagreement. Cumulative rates for “definitive” VRI (8.4%) were lower than “suspected” VRI (13.5%). Qualitatively assessed, studies with narrow definitions presented lower VRI rates. All 17/17 meta-analyses and systematic reviews, and 15/19 literature reviews cited ≥ 1 definition inaccurately. Trial results may change based on definition choice. Definition heterogeneity was not sufficiently accounted for in meta-analyses. All literature-based studies were confounded by definition heterogeneity. Previously reported findings based on meta-analytical methodologies may be invalid, and inaccurately presented definitions could give a false impression of trial comparability. A consensus set of definitions are necessary to allow comparison between studies, and should be constructed to account for the intended use since sensitivity and specificity may have different weight depending on the context.
... Community-acquired infection refers to an infection that was acquired outside the hospital or within 48 hours after admission. Hospital-associated infection was defined as an infection that occurred more than 48 hours after a patient was admitted to the hospital (18) . Inappropriate antibiotic treatment could be classified into two categories, undertreatment and overtreatment. ...
... Infections were classified as described by Al Muderis et al. [2] as follows: (1) low-grade soft tissue infection, (2) highgrade soft tissue infection, (3) bone infection, and (4) septic implant failure. Complications occurring between surgical stages, such as surgical site infections when there was twostage surgery, were also recorded separately and described [29]. Complications were classified as minor or moderate/ severe [8,48] (Supplemental Table 2; http://links.lww. ...
Background
Many patients with a lower limb socket-suspended prothesis experience socket-related problems, such as pain, chronic skin conditions, and mechanical problems, and as a result, health-related quality of life (HRQoL) is often negatively affected. A bone-anchored prosthesis can overcome these problems and improve HRQoL, but these prostheses have potential downsides as well. A valid and reliable tool to assess potential candidates for surgery concerning a favorable risk-benefit ratio between potential complications related to bone-anchored prostheses and improvements in HRQoL is not available yet. Having this information may inform treating physicians and patients when deciding whether to pursue bone-anchored prostheses.
Questions/purpose
In this study, we asked: (1) What is the difference in HRQoL at 6, 12, and 24 months among patients who underwent lower limb bone-anchored prosthesis treatment after using a socket-suspended prosthesis preoperatively? (2) What factors are associated with change in HRQoL 24 months after lower limb bone-anchored prosthesis treatment? (3) Which complications occurred within 24 months after lower limb bone-anchored prosthesis treatment? (4) What factors are associated with minor to severe complications within 24 months after lower limb bone-anchored prosthesis treatment?
Methods
A total of 206 patients who underwent lower limb bone-anchored prosthesis treatment (femoral or tibial) at the Radboud University Medical Center between May 2014 and September 2020 were included in this study. Of those, 8% (17 of 206) were lost to follow-up at 24 months without meeting a study endpoint (not attending the clinic unrelated to the bone-anchored prosthesis, re-amputation), and another < 1% (1 of 206) died prior to 24 months, leaving 92% (189 of 206) of the original group who had a follow-up time of at least 24 months. The mean ± SD age was 54.3 ± 12.7 years, and 72% were men. Amputation levels included 64% (139 of 218) transfemoral amputation, 3% (7 of 218) knee exarticulation, 32% (70 of 218) transtibial amputation, 0.5% (1 of 218) foot amputation, and 0.5% (1 of 218) osseointegration implant after primary amputation. Causes of amputation included 52% (108 of 206) trauma, 8% (17 of 206) oncology, 19% (38 of 206) dysvascular, 12% (25 of 206) infection, 1% (2 of 206) congenital, and 8% (16 of 206) other. Primary outcomes were generic HRQoL (Short-Form 36 health survey mental component summary [MCS] and physical component summary [PCS] scores), disease-specific HRQoL (Questionnaire for Persons with a Transfemoral Amputation global score), and complication occurrence (infection, implant complications such as loosening or breakage, stoma-related problems, periprosthetic fracture, and death). Multivariable multiple regression was used to develop association models. These models demonstrated which group of characteristics were associated with change in HRQoL at 24 months of follow-up and occurrence of complications within 24 months of follow-up. Assessments were carried out at baseline (preoperative while using a socket-suspended prosthesis) and after 6, 12, and 24 months of bone-anchored prosthesis use.
Results
Generic HRQoL PCS score improved 25% (β 9 [95% confidence interval (CI) 7 to 11]) at 6 months and maintained that improvement at the 12-month (β 9 [95% CI 7 to 11]) and 24-month (β 8 [95% CI 7 to 10]) follow-up visit compared with baseline (p < 0.001). The generic HRQoL MCS score did not change compared with baseline. Disease-specific HRQoL improved 77% (β 30 [95% CI 25 to 34]), 85% (β 33 [95% CI 28 to 37]), and 72% (β 28 [95% CI 24 to 33]) at 6-month, 12-month, and 24-month follow-up, respectively, compared with baseline (p < 0.001). Patients with the following group of characteristics were more likely to experience a better physical generic HRQoL at 24 months of follow-up: younger patients with a lower physical generic HRQoL, and a traumatic cause of amputation combined with a lower activity level. Patients with the following group of characteristics were more likely to experience a better disease-specific HRQoL at 24 months of follow-up: dysvascular cause of amputation, lower prosthetic comfort combined with a lower activity level, and lower prosthetic comfort combined with a lower or higher activity level. In addition, patients with an average mobility level were more likely to experience less improvement in disease-specific HRQoL at 24 months of follow-up. Infections were the most common complications in the total cohort (116 events in 206 patients), of which the majority consisted of soft tissue infections (98% [114 of 116]). Bone infection did not occur. Septic implant loosening occurred in 1% (2 of 214) of total implants (3% [2 of 66] of tibial implants), both treated with transfemoral amputation. Younger and higher functioning patients had the lowest risk of minor complications within 24 months of follow-up. Women, older patients, patients with a lower activity level, and older patients with more time since amputation had the highest risk of minor complications within 24 months of follow-up. Patients with a higher disease-specific HRQoL had the highest risk of moderate or severe complications within 24 months of follow-up.
Conclusion
In agreement with earlier research, this study confirmed that generic HRQoL and disease-specific HRQoL improved after bone-anchored prosthesis use. Additionally, this study confirmed that bone-anchored prosthesis has a relatively low likelihood of severe complications but with a high occurrence of minor complications. These were often successfully treated with nonsurgical interventions. Patients who have a favorable risk-benefit ratio between improvements in HRQoL and potential treatment-related complications are most eligible for a bone-anchored prosthesis. These findings may be helpful to patients and treating physicians to aid in patient selection and to inform patients about potential short-term expectations of treatment.
Level of Evidence
Level III, therapeutic study.
... Urine analysis included microscopy [10], Gram stain [11] and culture [12,13]. Clinical and laboratory criteria for definition of NUTI were based on the CDC criteria 1988 [14]. ...
Nosocomial urinary tract infections (NUTI) are one of the commonest infections in a Pediatric Intensive Care Unit (PICU).
This prospective study was conducted in PICU between January and December 2008 to study the incidence, organisms and risk
factors for NUTI. A total of 287 consecutive patients with >48 h PICU stay and sterile admission urine culture, were enrolled
and monitored for NUTI (defined as per CDC criteria 1988) till discharge or death. Patients with and without NUTI were compared
with respect to demographics, PRISM scores, primary diagnosis, nutritional status and device utilization to identify risk
factors. Outcome was defined as length of PICU stay and survival or death. There were 69 episodes of UTI in 60 (20.9%) patients;
incidence being 18 episodes/1000 patient days. Candida (52.1%) and Enterococcus (13%) were commonest followed by Escherichia coli (11.6%) and Klebsiella pneumoniae (10.1%). Catheterization and duration of catheterization were the risk factors for NUTI (p < 0.001). The median length of PICU stay was significantly longer in NUTI group compared to non-NUTI group (19 vs. 8 days,
p = 0.001). Mortality rates in both the groups were similar.
... Developing countries are reported to have up to 20 times the risk of contracting a nosocomial infection when compared with developed countries [1]. The British Medical Association (BMA) in 2006 recognizes that the occurrence of nosocomial infections, while not new, is to some degree inevitable in any primary, community or secondary healthcare setting [7]. The importance of nosocomial infection lies not solely on its ability to largely alter its proportion of spread and death rate, but also in its economic inferences. ...
... Data from index ED admission was collected in a confidential Excel spreadsheet. Bacteremia is defined by the Centers for Disease Control as a positive blood culture with viable bacteria in the patient's bloodstream [13]. The primary outcome was 28-day all-cause mortality. ...
Background
Bacteremia, a common emergency department presentation, has a high burden of mortality, cost and morbidity. We aimed to identify areas for potential improvement in emergency department bacteremia management.
Methods
This retrospective cohort study included adults with bacteremia in an emergency department in 2019 and 2022. The primary outcome was 28-day mortality. Descriptive analyses evaluated demographics, comorbidities and clinical characteristics. Univariate and multivariate analyses identified mortality predictors.
Results
Overall, 433 patients were included [217 males (50.1%), mean ± SD age: 74.1 ± 15.2 years]. The 28-day mortality rate was 15.2% (n = 66). In univariate analysis, age ≥ 70 years, arrival by ambulance, arrhythmia, congestive heart failure, recent steroid use, hypotension (< 90/60 mmHg), mechanical ventilation, cardiac arrest, intensive care unit (ICU) admission, intravenous antibiotics, pneumonia as bacteremia source, non-urinary tract infections, no infectious disease consultation, no antibiotic adjustment and no control blood cultures were significantly associated with 28-day mortality (p < 0.05). Malignancy showed a statistical trend (0.05 < p < 0.15). The above-stated sixteen variables, identified in univariate analysis, were assessed via multivariate analysis. Primarily, clinical relevance and, secondarily, statistical significance were used for multivariate model creation to prioritize pertinent variables. Five risk factors, significantly associated with mortality (p < 0.05), were included in the model: ICU admission [adjusted OR (95% CI): 6.03 (3.08–11.81)], pneumonia as bacteremia source [4.94 (2.62–9.32)], age ≥ 70 [3.16 (1.39–7.17)], hypotension [2.12 (1.02–4.40)], and no infectious disease consultation [2.02 (1.08–3.78)]). Surprisingly, initial antibiotic administration within 6 h, inappropriate initial antibiotic regimen and type of bacteria (Gram-negative, Gram-positive) were non-significant (p > 0.05).
Conclusions
We identified significant mortality predictors among emergency department patients presenting with bacteremia. Referral to an infectious disease physician is the only modifiable strategy to decrease 28-day mortality with long-term effect and should be prioritized.
... 20 patients with nosocomially-acquired Legionella pneumonia (NALP), and 26 patients with community-acquired Legionella pneumonia (CALP) were included in the study. We applied the Centers for Disease Control (CDC) [7] and the World Health Organization (WHO) [8]. criteria for diagnosis both of nosocomial infection and Legionella pneumonia. ...
... En recién nacidos, las definiciones de los Centers for Disease Control and Prevention (CDC) de Estados Unidos &SHY;las más aceptadas y habitualmente empleadas por la comunidad científica&SHY; consideran nosocomiales a las infecciones que se adquieren al nacer como resultado del paso por el canal del parto, pero no a las contagiadas por vía transplacentaria. (3,4,5) Los recién nacidos (RN) tienen menos capacidad de respuesta frente a las infecciones. En estos pacientes existen características especiales en el sistema inmunitario que motivan una mala capacidad de localización de estas infecciones y un deficiente defensa de forma general. ...
... Nosocomial infections, sometimes referred to as hospital-acquired infections, are illnesses that patients get while undergoing medical care; they are usually not present when they are admitted [1] . Intensive care units (ICUs) have a 2-5 times higher infection rate than the overall inpatient population, indicating a notable increase in the prevalence of these illnesses there [2] . ...
... Diagnostic criteria for HAI were based on U.S.A. Centers for Disease Control and Prevention diagnostic criteria [10]. We obtained blood, wound, tracheal aspirate, and/or urine samples for culture from patients who were suspected of infection according to clinical, radiological, and laboratory findings. ...
Introduction: Healthcare-associated infections (HAIs) are common in intensive care unit (ICU) patients and may cause devastating consequences. However, the prevalence of HAI and its effects on in-hospital mortality among critically ill COVID-19 patients is ambiguous. We determined the prevalence of HAI and the rate of mortality in critically ill COVID-19 patients and compared it with pre-pandemic ICU patients. Methodology: This retrospective study was conducted with adult ICU patients admitted to Gazi Yaşargil Training and Research Hospital (Diyarbakir,Turkey) in April-November 2019 (defined as the pre-pandemic period) and in April-November 2020 (defined as the pandemic period). All patients in the pandemic period had COVID-19, while none in the pre-pandemic period did. Patients diagnosed with HAIs during the in-hospital follow-up period were recorded. Results: Of 4596 enrollees, 3386 (73.7%) were pandemic-period patients and 1210 (26.3%) were pre-pandemic-period patients. HAI prevalence was significantly higher at 5.9% (n = 71) in the pandemic-period patients and 2.7% (n = 91) in the pre-pandemic-period patients (p < 0.001). Comorbidities including hypertension (63.4% vs 14.2%, p < 0.001), diabetes mellitus (39.4% vs 8.8%, p < 0.001), and coronary artery disease (30.9% vs 10.9%, p = 0.002) were significantly more frequent in pandemic-period HAI-positive patients. The most common HAI was catheter-related bloodstream infection in both groups, with similar frequency (p = 0.652). In-hospital mortality rate was 85.9% versus 65.9% in pandemic- versus pre-pandemic-period HAI-positive patients (p < 0,05). Conclusions: The prevalence of HAI and the in-hospital mortality rate was significantly higher among pandemic-period patients.
... A microbiologically documented infection (MDI) included either bacteremia or a defined site of infection with or without positive blood cultures. Different infection foci were defined according to The Centers for Disease Control definitions (CDC) [42]. Mucositis with a World Health Organization (WHO) score > 2 and diarrhea with a frequency of more than 8 times a day were considered clinically documented infections [39]. ...
Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a lifesaving treatment but carries a high infection risk. Diagnosing infections remains challenging due to the limited accuracy of standard biomarkers. Methods: This single-center study aimed to evaluate presepsin (PSP) and YKL-40 as infection biomarkers in febrile patients during the allo-HSCT pre-engraftment phase. Biomarker levels were prospectively measured in 61 febrile episodes from 54 allo-HSCT patients at admission, representing baseline levels, and then at Day 1, 3, 5, and 7 following fever onset. The diagnostic value was compared to that of procalcitonin (PCT). Results: PSP showed fair diagnostic value on Day 1 (AUC 0.656; 95% CI: 0.510–0.802) and Day 3 (AUC 0.698; 95% CI: 0.559–0.837). YKL-40 did not provide any significant diagnostic value across measured time points. PCT outperformed PSP and YKL-40, particularly on Day 3 (AUC 0.712; 95% CI: 0.572–0.852). When combining biomarkers, the best model for predicting infection used PSP > 3.144 ng/mL and PCT > 0.28 μg/L on Day 3, resulting in R² of about 31% (p < 0.001). Conclusions: Neither test showed sufficient discriminative power for early infection to recommend their use as individual diagnostic tools in clinical practice.
... Polymicrobial BSI was defined as the isolation of more than one microbial species in the same BSI episode. On the basis of the isolation of etiologic pathogens and/or clinical diagnoses, a patient was allocated to one of the BSI sources, following previously established concepts [13,14]. The severity of BSI onset was graded using a Pitt bacteremia score (PBS) [2,15]. ...
Purpose
Misdiagnosis or delayed diagnosis of paravertebral and/or iliopsoas abscess (PVIPA) has been frequently reported to be associated with unfavorable prognosis. We aimed to develop a scoring algorithm that can easily and accurately identify patients at greater risk for PVIPA among individuals with community-onset bloodstream infections.
Methods
In a multicenter, retrospective cohort study, the score was developed with the first four study years and validated with the remaining two years. Applying logistic regression, the score values of prediction determinants were derived from the adjusted odds ratios (AOR). The performance of the scoring algorithm was assessed with the receiver operating characteristic (ROC) curve.
Results
In the derivation (3869 patients) and validation (1608) cohorts, patients with PVIPA accounted for 1.7% and 1.4%, respectively. In the derivation cohort, five independent predictors of PVIPA were recognized using multivariable analyses: time-to-defervescence > 5 days (AOR, 7.00; 2 points), Panton-Valentine Leukocidin (PVL)-producing Staphylococcus aureus (AOR, 5.98; 2 points), intravenous drug users (AOR, 2.60; 1 points), and comorbid hemato-oncology (AOR, 0.41; -1 point) or liver cirrhosis (AOR, 2.56; 1 points). In the derivation and validation cohorts, areas under ROC curves (95% confidence intervals) of the prediction algorithm are 0.83 (0.77–0.88) and 0.85 (0.80–0.90), and a cutoff score of + 2 represents sensitivity of 83.3% and 95.7%, specificity of 68.6% and 67.7%, positive predictive values of 4.4% and 4.1%, and negative predictive values of 99.6% and 99.9%, respectively.
Conclusions
Of a scoring algorithm with substantial sensitivity and specificity in predicting PVIPA, PVL-producing S. aureus and Time-to-defervescence > 5 days were crucial determinants.
... The patients were regularly monitored for signs of surgical site infection; both during the hospital stay and at outpatient follow-up, based on Centers for Disease Control and Prevention (CDC) criteria. [13] Clinical suspicion of infection necessitated operative intervention, during which, deep intraoperative cultures were sent to isolate the microorganism. Isolation of the infecting microorganisms guided antibiotic management in patients with infected open fractures. ...
Introduction
Recent literature suggests a significant risk of infection by Gram-negative bacilli (GNB) in open Grade III fractures. Our prospective study aimed to identify the rate of infection with multidrug-resistant GNB (MDR-GNB) in open Grade III fractures and also study its clinical outcome.
Materials and Methods
A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long-bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics, and index procedure were noted. Length of hospital stay, number of additional surgeries, and occurrence of complications were also noted. In infected open fractures, bacteriology and resistance pattern of the isolated microorganism were noted. Clinical outcomes of all included study patients were measured at 9 months.
Results
A total of 231 patients with 275 open fractures involving femur, tibia, or fibula were studied. There was clinical suspicion of infection in 84 patients (36.4%) with 99 fractures (36%). Culture was positive in 43 patients (51.2%). MDR-GNB infection was seen in 19 patients representing 8.2% of all included study patients. Patients with MDR-GNB infection required a significantly higher percentage of additional surgical procedures than patients with non-MDR-GNB infection (2.2% vs. 0.8%, P < 0.0001) and had a lower return to work status (5.3% vs. 30.7%, P = 0.03), suggesting MDR-GNB infections have a worse outcome.
Conclusion
Our study showing a high rate of MDR-GNB infection in open fractures highlights the therapeutic challenges involved in treating this nosocomial problem. MDR-GNB infection in open fractures is a serious cause of morbidity and poor outcome.
... A patient with at least 1 of the following signs or symptoms: fever (>38°C), chills, or hypotension and signs and symptoms and positive laboratory results are not related to an infection [14]. ...
... Severe sepsis and septic shock were defined according to the International Pediatric Sepsis Consensus [9]. Hospital-acquired infection was defined according to the Centers for Disease Control and Prevention (CDC) criteria [10]. The vasoactive inotrope score (VIS) was used as a measure of cardio-vascular support [11]. ...
To assess the association between monocytic Human Leukocyte Antigen-DR (mHLA-DR) expression and outcome in children with severe sepsis.
Consecutive children, aged 29 days to 15 years, who were admitted with severe sepsis or septic shock in the pediatric intensive care unit (PICU) were enrolled. mHLA-DR expression [antigen bound per cell (ABC)] was assessed on two time points: between 72 to 120 hours (P1) and 121 to 168 hours (P2), of stay in PICU and the difference between the two was calculated as delta mHLA-DR. Outcomes were noted for survival, mortality and secondary infection during the hospital stay.
Forty-seven children with median (IQR) age 24 (10, 96) months and a median (IQR) duration of illness of 3 (3, 5) days, were enrolled consecutively. Pediatric Logistic Organ Dysfunction (PELOD) score >10 was observed in 63.8% children. 18 children succumbed. The median mHLA-DR levels (ABC) at P1 were significantly higher in children who survived as compared with those who expired (7409 vs. 2509, P = 0.004). Similarly, the median mHLA-DR levels (ABC) at P2 were higher in those who survived than the expired group (14728 vs. 2085, P = 0.001). The median delta mHLA-DR levels (ABC) were 4574 and 309 for the survived and expired group, respectively (P = 0.012). mHLA-DR at P1 (P = 0.004), mHLA-DR at P2 (P = 0.001) and delta mHLA-DR (P = 0.012) was significantly associated with mortality but not associated with secondary infection. A negative correlation was observed between PELOD score and mHLA-DR at P1 (r = −0.25, P = 0.46), at P2 (r = −0.425, P = 0.018) and delta mHLA-DR (r = −0.27, P = 0.41). The area under curve (95%CI) of mHLA-DR expression (ABC) at P2 for a cutoff of < 6631 was 0.966 (0.907, 1.0) to predict mortality in severe sepsis.
mHLA-DR levels were significantly lower in children who succumbed than those who survived at both time points. mHLA-DR levels can be a useful biomarker to diagnose immune-paralysed state.
... During our investigation period, 30% of the patients developed infections 3 days after their admission in hospital ICU, and therefore, it was declared that they had nosocomial infection. 13 The pattern of nosocomial infection was statistically insignificant among the gender and age groups. It was observed that nosocomial infection developed in every Therapy changed after CST patient who was not administered empiric antibiotic therapy (P=0.0002), as shown in Table 2. ...
Background: Intensive care units (ICUs) are specialized units where patients with critical conditions are admitted for getting specialized and individualized medical treatment. High mortality rates have been observed in ICUs, but the exact reason and factors affecting the mortality rates have not yet been studied in the local population in Pakistan.
Aim: This study was aimed to determine rational use of antibiotic therapy in ICU patients and its impact on clinical outcomes and mortality rate.
Methods: This was a retrospective, longitudinal (cohort) study including 100 patients in the ICU of the largest tertiary care hospital of the capital city of Pakistan.
Results: It was observed that empiric antibiotic therapy was initiated in 68% of patients, while culture sensitivity test was conducted for only 19% of patients. Thirty-percent of patients developed nosocomial infections and empiric antibiotic therapy was not initiated for those patients (P<0.05). Irrational antibiotic prescribing was observed in 86% of patients, and among them, 96.5% mortality was observed (P<0.05). The overall mortality rate was 83%; even higher mortality rates were
observed in patients on a ventilator, patients with serious drug–drug interactions, and patients prescribed with irrational antibiotics or nephrotoxic drugs. Adverse clinical outcomes leading to death were observed to be significantly associated (P<0.05) with irrational antibiotic prescribing, nonadjustment of doses of nephrotoxic drugs, use of steroids, and major drug–drug interactions.
Conclusion: It was concluded that empiric antibiotic therapy is beneficial in patients and leads to a reduction in the mortality rate. Factors including irrational antibiotic selection, prescribing contraindicated drug combinations, and use of nephrotoxic drugs were associated with high mortality rate and poor clinical outcomes.
Keywords: clinical outcomes, mortality rate, intensive care unit, rational use of antibiotics, nosocomial infections, medication review
... The complicated group comprises individuals with risk factors such as those with anatomic or functional abnormalities, urinary catheter users, renal disease, pregnant women, men, and immunodeficiency diseases (7). CDC standard definitions for nosocomial UTIs were used (8). Past UTI history is defined as the previous 12 months before admission, and past antibiotic use and hospitalization are defined as the last three months before admission. ...
OBJECTIVE: Urinary tract infections are common in older adults and associated with significant morbidity and mortality. This study aimed to characterize the clinical features, bacterial etiologies, antimicrobial resistance patterns, and risk factors for mortality in elderly patients hospitalized with urinary tract infection. MATERIAL AND METHODS: Data were retrospectively analyzed from 118 patients aged ≥65 years hospitalized with a diagnosis of urinary tract infection between January 2018 and December 2022. Urinary tract infections were defined according to Centers for Disease Control and Prevention criteria. Isolated microorganisms in urine cultures and antimicrobial resistance rates were determined. Risk factors associated with mortality were evaluated by logistic regression analysis. RESULTS: 50.8% of patients were female; the mean age was 72.5±7.0 years. The most common symptoms were dysuria (65.3%), anorexia (65.3%), and flank pain (57.6%). Forty-nine patients (41.5%) had nosocomial urinary tract infections. All cause in hospital mortality was observed in 48 patients (40.6%), and 22 patients (18.6%) had in-hospital mortality directly related to urinary tract infection. Urosepsis (OR: 13.518, 95% CI: 1.711-106.793, p=0.014), kidney stones (OR: 7.529, 95% CI: 1.596-35.525, p=0.011) and urinary tract infections caused by multidrug-resistant organisms (OR: 18. 612, 95% CI: 1.564-4.283, p<0.001) were independent risk factors for mortality, and appropriate treatment (OR: 0.090, 95% CI: -3.736--1.085, p<0.001) was an independent protective factor for mortality. CONCLUSIONS: Urinary tract infections in elderly adults present with a wide range of symptoms and are predominantly caused by drug-resistant Escherichia coli. Urosepsis and kidney stones are critical determinants of mortality, emphasizing the need for rapid and appropriate management strategies. Understanding the etiology, clinical features, and mortality risk factors of urinary tract infections in elderly adults is crucial for optimizing infection management in this vulnerable population.
... During our investigation period, 30% of the patients developed infections 3 days after their admission in hospital ICU, and therefore, it was declared that they had nosocomial infection. 13 The pattern of nosocomial infection was statistically insignificant among the gender and age groups. It was observed that nosocomial infection developed in every Therapy changed after CST patient who was not administered empiric antibiotic therapy (P=0.0002), as shown in Table 2. ...
Background: Intensive care units (ICUs) are specialized units where patients with critical conditions are admitted for getting specialized and individualized medical treatment. High mortality
rates have been observed in ICUs, but the exact reason and factors affecting the mortality rates have not yet been studied in the local population in Pakistan.
Aim: This study was aimed to determine rational use of antibiotic therapy in ICU patients and its impact on clinical outcomes and mortality rate.
Methods: This was a retrospective, longitudinal (cohort) study including 100 patients in the ICU of the largest tertiary care hospital of the capital city of Pakistan.
Results: It was observed that empiric antibiotic therapy was initiated in 68% of patients, while culture sensitivity test was conducted for only 19% of patients. Thirty-percent of patients developed nosocomial infections and empiric antibiotic therapy was not initiated for those patients (P<0.05). Irrational antibiotic prescribing was observed in 86% of patients, and among them, 96.5% mortality was observed (P<0.05). The overall mortality rate was 83%; even higher mortality rates were observed in patients on a ventilator, patients with serious drug–drug interactions, and patients prescribed with irrational antibiotics or nephrotoxic drugs. Adverse clinical outcomes leading to death were observed to be significantly associated (P<0.05) with irrational antibiotic prescribing, nonadjustment of doses of nephrotoxic drugs, use of steroids, and major drug–drug interactions.
Conclusion: It was concluded that empiric antibiotic therapy is beneficial in patients and leads to a reduction in the mortality rate. Factors including irrational antibiotic selection, prescribing
contraindicated drug combinations, and use of nephrotoxic drugs were associated with high mortality rate and poor clinical outcomes.
Keywords: clinical outcomes, mortality rate, intensive care unit, rational use of antibiotics, nosocomial infections, medication review
... ença cardíaca isquêmica para aumentar o número de participantes com as duas alterações associadas, agravos que simultaneamente acometem uma faixa etária mais tardia e pelo elevado risco de IAM naqueles com DM18 . Apesar desta adaptação a mediana de idade foi 4%, mais próxima do nosso projeto do que o do estudo de Umpierrez[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] .Houve significância estatística no tempo de internação entre os participantes sem disglicemia (21 dias) com aqueles com disglicemia (34 dias), e não foi observado esta diferença significativa ao avaliar a conformidade ao protocolo. Esse achado pode ser devido ao número reduzido de participantes. ...
Introdução: O diabetes é uma doença crônica que acarreta altas taxas de internação. O descontrole está associado a desfechos desfavoráveis, culminando com o aumento do custo.Objetivo: Realizar um projeto piloto integrado a um estudo de avaliabilidade para uma avaliação de custo-efetividade de um protocolo de hiperglicemia em pacientes internados em um hospital público em situação de pandemia por COVID-19. Métodos: O estudo de avaliabilidade incluiu: 1. Elaboração do Modelo Lógico; 2. Caracterização dos stakeholders e definição das perguntas avaliativas; 3. Elaboração do Modelo da Avaliação e 4. Operacionalização do estudo piloto. Foram realizados: análise documental, revisão bibliográfica, análise de prontuários, estudo piloto para verificação de condições reais de infraestrutura e interacionais de uma unidade hospitalar. Conclusão: Os principais achados foram a descrição da intervenção e o modelo de avaliação de um estudo de custo-efetividade, em crise sanitária. A principal lição aprendida foi a identificação da necessidade de aproximação, interação e ação colaborativa com os diferentes stakeholders.
... A hospital-acquired infection (HAI) or nosocomial infection is a condition that is typically not present in the patient at the time of admission but might be observed during treatment at hospital premises. It takes a minimum of 48 h for such kind of infection to appear among patients but it may get prolonged in a few cases [1]. HAI occurs among patients by touching the contaminated surface, inhaling the aerosol droplets of an infected person, or ingesting contaminated food during treatment at a hospital [2]. ...
Hospital-acquired infections are a marked burden on the healthcare system and the leading cause of death in hospitals. Medical devices and implants contribute significantly to the infection because it has direct contact with the patient body cavity. To solve this issue surface of the devices needs to be modified for efficient functioning. To achieve different surface properties advanced surface modification strategies like plasma-assisted surface modification, plasmonic lithography, nanopatterning by laser beam or electron beam, and chemical etching oxidation can be used. Nanostructure inhibits bacterial growth without causing toxicity or the least toxicity to the surrounding tissue in the human body. The current review summarizes the numerous surface modification strategies adopted for developing novel nanostructured surfaces with more emphasis on titanium-based nanostructure in medical devices along with a brief review of the bactericidal mechanism. This review also sheds some light on the biomedical importance of polymeric and Inorganic nanocomposite materials with their biocompatibility and toxicity profile.
Graphical Abstract
... Based on the isolation of pathogens and/or clinical diagnoses, in line with established concepts [12,13], a patient was allocated to one of the primary bacteraemia sources. As previously suggested [14,15], the need of source control and the appropriateness of specific percutaneous or surgical control, such as the drainage of infected fluid accumulation, drainage of abscesses or obstructive tracts, removal of infected devices, debridement of infected necrotic tissue, and definitive control of sources underwent microbial contamination, were jointly determined by one board-certified ID and another ED physician (as part of the data capturing process), The source control techniques enrolled in our study were listed in detail in Appendix S1. ...
Background
Bacteraemia is a critical condition that generally leads to substantial morbidity and mortality. It is unclear whether delayed antimicrobial therapy (and/or source control) has a prognostic or defervescence effect on patients with source-control-required (ScR) or unrequired (ScU) bacteraemia.
Methods
The multicenter cohort included treatment-naïve adults with bacteraemia in the emergency department. Clinical information was retrospectively obtained and etiologic pathogens were prospectively restored to accurately determine the time-to-appropriate antibiotic (TtAa). The association between TtAa or time-to-source control (TtSc, for ScR bacteraemia) and 30-day crude mortality or delayed defervescence were respectively studied by adjusting independent determinants of mortality or delayed defervescence, recognised by a logistic regression model.
Results
Of the total 5477 patients, each hour of TtAa delay was associated with an average increase of 0.2% (adjusted odds ratio [AOR], 1.002; P < 0.001) and 0.3% (AOR 1.003; P < 0.001) in mortality rates for patients having ScU (3953 patients) and ScR (1524) bacteraemia, respectively. Notably, these AORs were augmented to 0.4% and 0.5% for critically ill individuals. For patients experiencing ScR bacteraemia, each hour of TtSc delay was significantly associated with an average increase of 0.31% and 0.33% in mortality rates for overall and critically ill individuals, respectively. For febrile patients, each additional hour of TtAa was significantly associated with an average 0.2% and 0.3% increase in the proportion of delayed defervescence for ScU (3085 patients) and ScR (1266) bacteraemia, respectively, and 0.5% and 0.9% for critically ill individuals. For 1266 febrile patients with ScR bacteraemia, each hour of TtSc delay respectively was significantly associated with an average increase of 0.3% and 0.4% in mortality rates for the overall population and those with critical illness.
Conclusions
Regardless of the need for source control in cases of bacteraemia, there seems to be a significant association between the prompt administration of appropriate antimicrobials and both a favourable prognosis and rapid defervescence, particularly among critically ill patients. For ScR bacteraemia, delayed source control has been identified as a determinant of unfavourable prognosis and delayed defervescence. Moreover, this association with patient survival and the speed of defervescence appears to be augmented among critically ill patients.
... Infection was diagnosed based on the modified Centers for Disease Control and Prevention (CDC) criteria by trained and experienced clinicians and was divided into three groups: pneumonia, UTI, and septicemia. 16 The clinical diagnosis of pneumonia was based on the following findings: a new or progressive infiltrate, consolidation, or ground glass opacity revealed on chest computed tomography (CT) or radiography, plus two or more of the following three criteria: (1) fever (>38°C) without another cause; (2) leukopenia (<4000 leukocytes/ with positive microbiological cultures, negative cultures with leukocytosis, fever (temperature ≥38°C), or both. 19 Septicemia was defined as: (1) at least one of the following signs or symptoms: fever (>38°C), chills, or hypotension; and (2) positive blood cultures (common skincontaminating bacteria such as Staphylococcus epidermidis need to be isolated from 2 or more blood cultures). ...
Aims
Infection is a common complication following acute ischemic stroke (AIS) and significantly contributes to poor functional outcomes after stroke. This study aimed to investigate the effects of infection after endovascular treatment (post‐EVT infection) on clinical outcomes and risk factors in patients with AIS.
Methods
We retrospectively analyzed AIS patients treated with endovascular treatment (EVT) between January 2016 and December 2022. A post‐EVT infection was defined as any infection diagnosed within 7 days after EVT. The primary outcome was functional independence, defined as a modified Rankin scale (mRS) score of 0–2 at 90 days. A multivariable logistic regression analysis was conducted to determine independent predictors of post‐EVT infection and the associations between post‐EVT infection and clinical outcomes.
Results
A total of 675 patients were included in the analysis; 306 (45.3%) of them had post‐EVT infections. Patients with post‐EVT infection had a lower rate of functional independence than patients without infection (31% vs 65%, p = 0.006). In addition, patients with post‐EVT infection achieved less early neurological improvement (ENI) after EVT (25.8% vs 47.4%, p < 0.001). For safety outcomes, the infection group had a higher incidence of any intracranial hemorrhage (23.9% vs 15.7%, p = 0.01) and symptomatic intracranial hemorrhage (10.1% vs 5.1%, p = 0.01). Unsuccessful recanalization (aOR 1.87, 95% CI 1.11–3.13; p = 0.02) and general anesthesia (aOR 2.22, 95% CI 1.25–3.95; p = 0.01) were identified as independent predictors for post‐EVT infection in logistic regression analysis.
Conclusion
AIS patients who develop post‐EVT infections are more likely to experience poor clinical outcomes. Unsuccessful recanalization and general anesthesia were independent risk factors for the development of post‐EVT infection.
... The type of ECMO-related NI included bloodstream infection (BSI), respiratory tract infection (RTI), urinary tract infection (UTI), and cannula insertion site infections (CISI). The diagnosis and definition of ECMO-related NI were based on the Centers for Disease Control and Prevention definitions for NI 13 or based on the patient's clinical status. Isolation of pathogenic microorganisms was related to clinical symptoms, typical inflammation characteristics in blood samples, and radiographic findings. ...
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is an important treatment strategy for severe acute respiratory and/or cardiac failure. Despite advancements in device technology and intensive care, mortality rates, and complications remain high. Patients undergoing ECMO are at an increased risk of infection due to factors such as immunosuppression, the presence of cannulas, and variable antibiotic pharmacokinetics. Unfortunately, an acquired infection in these patients can lead to increased morbidity, longer hospital stays, and even mortality. The purpose of this study was to examine the prevalence, profiles, and sites of ECMO-related infections, as well as underlying risk factors associated with these infections. PATIENTS AND METHODS: We retrospectively analyzed clinical data from 73 patients who received veno-arterial (VA) and/or venovenous (VV) ECMO support due to severe but potentially reversible cardiac and/or pulmonary failure lasting ≥24 hours. We involved patients with no suspicion of pre-existing infection before ECMO insertion from January 2015 to February 2023, classifying them into either infected or non-infected based on available evidence. The estimated probability for infection according to ECMO-day was established. Significance was set at p<0.05. The primary interesting outcome is the infection probability. RESULTS: Mean age was 52.2±14.8 years in all groups, and 55 (75.3%) were male. Median hospital stay was 6 (2-16) days and duration of ICU was 5 (2-10) days in all groups. The duration of ICU stay was significantly higher in the infected group compared to the non-infected group [10 days (5-15) vs. 3 days (2-7)], p<0.001, respectively. 66 patients (90.4%) received VA ECMO and 18 of them (94.7%) were infected. In all groups, the ECMO wean ratio was 28.8%. Death before 48 hours occurred in 28 patients (38.4%). 26% of patients under ECMO support consisted of the infected group and had 68 episodes per 1,000 ECMO days. Of these, the most frequent infection site was lower respiratory tract infection (47.3%). The most common pathogen among these was K. pneumonia. 39.7% of patients received no antibiotics. The probability of infection was 19% for 1.5 (mean-1SD) ECMO days, approximately 41% for 4 ECMO days, and 52% for (mean+1SD) 6.5 ECMO days. CONCLUSIONS: Nosocomial infections, which are commonly observed during ECMO procedures, are considered a significant concern. The respiratory system is frequently affected by such infections. Even though the use of antibiotics for prophylaxis remains debatable, it is predicted that there will be an inclination towards the regular application of prophylac-tic measures and the development of standardized protocols based on solid evidence obtained from prospective research studies in the future.
... The name "nosocomial" comes from the Greek word nosus meaning "disease" and komeion meaning "to take care of", or Latin words nosocomium meaning "hospital". Infections of the operating site can be divided into superficial infections, deep infections and organ infections (9). ...
... During these 30 years, the criteria for pneumonia diagnosis have changed substantially. For example, the 1988 CDC criteria for pneumonia diagnosis were clinical, radiologic, or microbiologic, while body temperature was not included as a criterion [68]. However, the 2018 guideline provides [43] 1992 Spain 1988-1990 Prospective Study 161 14 Moore [44] 1989 United States 1984-1987 Prospective, randomized study 308 15 Moore [45] 1989 United States 1985-1987 Prospective, randomized study 59 13 LoCurto [46] 1986 United States 1984-1985 Prospective, randomized study 58 13 Grover [47] 1977 United States Unknown Double-blind prospective study 75 13 § The study quality was measured using the MINORS criteria; the potential score ranges from 0 (lowest) to 16 or 24 (highest) * These studies could score a maximum of 16 points Content courtesy of Springer Nature, terms of use apply. ...
Purpose
What are reported definitions of HAP in trauma patient research?
Methods
A systematic review was performed using the PubMed/MEDLINE database. We included all English, Dutch, and German original research papers in adult trauma patients reporting diagnostic criteria for hospital-acquired pneumonia diagnosis. The risk of bias was assessed using the MINORS criteria.
Results
Forty-six out of 5749 non-duplicate studies were included. Forty-seven unique criteria were reported and divided into five categories: clinical, laboratory, microbiological, radiologic, and miscellaneous. Eighteen studies used 33 unique guideline criteria; 28 studies used 36 unique non-guideline criteria.
Conclusion
Clinical criteria for diagnosing HAP—both guideline and non-guideline—are widespread with no clear consensus, leading to restrictions in adequately comparing the available literature on HAP in trauma patients. Studies should at least report how a diagnosis was made, but preferably, they would use pre-defined guideline criteria for pneumonia diagnosis in a research setting. Ideally, one internationally accepted set of criteria is used to diagnose hospital-acquired pneumonia.
Level of evidence
Level III.
... Up to 25% of women with this form of tear subsequently develop wound infection or dehiscence [1,3]. Wound infection, defined as abscess formation or secretion of pus from the rupture [4], can cause painful and reduced healing and wound dehiscence as well as long-term consequences, for example dyspareunia and weakening of the pelvic floor. Wound dehiscence is defined as diastasis of more than 5 mm between the wound edges and is seen in up to 25% in women with a second-degree tear or an episiotomy [1,3]. ...
Background
Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications suggest that intravenous antibiotics administrated during delivery reduces this risk. We do not know if oral antibiotics given after delivery can reduce the risk of wound dehiscence or infection. Our aim is to investigate whether three doses of oral antibiotics (amoxicillin 500 mg/clavulanic acid 125 mg) given after delivery can reduce the risk of wound dehiscence and infection in patients with a second-degree obstetric tear or episiotomy.
Methods
We will perform a randomized, controlled, double-blinded study including 221women in each arm with allocation 1:1 in relation to the randomization. The study is carried out at Department of Obstetrics & Gynecology, Herlev University Hospital, Copenhagen, Denmark. The women will be included after delivery if they have had a second-degree tear or episiotomy. After inclusion, the women will have a clinical follow-up visit after 1 week. The tear and healing will be evaluated regarding signs of infection and/or dehiscence. The women will again be invited for a 1-year clinical examination including ultrasound. Questionnaires exploring symptoms related to the obstetric tear and possible complications will be answered at both visits. Our primary outcome is wound dehiscence and/or wound infection, which will be calculated using χ² tests to compare groups. Secondary outcomes are variables that relate to wound healing, as pain, use of painkillers and antibiotics, need for further follow-up, as well as outcomes that may be related to the birth or healing process, urinary or anal incontinence, symptoms of prolapse, female body image, and sexual problems.
Discussion
Reducing the risk of wound dehiscence and/or infection would decrease the number of control visits, prevent the need for longer antibiotic treatment, and possibly also decrease both short-term and long-term symptoms. This would be of great importance so the mother, her partner, and the baby could establish and optimize their initial family relation.
Trial registration
The conduction of this study is approved the 2/2–2023 with the EU-CT number: 2022–501930-49–00. ClinicalTrials.gov Identifier: NCT05830162.
... [4] Any post-operative complications such as nosocomial infections including ventilator-associated pneumonia, urinary tract infections, bloodstream infections, meningitis, and so on and adult respiratory distress syndrome (ARDS) were recorded. [16][17][18] Outcome assessment The outcome was graded using mRS at discharge or 7 days, whichever was earlier. A score of 0-2 was considered good/ favorable, whereas an mRS score of 3-6 was considered poor/ unfavorable. ...
Background
Anemia is a common complication of aneurysmal subarachnoid hemorrhage and is associated with unfavorable outcomes. Whether the physiological benefits of transfusion for anemia surpass the risk of blood transfusion remains to be determined.
Objectives
The primary outcome was to evaluate the impact of peri-operative blood transfusion on the long-term neurological outcome, assessed by Glasgow Outcome Scale Extended at 3 months. The secondary outcomes included the impact of transfusion on the short-term neurological outcome, assessed by Modified Rankin Score at discharge/7 days, and on the incidence of vasospasm, infarction, re-exploration, tracheostomy, and length of hospital stay.
Material and Methods
This prospective observational study was conducted on 185 patients with aneurysmal subarachnoid hemorrhage undergoing clipping of the aneurysmal neck. In our study, blood transfusion was administered to keep the target Hb around 10 g/dL.
Results
Unfavorable long-term outcome was found in 27/97 (28%) of patients who received a blood transfusion as compared to 13/74 (18%) of patients who did not receive a transfusion ( P = 0.116). Patients receiving transfusion had more chances of an unfavorable outcome at discharge/7 days as compared to those not transfused [44/103 (43%) versus 22/80 (27%)], P = 0.025. There were increased chances of vasospasm, infarction, re-exploration, tracheostomy, and increased length of hospital stay in patients receiving transfusion ( P < 0.05).
Conclusions
The use of blood transfusion in patients with aneurysmal subarachnoid hemorrhage was associated with increased neurological complications and hence an unfavorable short-term outcome. However, when used judiciously as per the clinical requirements, blood transfusion did not have a significant effect on long-term neurological outcome.
... Bacteremias were classified as nosocomial if the patient had been admitted for more than 48 h before the blood culture was drawn, hospital-associated if the patient had been admitted to the hospital for more than 48 h within the 14 days prior to the blood culture being drawn, and community acquired if the blood culture was collected within 48 h of admission [24]. ...
Introduction
The Neutrophil-Lymphocyte Ratio (NLR) in blood has demonstrated its capability to predict bacteremia in emergency departments, and its association with mortality has been established in patients with sepsis in intensive care units. However, its potential concerning mortality and readmission in patients with Gram-negative bacteremia (GNB) is unexplored.
Methods
This retrospective cohort study included patients with GNB between 2018 and 2022 from six hospitals in the Capital Region of Denmark. Patients who were immunosuppressed or had missing NLR values on the day of blood culture were excluded. Logistic regression models were used to analyze the association between NLR levels and 90-day all-cause mortality, while the logit link interpretation of the cumulative incidence function was used to assess the association between NLR levels and 60-day readmission. Associations were quantified as odds ratios (OR) with corresponding 95% confidence intervals (CI).
Results
The study included 1763 patients with a median age was 76.8 years and 51.3% were female. The median NLR was 17.3 and 15.8% of patients had a quick sequential organ failure assessment score of two or three. Urinary tract infection (UTI) was the most frequent focus and Escherichia coli the most frequent pathogen. Statistically significant differences in median NLR were found by age group and pathogen, and for patients with or without hypertension, liver disease, chronic obstructive pulmonary disease, dementia, and alcohol abuse. 378 patients (21.4%) died before 90 days. 526 (29.8%) patients were readmitted to the hospital within 60 days. For each doubling of the NLR, the OR for all-cause 90-day mortality was 1.15 (95% CI, 1.04–1.27) and 1.12 (95% CI, 1.02–1.24) for 60-day readmission. Analysis of subgroups did not show statistically significant differences between groups in relation to the association between NLR and mortality. The discriminatory ability of NLR for mortality was limited and comparable to blood neutrophil or lymphocyte count, producing receiver operating characteristic curves with an area under the curve of 0.59 (95% CI, 0.56–0.63), 0.60 (95% CI, 0.56–0.65) and 0.53 (95% CI, 0.49–0.56), respectively.
Conclusion
Blood neutrophil-lymphocyte ratio was associated with 90-day all-cause mortality and 60-day readmission in patients with GNB. However, the ratio has limited ability in predicting mortality or readmission.
... The diagnostic classification used was the one proposed by the CDC, in the years 2008 and 2014 29,30 ; however, 1 study 23 opted for the 1 published in 1988. 31 The study led by Boonyasiri 27 reported using the definition given by the CDCs; however, the year of publication was not reported. Reis 26 referenced the definition given by the Brazilian Health Regulatory Agency, published in 2013, 32 which is based on the CDCs criteria in effect that year. ...
Background: Recommendations for different types of bathing to prevent central line-associated bloodstream infections (CLABSI) are still divergent. The objective of this study was to verify whether bed bathing with wipes impregnated with 2% chlorhexidine (CHG) compared to conventional bed bathing is more effective in preventing CLABSI.
Methods: Systematic review of the literature by consulting the electronic databases PubMed/Medline, Embase, CINAHL, Scopus and Web of Science from the date of inception until July 1, 2023, with no language or time restrictions.
Results: A total of 84,462 studies was examined, of which 6 were included in the meta-analysis. Data from 20,188 critical care patients included in primary studies were analyzed. The meta-analysis found that bed bathing with wipes impregnated with 2% CHG reduced the risk of CLABSI by 48% compared to conventional bed bathing (RR 0.52; 95%CI, 0.37 to 0.73), and this is moderate-quality evidence. The reduction in length of stay in the ICU and length of hospital stay as well as the risk of death were not significantly different between the study groups. Whether bed bathing with 2% CHG-impregnated wipes increases the occurrence of skin reactions is unclear.
Conclusion: This meta-analysis provides moderate-quality evidence that daily bathing with 2% CHG-impregnated wipes is safe and helps prevent CLABSI among adult ICU patients.
Keywords: Central venous catheters; Chlorhexidine; Critical care; Infection control.
... Definitions P. aeruginosa BSIs were defined as the presence of a positive blood culture of P. aeruginosa with simultaneous clinical signs and symptoms of infections (16). Onset of P. aeruginosa BSIs was defined as the moment of taking the first positive blood culture of P. aeruginosa. ...
Background
Pseudomonas aeruginosa (P. aeruginosa) accounts for high antimicrobial resistance and mortality rates of bloodstream infections (BSIs). We aim to investigate incidence, antimicrobial resistance and risk factors for mortality of P. aeruginosa BSIs among inpatients.
Methods
A retrospective cohort study were conducted at two tertiary hospitals in 2017–2021. Medical and laboratory records of all inpatients diagnosed with P. aeruginosa BSIs were reviewed. A generalized linear mixed model was used to identify risk factors for mortality.
Results
A total of 285 patients with P. aeruginosa BSIs were identified. Incidence of P. aeruginosa BSIs fluctuated between 2.37 and 3.51 per 100,000 patient-days over the study period. Out of 285 P. aeruginosa isolates, 97 (34.04%) were carbapenem-resistant (CR) and 75 (26.32%) were multidrug-resistant (MDR). These isolates showed low resistance to aminoglycosides (9.51–11.62%), broad-spectrum cephalosporins (17.19–17.61%), fluoroquinolones (17.25–19.43%), and polymyxin B (1.69%). The crude 30-day mortality rate was 17.89% (51/285). Healthcare costs of patients with MDR/CR isolates were significantly higher than those of patients with non-MDR/CR isolates (P < 0.001/=0.002). Inappropriate definitive therapy [adjusted odds ratio (aOR) 4.47, 95% confidence interval (95% CI) 1.35–14.77; P = 0.014], ICU stay (aOR 2.89, 95% CI: 1.26–6.63; P = 0.012) and corticosteroids use (aOR 2.89, 95% CI: 1.31–6.41; P = 0.009) were independently associated with 30-day mortality.
Conclusion
Incidence of P. aeruginosa BSIs showed an upward trend during 2017–2020 but dropped in 2021. MDR/CR P. aeruginosa BSIs are associated with higher healthcare costs. Awareness is required that patients with inappropriate definitive antimicrobial therapy, ICU stay and corticosteroids use are at higher risk of death from P. aeruginosa BSIs.
... Blood stream infections are defined using modified Centers for Disease Control and Prevention (CDC) criteria which require at least one positive blood culture for all bacterial pathogens except common skin contaminants which require ≥ 2 positive blood cultures within 48 hours. Bloodstream infections are classified into community-acquired (CABSI) and hospital-acquired (HABSI) because their causative pathogens, resistance patterns and outcomes have been 1 reported to be markedly different. BSI is defined as community-acquired when it occurs within the first 48 hours of admission while hospital-acquired BSI is which occurs 48 hours after hospital admission. ...
Blood Stream Infections in a tertiary care hospital
... The definitions of infections were based on the criteria issued by the CDC, particularly the definitions of hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), bacteremia, catheter-related bloodstream infection (CR-BSI), surgical site infection, mediastinitis and urinary tract infection (UTI) [15][16][17][18]. ...
Background
At some point in their lives, many people will require major heart surgery (MHS). Patients are generally older adults with various risk factors for infection. However, the incidence of infection after MHS is poorly known, as reported infection data are frequently biased due to different factors like the surgical procedure, postoperative timing, and infectious syndromes or etiologic agents, among others. In addition, most patient data are retrospectively obtained.
Purpose and methods
Data were prospectively collected regarding the incidence of all nosocomial infections produced from the time of surgery to hospital discharge in a cohort of 800 adults consecutively undergoing a MHS procedure.
Results
During postoperative hospitalization, 124 of the 800 participants developed one or more infections (15.5%): during their ICU stay in 68 patients (54.8%), during their stay on the general ward post ICU in 50 (40.3%), and during their stay in both wards in 6 (4.8%). The most common infections were pneumonia (related or not to mechanical ventilation), surgical site and bloodstream. As etiological agents, 193 pathogens were isolated: mostly Gram-negative bacilli (54.4%), followed by Gram-positive bacteria (30%), viruses (4.6%) and fungi (1.5%). In our cohort, all-cause mortality was recorded in 33 participants (4.1%) and 9 infection-related deaths (1.1%) were produced. Among subjects who developed infections, overall mortality was 13.7% and in those who did not, this was only 2.3%.
Conclusion
Infection following MHS remains frequent and severe. Our data suggest that hospital-acquired infection studies should consider episodes of infection in all populations during their entire hospital stay and not only those related to specific clinical syndromes or acquired while the patient is in intensive care.
... The following three commonly encountered MDAI: CLABSI, CAUTI, and VAP, as per the definition of the CDC's NNIS system criteria, were targeted. 1,2 The patients who had catheterization (involving intermittent, indwelling, or suprapubic catheters, etc.) were reviewed for chart analysis. The study's methodology, purpose, and voluntary nature were all communicated to the patients and their family members, along with the confidentiality of the patient's data. ...
Background
There is a scarcity of studies evaluating the microbial profile, antimicrobial susceptibility, and prevalence of MDR/XDR pathogens causing medical device-associated infections (MDAIs). The present study was sought in this regard.
Materials and methods
An ambispective-observational, site-specific, surveillance-based study was performed for a period of 2 years in the intensive care unit (ICU) and high dependency unit (HDU) (medicine/surgery) of a Tertiary-care University Hospital. Three commonly encountered MDAIs including central-line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP), were targeted.
Results and conclusion
Of the total 90 patients, 46 (51.1%) were admitted to the ICU (medicine/surgery), and the remaining 44 (48.8%) were admitted to the HDU (medicine/surgery). The median (P25–P75) age of the total patients was 55 (43.1–62.3) years. Male 61 (67.8%) preponderance was observed. Sixty-two of 90 (68.9%) were immunocompromised. A total of 104 pathogens causing MDAIs were isolated. Staphylococcus epidermidis (CoNS), and Staphylococcus capitis were commonly isolated multi-drug resistant (MDR) gram-positive pathogens causing MDAIs. Similarly, carba-resistant Klebsiella pneumoniae, Stenotrophomonas maltophilia, and carba-resistant Acinetobacter baumanni were commonly isolated MDR gram-negative pathogens causing MDAIs. Five of 9 (55.5%) K. pneumoniae and three of 9 (33.3%) S. maltophilia isolates were found to be extensively drug resistant. Among Candida, C. parapsilosis was the most prevalent fungal pathogen causing CLABSI and CAUTI in patients admitted to ICU/HDU.
How to cite this article
Suryawanshi VR, Pawar A, Purandare B, Vijayvargiya N, Sancheti S, Philip S, et al. Microbial Profile, Antimicrobial Susceptibility, and Prevalence of MDR/XDR Pathogens Causing Medical Device Associated Infections: A Single Center Study. Indian J Crit Care Med 2024;28(2):152–164.
... • Aparición de bacteriemia, definida ésta, acorde con el CDC (Centers for Disease Control and Prevention) como la presencia de bacterias en la sangre, documentadas mediante un cultivo de sangre positivo [22]. • Microorganismos presentes en el hemocultivo positivo. ...
La enfermedad renal crónica se ha convertido en un problema de salud en la sociedad actual y el trasplante renal representa el tratamiento de elección en la mayoría de los casos. El receptor de un trasplante renal es un paciente de alto riesgo ya que, a las potenciales complicaciones quirúrgicas, hay que añadir el impacto de la inmunosupresión. La aparición de infecciones supone un riesgo aumentado de pérdida del injerto, así como de la mortalidad. Estudio observacional retrospectivo en pacientes trasplantados renales entre enero de 2016 y diciembre de 2019 durante el periodo del postrasplante inmediato. La incidencia de infección fue 67,9%, los síndromes descritos fueron ITU (50%), infección por citomegalovirus (7,2%), infección relacionada con catéter (10%) y i(16,7%), Klebsiella Pneumoniae (9,9%) y Staphylococcus Epidermis (9,9%). Se ha encontrado relación significativa entre la aparición de infección y el tipo de donante (asistolia o muerte cerebral) y con la duración del ingreso. También entre la incidencia de infección relacionada con CVC y el tiempo que permanece insertado. Conocer la etiología las complicaciones infecciosas nos ayudará a prevenirlas, reduciendo los costes sanitarios y aumentando la supervivencia y la calidad de vida del paciente.
... The source of infection was classified according to clinical and microbiological criteria following the Center for Disease Control guidelines [24]. In patients with multiple infections, only the main infectious episode leading to ICU admission was considered for the analysis. ...
Background
In the last decade, Ibrutinib has become the standard of care in the treatment of several lymphoproliferative diseases such as chronic lymphocytic leukemia (CLL) and several non-Hodgkin lymphoma. Beyond Bruton tyrosine kinase inhibition, Ibrutinib shows broad immunomodulatory effects that may promote the occurrence of infectious complications, including opportunistic infections. The infectious burden has been shown to vary by disease status, neutropenia, and prior therapy but data focusing on severe infections requiring intensive care unit (ICU) admission remain scarce. We sought to investigate features and outcomes of severe infections in a multicenter cohort of 69 patients receiving ibrutinib admitted to 10 French intensive care units (ICU) from 1 January 2015 to 31 December 2020.
Results
Median time from ibrutinib initiation was 6.6 [3–18] months. Invasive fungal infections (IFI) accounted for 19% (n = 13/69) of severe infections, including 9 (69%; n = 9/13) invasive aspergillosis, 3 (23%; n = 3/13) Pneumocystis pneumonia, and 1 (8%; n = 1/13) cryptococcosis. Most common organ injury was acute respiratory failure (ARF) (71%; n = 49/69) and 41% (n = 28/69) of patients required mechanical ventilation. Twenty (29%; n = 20/69) patients died in the ICU while day-90 mortality reached 55% (n = 35/64). In comparison with survivors, decedents displayed more severe organ dysfunctions (SOFA 7 [5–11] vs. 4 [3–7], p = 0.004) and were more likely to undergo mechanical ventilation (68% vs. 31%, p = 0.010). Sixty-three ibrutinib-treated patients were matched based on age and underlying malignancy with 63 controls receiving conventional chemotherapy from an historic cohort. Despite a higher median number of prior chemotherapy lines (2 [1–2] vs. 0 [0–2]; p < 0.001) and higher rates of fungal [21% vs. 8%, p = 0.001] and viral [17% vs. 5%, p = 0.027] infections in patients receiving ibrutinib, ICU (27% vs. 38%, p = 0.254) and day-90 mortality (52% vs. 48%, p = 0.785) were similar between the two groups.
Conclusion
In ibrutinib-treated patients, severe infections requiring ICU admission were associated with a dismal prognosis, mostly impacted by initial organ failures. Opportunistic agents should be systematically screened by ICU clinicians in this immunocompromised population.
... Se utilizaron los criterios diagnósticos del CDC (14) , junto con los de la Conferencia Internacional de Consenso sobre Sepsis en Pediatría (15) , como se ha propuesto recientemente (16) . ...
Introducción: Las infecciones nosocomiales (IN) por Candida sp. han incrementado la morbilidad y mortalidad hospitalaria en la última década. Representan las infecciones micóticas más frecuentes en pacientes hospitalizados y constituyen la cuarta causa más frecuente de IN hematógena en los Estados Unidos de América. Objetivo: Determinar las características clínicas y epidemiológicas de los pacientes con Infección del Torrente Sanguíneo (ITS) por Candida de adquisición nosocomial en los diferentes servicios del Instituto Nacional de Salud del Niño (INSN). Métodos: Se revisó las historias clínicas de todos los pacientes con hemocultivo positivo según registro del Servicio de Microbiología del INSN desde Enero a Diciembre del 2009 y que cumplieron con los criterios de inclusión establecidos para ITS. Para el análisis estadístico se utilizó el paquete estadístico SPSS 11.10 para Windows. Resultados: Las especies de Candida no albicans se aislaron en el 71,7% de todas las muestras, siendo C. parapsilosis la especie más frecuente (30%). Los pacientes donde se realizaron la mayoría de aislamientos fueron los hospitalizados en los servicios de Cirugía, UCI y Gastroenterología. El grupo etáreo más frecuentemente afectado fueron los menores de un año. Los factores de riesgo intrínsecos más frecuentes fueron ser portador de una malformación congénita, desnutrición y la colonización por Candida y entre los extrínsecos el uso previo de antibióticos de amplio espectro, el uso de catéter venoso central, la cirugía previa abdominal, nutrición parenteral y la intubación con ventilación mecánica. La letalidad bruta de candidemia nosocomial en el INSN fue de 45%. Conclusión: Las especies de Candida no albicans son cada vez más frecuentemente aisladas en ITS de adquisición nosocomial, siendo los factores de riesgo extrínsecos más frecuentes el uso previo de antibiótico de amplio espectro, catéter venoso central, cirugía previa abdominal, nutrición parenteral total y la intubación con ventilación mecánica. La población generalmente afectada es la de los lactantes menores de un año portadores de una malformación congénita.
... for CoNS in a symptomatic neonate (hypothermia <36°C, fever >38°C, bradycardia, apnea, lethargy, and poor sucking) and hematological parameters of NS (leukopenia, thrombocytopenia, raised CRP, or procalcitonin) and agreed upon as sepsis by three specialists. 16 These included case episodes where one of the two cultures sent was positive for CoNS and those where, due to technical difficulties, only one sample could be collected (extremely low BW <1000 g, very sick child, and technically difficult sampling) iii. Polymicrobial coinfection BSI (PBSI): CoNS-positive blood culture and positive growth with another pathogenic organism isolated in the same culture specimen or within a 48-h time span in a symptomatic neonate. ...
Background: Coagulase-negative Staphylococcus (CoNS) are known commensals and often contaminate neonatal blood cultures. Their unique ability to form biofilms, however, helps them evade immune mechanisms and antibiotics and cause neonatal sepsis (NS) in hospitalized neonates. True or probable Coagulase-negative Staphylococcus blood stream infection (CoNS BSI) must be differentiated from contaminants so that antibiotics are used judiciously and hospital stay is minimized. Aims and Objectives: The primary objective of the study was to estimate the proportion of NS and contaminants among CoNS-positive blood cultures in the index neonatal unit and the host and health-care variables associated with CoNS BSI. The secondary objective was to estimate the susceptibility of CoNS isolates to antibiotics used. Materials and Methods: This was a retrospective study from digital records, from January 2018 to December 2022. Results: 25% of CoNS isolates were associated with NS (health-care infections) and 75% were contaminants. Over 90% of CoNS BSI was associated with central lines (CLs) and prolonged hospital stay. All isolates were resistant to oxacillin while resistance to gentamicin rose annually to over 68%. Susceptibility to linezolid and vancomycin was present, but a few strains were resistant to them. Conclusion: CoNS were an important cause of NS in the index hospital. Prolonged hospital stays and CLs were associated with increased incidence of CoNS sepsis and must be minimized where possible. Antibiotic resistance was high, and reserve drugs could also become ineffective.
Objectives
To compare the discrimination and calibration of six risk scoring systems in the assessment of patients with stroke‐associated pneumonia (SAP) after acute ischemic stroke.
Methods
The validation cohort was derived from the Third China National Stroke Registry. SAP was diagnosed according to the criteria for hospital‐acquired pneumonia of the Centers for Disease Control and Prevention. The area under the receiver operating characteristic curve (AUROC) and Hosmer‐Lemeshow goodness‐of‐fit test were used to assess discrimination and calibration.
Results
A total of 12,071 patients were included in the study and 606 (5.02%) patients were diagnosed with in‐hospital SAP after ischemic stroke. The AUROC of the six clinical scores ranged from 0.660 to 0.752. In the pairwise comparison, the AIS‐APS score (0.752, 95% CI = 0.730–0.773, p < 0.001) showed significantly better discrimination than the other risk models, except the PASS score. The AIS‐APS score had the largest Cox and Snell R² for in‐hospital SAP after ischemic stroke. In the subgroup analysis, among patients over 61 years of age, all TOAST subtypes except small vessel disease, length of hospital stay longer than 8 days, male and female sex, different groups stratified by admission NIHSS score and time from onset to arrival, the AIS‐APS score showed better discrimination than other risk models with regard to SAP after AIS.
Conclusions
Our study compared the discrimination and calibration of the Kwon Pneumonia Score, A2DS2 score, PANTHERIS score, AIS‐APS score, ISAN score, and PASS score in SAP identification; of these, the AIS‐APS score showed the best performance.
(1) Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a lifesaving treatment but carries a high infection risk. Diagnosing infections remains challenging due to the limited accuracy of standard biomarkers. (2) Methods: This single-center study aimed to evaluate presepsin (PSP) and YKL-40 as infection biomarkers in febrile patients during the allo-HSCT pre-engraftment phase. Biomarker levels were prospectively measured in 61 febrile episodes from 54 allo-HSCT patients at admission, representing baseline levels and then at Day 1, 3, 5, and 7 following fever onset. The diagnostic value was compared to that of procalcitonin (PCT). (3) Results: PSP showed fair diagnostic value on Day 1 (AUC 0.656; 95% CI: 0.510 – 0.802) and Day 3 (AUC 0.698; 95% CI: 0.559 – 0.837). YKL-40 did not provide any significant diagnostic value across measured time points. PCT outperformed PSP and YKL-40, particularly on Day 3 (AUC 0.712; 95% CI: 0.572 – 0.852). When combining biomarkers, the best model for predicting infection used PSP > 3.144 ng/mL and PCT > 0.28 g/L on Day 3, resulting in R2 of about 31% (p < 0.001). (4) Conclusion: Neither test showed sufficient discriminative power for early infection to recommend their use as individual diagnostic tools in clinical practice.
Enterococcal BSI is associated with significant morbidity and mortality, with fatality rates of approximately 20–30%. There are microbiological and clinical differences between E. faecalis and E. faecium infections. The aim of this study was to investigate differences in predisposing factors for E. faecalis and E. faecium BSI and to explore prognostic factors.
This study was a post-hoc analysis of PROBAC, a Spanish prospective, multicenter, cohort in 2016–2017. Patients with E. faecalis or E. faecium BSI were eligible. Independent predictors for BSI development in polymicrobial and monomicrobial BSI and in-hospital mortality in the monomicrobial group were identified by logistic regression.
A total of 431 patients were included. Independent factors associated with E. faecium BSI were previous use of penicillins (aOR 1.99 (95% CI 1.20–3.32)) or carbapenems (2.35 (1.12–4.93)), hospital-acquired BSI (2.58 (1.61–4.12)), and biliary tract source (3.36 (1.84–6.13)), while congestive heart failure (0.51 (0.27–0.97)), cerebrovascular disease (0.45 (0.21–0.98)), and urinary tract source (0.49 (0.26–0.92)) were associated with E. faecalis BSI. Independent prognostic factors for in-hospital mortality in E. faecalis BSI were Charlson Comorbidity Index (1.27 (1.08–1.51)), SOFA score (1.47 (1.24–1.73)), age (1.06 (1.02–1.10)), and urinary/biliary source (0.29 (0.09–0.90)). For E. faecium BSI, only SOFA score (1.34 (1.14–1.58) was associated with in-hospital mortality.
The factors associated with E. faecium and E. faecalis BSI are different. These variables may be helpful in the suspicion of one or other species for empiric therapeutic decisions and provide valuable information on prognosis.
Background
Limited data is available regarding the weaning techniques employed for mechanical ventilation (MV) in elderly patients with dementia in China.
Objective
The primary objective of this study is to investigate diverse weaning methods in relation to the prognostic outcomes of elderly patients with dementia undergoing MV in the intensive care unit (ICU). Specifically, we seek to compare the prognosis, likelihood of successful withdrawal from MV, and the length of stay (LOS) in the ICU.
Methods
The study was conducted as a randomized controlled trial, encompassing a group of 169 elderly patients aged ≥ 65 years with dementia who underwent MV. Three distinct weaning methods were used for MV cessation, namely, the tapering parameter, spontaneous breathing trial (SBT), and SmartCare (Dräger, Germany).
Results
In the tapering parameter group, the LOS in the ICU was notably prolonged compared to both the SBT and SmartCare groups. However, no statistically significant differences were observed among the groups with respect to demographic characteristics, such as age and sex, as well as factors including the rationale for ICU admission, cause of MV, MV mode, oxygenation index, hemoglobin levels, albumin levels, ejection fraction, sedation and analgesia practices, tracheotomy, duration of MV, successful extubation, successful weaning, incidences of ventilator‐associated pneumonia, and overall prognosis.
Conclusions
Both the SBT and SmartCare withdrawal methods demonstrated a reduction in the duration of MV and LOS in the ICU when compared to the tapering parameter method.
Trial Registration
Chinese Clinical Trial Registry: ChiCTR1900028449
Introduction: Stenotrophomonas maltophilia is a Gram-negative,
motile, and glucose non fermenting bacterium commonly found in
hospital settings. It poses a significant risk to immunocompromised
individuals, often causing nosocomial infections.
Aim: To identify the risk factors associated with Stenotrophomonas
maltophilia bacteraemia and compare the factors influencing
patient survival and mortality.
Materials and Methods: Clinical and laboratory data from 39
cases of Stenotrophomonas bacteraemia encountered between
July 2021 and July 2022 in the Department of Microbiology,
Sanjay Gandhi Postgraduate Institute of Medical Sciences,
Lucknow, Uttar Pradesh, India, were analysed in the present
retrospective study in August 2022. The study included all
cultures positive for S. maltophilia bacteraemia, identified
through Matrix-assisted Laser Desorption Ionisation Time-
Of-Flight Mass Spectrometry (MALDI-TOF-MS). Antibiotic
susceptibility testing was performed using the Kirby-Bauer
disk diffusion method, following the Clinical and Laboratory
Standards Institute (CLSI) guidelines. Statistical analysis and
outcome assessment were conducted using Statistical Package
for Social Sciences (SPSS) version 20.0.
Results: Clinical data from all 39 bacteraemia patients were
extracted from the hospital information system for analysis.
The mean age of the patients included in the present study was
46.0±20.29 years, with a male predominance of 27 (69.23%).
The most common risk factors associated with S. maltophilia
bacteraemia were the presence of an indwelling catheter in 21/39
cases (53.8%) and co-existing pulmonary infections in 18/39
cases (46.2%). S. maltophilia isolates exhibited high susceptibility
to Minocycline (94.87%), Ticarcillin-Clavulanic acid (87.18%),
Levofloxacin (84.62%), and Cotrimoxazole (84.62%). The 30-day
mortality rate was reported as 28.20% (11/39).
Conclusion: S. maltophilia can cause various infections
in immunocompromised patients. The appropriate use of
empirical antibiotics and strict adherence to infection control
measures can reduce hospital stays, as well as 14-day and 30-
day mortality rates among affected patients
ResearchGate has not been able to resolve any references for this publication.