Bloodstream infections in adults: Importance of healthcare-associated infections

Vallès, Jordi; Calbo, Esther; Anoro, Eva; Fontanals, Dionísia; Xercavins, Mariona; Espejo, Elena; Serrate, G; Freixas, N.; Morera, M.; Font, Bernat; Bella, Feliu; Segura, Ferrán; Garau, Javier

doi:10.1016/j.jinf.2007.10.001

Cited by 79 publications

(99 citation statements)

References 23 publications

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“…Recent studies indicated that HCA infections are more similar to HA infections than to CoA infections [4,29]. It has also been reported that the antimicrobial resistance among HCA-UTI pathogens is much higher than that in their counterparts associated with CoA-UTI [3].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in health care-associated urinary tract infection: focus on susceptibility to fosfomycin

et al. 2015

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Fosfomycin could be an alternative treatment option for UTIs related to ESBL-producing E. coli spp. and CoA-UTI, but not for UTIs related to ESBL-producing Klebsiella spp. Antimicrobial susceptibilities of ESBL-producing strains were different according to the UTI classification. Fosfomycin showed decreased activity against isolates from HCA-UTI and HA-UTI. However, further clinical verification is required to assess the clinical efficacy of fosfomycin for the treatment of UTIs caused by ESBL-producing E. coli isolates.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in health care-associated urinary tract infection: focus on susceptibility to fosfomycin

et al. 2015

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“…Studies not limited to specific etiologies are summarized in Table 2 (50,(65)(66)(67)(68)(69)(70). While definitions and study populations have varied to some degree, compared to community-associated BSIs, health care-associated BSIs are more likely in older patients with comorbid illness, have a different distribution of pathogens (higher rates of Staphylococcus aureus and Pseudomonas aeruginosa and lower rates of Streptococcus pneumoniae and Escherichia coli), have higher rates of antimicrobial resistance, and are more lethal (65).…”

Section: Classification Of Community-onset Bloodstream Infectionsmentioning

confidence: 99%

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

2014

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SUMMARY Bloodstream infection (BSI) is a major cause of infectious disease morbidity and mortality worldwide. While a positive blood culture is mandatory for establishment of the presence of a BSI, there are a number of determinants that must be considered for establishment of this entity. Community-onset BSIs are those that occur in outpatients or are first identified <48 h after admission to hospital, and they may be subclassified further as health care associated, when they occur in patients with significant prior health care exposure, or community associated, in other cases. The most common causes of community-onset BSI include Escherichia coli , Staphylococcus aureus , and Streptococcus pneumoniae . Antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase/metallo-β-lactamase/carbapenemase-producing Enterobacteriaceae , have emerged as important etiologies of community-onset BSI.

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“…This distinction was driven by observations indicating an increased risk of antimicrobial resistance and a higher mortality rate among patients with health care-acquired BSIs (HCABSIs) than among those with community-acquired BSIs (CABSIs) (16)(17)(18). As a result, a growing consensus has advocated a different empirical antibiotic regimen based on the antimicrobial susceptibility profile anticipated for each of these categories.…”

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confidence: 99%

Bacterial and Clinical Characteristics of Health Care- and Community-Acquired Bloodstream Infections Due to Pseudomonas aeruginosa

Hattemer

Hauser

Diaz

et al. 2013

Antimicrob Agents Chemother

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f Health care-associated infections, including Pseudomonas aeruginosa bloodstream infection, have been linked to delays in appropriate antibiotic therapy and an increased mortality rate. The objective of this study was to evaluate intrinsic virulence, bacterial resistance, and clinical outcomes of health care-associated bloodstream infections (HCABSIs) in comparison with those of community-acquired bloodstream infections (CABSIs) caused by P. aeruginosa. We conducted a retrospective multicenter study of consecutive P. aeruginosa bacteremia patients at two university-affiliated hospitals. Demographic, clinical, and treatment data were collected. Microbiologic analyses included in vitro susceptibility profiles and type III secretory (TTS) phenotypes. Sixty CABSI and 90 HCABSI episodes were analyzed. Patients with HCABSIs had more organ dysfunction at the time of bacteremia (P ‫؍‬ 0.05) and were more likely to have been exposed to antimicrobial therapy (P < 0.001) than those with CABSIs. Ninety-two percent of the carbapenem-resistant P. aeruginosa infections were characterized as HCABSIs. The 30-day mortality rate for CABSIs was 26% versus 36% for HCABSIs (P ‫؍‬ 0.38). The sequential organ failure assessment score at the time of bacteremia (hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.1 to 1.3) and the TTS phenotype (HR 2.1; 95% CI, 1.1 to 3.9) were found to be independent predictors of the 30-day mortality rate. No mortality rate difference was observed between CABSIs and HCABSIs caused by P. aeruginosa. Severity of illness and expression of TTS proteins were the strongest predictors of the 30-day mortality rate due to P. aeruginosa bacteremia. Future P. aeruginosa bacteremia trials designed to neutralize TTS proteins are warranted. Bloodstream infections (BSIs) are serious clinical events with life-threatening consequences. The total number of deaths resulting from nosocomial BSIs is difficult to estimate and varies greatly, depending on the etiology. However, the attributable mortality rate may be as high as 80% among patients in intensive care units (1). Pseudomonas aeruginosa accounts for 3 to 7% of all BSIs and 23 to 26% of Gram-negative bacteremias (2, 3). Pneumonia, pancreaticobiliary tract infection, indwelling catheters, and urinary tract infection have all been implicated as potential sources of infection (1, 4). Despite recent advances in critical-care management, mortality rates due to P. aeruginosa BSI remain high, ranging between 27 and 48% (1, 5).Poor outcomes of P. aeruginosa BSIs have been associated with both microbial and host factors. Neutropenia, a respiratory source of bacteremia, shock, renal failure, and metastatic foci of infection are among the host factors implicated in increased mortality rates (4, 6). Bacterial attributes include a high degree of intrinsic virulence (7, 8) and widespread antibiotic resistance. P. aeruginosa is intrinsically resistant to many structurally unrelated antimicrobial agents (9) because of the low permeability of its outer membrane, the constitutiv...

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Bloodstream infections in adults: Importance of healthcare-associated infections

Cited by 79 publications

References 23 publications

Antimicrobial susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in health care-associated urinary tract infection: focus on susceptibility to fosfomycin

Antimicrobial susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in health care-associated urinary tract infection: focus on susceptibility to fosfomycin

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

Bacterial and Clinical Characteristics of Health Care- and Community-Acquired Bloodstream Infections Due to Pseudomonas aeruginosa

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