Characteristics of Hospital-Acquired and Community-Onset Blood Stream Infections, South-East Austria

Hoenigl, Martin; Wagner, Jasmin; Raggam, Reinhard B.; Prueller, Florian; Prattes, Juergen; Eigl, Susanne; Leitner, Eva; Hönigl, Katharina; Valentin, Thomas; Zollner‐Schwetz, Ines; Grisold, Andrea; Krause, Robert

doi:10.1371/journal.pone.0104702

Cited by 35 publications

(37 citation statements)

References 31 publications

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“…Patients with P. aeruginosa BSI, relative to those with non-P. aeruginosa BSI, more often had hospital-acquired BSI (51% versus 27%). Prior studies have demonstrated hospital-acquired infections to be associated with increased mortality (22)(23)(24). Although the overall effect of adding the "days to BSI" covariate on the P. aeruginosa BSI hazard ratio was small (Tables 4 and see Table S3 in the supplemental material), it is certainly possible that patients with hospital-acquired infections may have additional risks for poor outcome that were not fully accounted for in our multivariable Cox regression model.…”

Section: Thaden Et Almentioning

confidence: 98%

Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria

Thaden

Park

Maskarinec

et al. 2017

Antimicrob Agents Chemother

138

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The impact of bacterial species on outcome in bloodstream infections (BSI) is incompletely understood. We evaluated the impact of bacterial species on BSI mortality, with adjustment for patient, bacterial, and treatment factors. From 2002 to 2015, all adult inpatients with monomicrobial BSI caused by Staphylococcus aureus or Gram-negative bacteria at Duke University Medical Center were prospectively enrolled. Kaplan-Meier curves and multivariable Cox regression with propensity score models were used to examine species-specific bacterial BSI mortality. Of the 2,659 enrolled patients, 999 (38%) were infected with S. aureus, and 1,660 (62%) were infected with Gram-negative bacteria. Among patients with Gram-negative BSI, Enterobacteriaceae (81% [1,343/1,660]) were most commonly isolated, followed by non-lactose-fermenting Gram-negative bacteria (16% [262/1,660]). Of the 999 S. aureus BSI isolates, 507 (51%) were methicillin resistant. Of the 1,660 Gram-negative BSI isolates, 500 (30%) were multidrug resistant. The unadjusted time-to-mortality among patients with Gram-negative BSI was shorter than that of patients with S. aureus BSI (P ϭ 0.003), due to increased mortality in patients with non-lactose-fermenting Gramnegative BSI generally (P Ͻ 0.0001) and Pseudomonas aeruginosa BSI (n ϭ 158) in particular (P Ͻ 0.0001). After adjustment for patient demographics, medical comorbidities, bacterial antibiotic resistance, timing of appropriate antibiotic therapy, and source control in patients with line-associated BSI, P. aeruginosa BSI remained significantly associated with increased mortality (hazard ratio ϭ 1.435; 95% confidence interval ϭ 1.043 to 1.933; P ϭ 0.02). P. aeruginosa BSI was associated with increased mortality relative to S. aureus or other Gram-negative BSI. This effect persisted after adjustment for patient, bacterial, and treatment factors. KEYWORDS Gram negative, Pseudomonas aeruginosa, Staphylococcus aureus, bloodstream infections Bacterial bloodstream infections (BSI) are a leading cause of morbidity and mortality in contemporary medical practice (1-3). The determinants of poor outcome in patients with BSI are among the most intensely investigated areas of infectious diseases. Although the intrinsic characteristics of bacterial species are thought to influence clinical outcomes, there is surprisingly little clinical data to support this impression. Several studies have shown that patients with Pseudomonas aeruginosa BSI experienced increased crude mortality relative to BSI caused by other bacterial species (4-9). However, these studies were unable to discriminate how much of this clinical outcome, if any, was attributable to the intrinsic virulence of P. aeruginosa rather than patient or

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Section: Thaden Et Almentioning

confidence: 98%

Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria

Thaden

Park

Maskarinec

et al. 2017

Antimicrob Agents Chemother

138

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“…were about 3.3% of our all the BSI pathogens of our patients, of which candida was the predominant agent (Table 1). In a study that carried out by Hoenigl et al [20] in Austria, it was reported that no fungal pathogen was detected in community-acquired BSIs. Therefore, we thought that some of the hospitalized patients in immunosuppressive situation could re-admit to EC department in the study period.…”

Section: Discussionmentioning

confidence: 96%

The pathogens of blood stream infection in the patients who applied to emergency medicine service: a three year retrospective analysis of a university hospital

Sarıhan¹

2017

Med-Science

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Blood stream infection (BSI) is a critical clinic situation that requires immediate diagnosis and treatment. In this study, we aimed to determine the BSI pathogens among the patients who admitted to emergency medicine clinic (EC). A retrospective surveillance study was conducted to evaluate the results of blood culture of the emergency patients in a university hospital between January 2015 and December 2017. Total 4569 blood culture were performed between the study period, and 802 (17.5%) of them yielded positive result, of which 14 (1.7%) were fungi, and remaining 788 (98.3%) were bacteria. Except the coagulase-negative staphylococci (CNSs) which was the major contaminant of blood cultures; Escherichia coli (n: 170; 21.2%) was the most frequently isolated organisms in this survey, and this was followed by Klebsiella spp. (n: 55; 6.8%) and Staphylococcus aureus (n: 54; 6.7%). The frequency of extended spectrum beta-lactamases (ESBLs) among the members of Enterobacteriaceae was measured as 38.2%, and the methicillin resistance of S. aureus was 7.4%. The common community acquired bacteremia agents were detected as relatively less, in such an order as Streptococcus pneumoniae (n: 14; 1.7%), beta-hemolytic streptococci (n: 11; 1.3%), and Brucella spp. (n: 7; 0.8%). This study indicates that gram negative enteric bacteria are the most frequent pathogens of BSI, and the high antimicrobial resistance mediated by ESBL resistance poses a substantial therapeutic problem in our region. The results also suggest that S. pneumoniae seems to be circulating in the community despite the vaccination campaigns. Emergency departments are critical units to diagnose community-acquired bacteremia and to commence appropriate antimicrobial chemotherapy for the patients with BSI.

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“…(13.7%) and finally Pseudomonas aeruginosa (7.4%). A recent study on the characteristics of hospital-acquired and community-onset blood stream infections from Austria (Hoenigl et al, 2014), E. coli followed by Staphylococcus aureus were the most frequently isolated pathogens. This study has shown that, ESBL producing E. coli is an important cause of bloodstream infection presenting from bot h, the community and the hospit al settings (40.9 and 35.9%, respectively).…”

Section: Discussionmentioning

confidence: 97%

“…The spread of communityacquired and hospital -acquired (nosocomial) bacteremia cause by E. coli imposes a major health burden. However, only few regional information is available on the differenc es between hospital-acquired and community acquired E. coli bacteremia (Hoenigl et al, 2014). Community and hospital spread of E. coli producing extended-spectrum beta-lactamases has increasingly been reported, most notably E. coli producing CTX-M strains (Woodford et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Escherichia coli bacteremia: Clinical features, risk factors and clinical implication of antimicrobial resistance

Al-Otaibi¹,

Bukhari²

2017

Afr. J. Microbiol. Res.

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Escheri chia coli i s an important cause of both communi ty acquired (CA) and hospital acquired (HA) bacteremia. A prospecti ve study was conducted at a tertiary care University Hospital from January, 2012 to July 2014, to compare the clinical features, risk factors, outcomes and antimicrobial resistance between E. coli bacteremia acquired from the community (CA) versus E. coli bacteremia acquired from the hospital (HA). Clinical and laboratory data of 171 adult patients with at least one positi ve blood culture of E. coli were analyzed. Data were collected from patients with significant blood stream infection, using medical and laboratory record file s and information from treating medical staff. The overall incidence of extended spectrum beta lactamase (ES BL) infection was high, 67/171 (77.4%). Thirty-eight (40.9%) of the CA i solates were found to produce ESBL, while 28 (35.9%) of the HA i solates were ESBL producers. Patients with CA bacteremia tend to be older than those with HA bacteremia (0.003). Neoplastic di sease s (hematological malignancy (<0.001), solid tumors (<0. 001)), renal transplantation end stage renal disease (ES RD) (<0.006), and wound infection (<0.001) were the most commonly associated conditions in patients with HA bacteremia. Patients from the community are more likely to present with UTI (<0.001), fever and pyelonephritis (0.001). Both CA and HA E. coli isolates showed the highest sensiti vity to imipenem, meropenem and amikacin followed by gentamicin and tazocin. The CA i solates are more susceptible to amikacin, tazocin and ciprofloxacin than the HA isolate s. No significant di fference in the mortality rate between patients with CA bacteremia and patients who acquire the bacteremia in a hospital setting (0.836) was observed. Clinicians need to be aware of the risk factors and changing pattern of antimicrobial resi stance of thi s pathogen and should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors

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Characteristics of Hospital-Acquired and Community-Onset Blood Stream Infections, South-East Austria

Cited by 35 publications

References 31 publications

Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria

Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria

The pathogens of blood stream infection in the patients who applied to emergency medicine service: a three year retrospective analysis of a university hospital

Escherichia coli bacteremia: Clinical features, risk factors and clinical implication of antimicrobial resistance

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