Epidemiology and management of healthcare-associated bloodstream infections in non-neutropenic immunosuppressed patients: a review of the literature

Abstract

Advancements in medicine have led to a considerable increase in the proportion of patients living with severe chronic diseases, malignancies, and HIV infections. Most of these conditions are associated with acquired immune-deficient states and treatment-related immunosuppression. Although infections as a result of neutropenia have long been recognized and strategies for management were developed, non-neutropenic immunosuppression has been overlooked. Recently, community-acquired infections in patients with frequent, significant exposure to healthcare settings and procedures have been classified as 'healthcare-associated infections' since they are more similar to hospital-acquired infections. Most of the non-neutropenic immunosuppressed patients have frequent contact with the healthcare system due to their chronic and severe diseases. In this review, we focus on the healthcare-associated bloodstream infections in the most common non-neutropenic immunosuppressive states and provide an update of the recent evidence for the management of these infections.

Ocorrência e perfil de sensibilidade e resistência de bactérias isoladas de culturas de aspirados traqueais de um Hospital Universitário do Sertão de Pernambuco

“…A infecção hospitalar (IH) é definida como as infecções que são adquiridas após 48 a 72 horas da admissão no serviço hospitalar e que ocorrem durante o período de internação ou após a alta, desde que esteja relacionada com o tempo de internação ou ainda aos procedimentos realizados no âmbito hospitalar (Babady, 2016;Cardoso et al, 2014;World Health Organization, 2016). Infecções adquiridas na comunidade, em pacientes que com frequência são expostos a procedimentos invasivos em locais que fornecem cuidados em saúde, foram classificadas como infecções associadas a cuidados de saúde (IACS), uma vez que são semelhantes às infecções hospitalares (Calik Basaran & Ascioglu, 2017). As IACS são também responsáveis por alta taxa de morbidade e mortalidade e elevam os custos da saúde (Al-Tawfiq & Tambyah, 2014).…”

Condições crônicas complexas e desfechos hospitalares em uma unidade de terapia intensiva pediátrica

“…(5) Revisão integrativa publicada em 2017, ao analisar a incidência de infecções primárias de corrente sanguínea, uma das vertentes das IRAS, em uma população de adultos não neutropênicos, associou a condição de doença crônica com maiores tempos de hospitalização, bem como maior necessidade de antimicrobianos, consequentemente, maiores incidências de infecções adquiridas no ambiente hospitalar. (19) A condução de CCC é desafiadora e divergente entre os profissionais de saúde. Apesar do avanço das discussões sobre cuidados paliativos na infância, muitas crianças crônicas com doenças incompatíveis com a vida acabam recebendo suporte terapêutico curativista.…”

Analysis of pathogenic distribution and drug resistance of catheter-related blood stream infection in hemodialysis patients with vein tunneled cuffed catheter

“…Gram-negative bacteria infection accounted for 33.3% in this group of data, including two strains of Enterobacter cloacae , two strains of Fluorescent pseudomonad , two strains of Klebsiella pneumoniae , one strain of Acinetobacter haemolyticu , one strain of Serratia marcescen , one strain of Enteroaerogen , one strain of Human pale bacillu , and one strain of Aeromonas hydrophila , most of which are the conditional pathogenic bacteria. This may be related with CRF patients with low immunity, 10 poor nutritional status, 10 and long-term hospitalization. One of the two strains of Klebsiella pneumoniae was found to be extended spectrum beta-lactamase (ESBL) positive, which was the main mechanism of resistance to beta-lactamide antibiotics.…”

“…Some of CRBSI patients have secondary serious complications, such as infective endocarditis, suppurative arthritis, epidural abscess, and other suppurative infections, which Staphylococcus aureus infection is an independent risk factor for. 9,10 Antibiotic selection for CRBSI caused by Staphylococcus aureus especially drug resistant strains, is particularly important. In the case of severe secondary complications of CRBSI, the average length of hospital stay, number of hospital admissions and treatment costs are all increased compared with the simple CRBSI.…”

“…In the case of severe secondary complications of CRBSI, the average length of hospital stay, number of hospital admissions and treatment costs are all increased compared with the simple CRBSI. 10 Therefore, analysis of common pathogenic bacteria distribution and antibiotic susceptibility of bacteria of CRBSI in HD patients with TCC has become increasingly important for the treatment and prognosis by clinicians. In the present study, the bacterial distribution and drug sensitivity of 75 HD patients with TCC diagnosed with CRBSI were retrospectively analyzed, providing a reference for clinical diagnosis and treatment.…”