Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

Yan

Antimicrob Resist Infect Control

et al. 2018

BackgroundGram-positive bacterial bloodstream infections (BSIs) are serious diseases associated with high morbidity and mortality. The following study examines the incidence, clinical characteristics and microbiological features, drug resistance situations and mortality associated with Gram-positive BSIs at a large Chinese tertiary-care hospital in Beijing, China.MethodsA retrospective cohort study of patients with Gram-positive BSIs was performed between January 1, 2011, and June 31, 2017, at the Chinese People’s Liberation Army General Hospital. The patients’ data were collected and included in the reviewing electronic medical records.ResultsA total of 6887 episodes of Gram-positive BSIs occurred among 4275 patients over 6 years, and there were 3438 significant BSI episodes 69% of these cases were healthcare-associated, while 31% were community-associated. The overall incidence of Gram-positive BSIs fluctuated from 7.26 to 4.63 episodes per 1000 admissions over 6 years. Malignancy was the most common comorbidity and indwelling central intravenous catheter was the most common predisposing factor for BSI. Staphylococci were the major pathogen (65.5%), followed by Enterococcus spp:(17.5%), Streptococcus spp.(7.1%) and other bacterial pathogens (9.9%). The resistance rates of Staphylococci and E.faecium to penicillins were more than 90%. the vancomycin-resistant isolates were E. faecium (4.1%) and staphylococcus epidermidis (0.13%); and only E.faecalis and E.faecium showed resistance to linezolid (3.8% and 3.1%). Between 2011 and 2017, the overall mortality of Gram-positive BSIs decreased from 6.27 to 4.75% (X2 = 0.912, p = 0.892). Neverthess, the mortality in the ICU decreased from 60.46 to 47.82%, while in the general ward it increased from 39.54 to 52.18%.ConclusionsThe morbidity and mortality of Gram-positive BSIs have showed downward trends. Vancomycin and linezolid are still consider the best treatment for patients with Gram-positive BSIs.

Section: Discussionsupporting

confidence: 82%

“…Streptococcus spp. Gram-positive bacilli and others [18–20], neverthless, only few studies have focused on Gram-positive bloodstream infections [21]. …”

Section: Discussionmentioning

confidence: 99%

Epidemiology and microbiology of Gram-positive bloodstream infections in a tertiary-care hospital in Beijing, China: a 6-year retrospective study

Yan

Antimicrob Resist Infect Control

et al. 2018

“…This results were comparable to other studies who reported 13.7%, 12.2% and 10.78% of A.baumannii from blood. [10][11][12] While H. Wisplingh off et al found 1.6% blood stream infection due A.baumannii from ICU patients this result was lesser than the present study. 13 Proper aseptic sample collection and better diagnostic methods could be a reason for increased rate of isolation.…”

Section: Discussioncontrasting

confidence: 69%

Extreme drug resistant A.baumannii associated with CLA-BSI in Kanpur

Pal

Sujatha

2017

Int J Res Med Sci

Background: Nosocomial bloodstream infection on the critically ill patients has been associated with high mortality. Central venous catheters (CVC) have become essential in the management of patients who are critically ill and those who require long-term medical care. This study was conducted to determine the Central line associated blood stream infections (CLA-BSIs) due to A.baumannii its risk factors and antibiotic resistant patterns.Methods: A total of 52 samples (blood or central line tip) were received from patients with a clinical diagnosis of sepsis after central venous catheterization. The semi quantitative method was used for catheter tip culture. Bacterial identification and antibiotics resistant pattern was performed by Standard microbiological protocol.Results: Of 52 test samples (blood or central line tip), 2 pathogenic strains were isolated from blood, 2 strains of A.baumannii isolated from catheter tips were colonizer and 3 strains of A.baumannii were pathogenic which caused CLA-BSI. The rate of CLABSI due A.baumannii was 11.11 per 1000 catheter days. All A.baumannii were extreme drug resistant (XDR). They only sensitive for polymyxins and tegicyclines.Conclusions: Central venous catheters are increasingly being used in critical care and have been directly related to patient mortality and morbidity. Microbiological surveillance may guide management of multidrug resistant isolates and its complications. Proper infection control practices can reduce the nosocomial infection rate.

“…In the present study, there was no obvious change in overall incidence both in the ICU and on general ward per year. Nevertheless, many studies have reported a decrease in the incidence of gram-negative BSIs in general ward and ICU [19,20,21] . This might be explained with the incidence of gram-negative BSIs in our hospital was lower than other study [20] in china which has reported the incidence rate was 5.7/1000 admissions and our hospital is one of the largest general hospitals in China with more critically ill patients which means more invasive manipulation, more catheter indwelling, more comorbidity and other risk factors that lead to the occurrence of bloodstream infection.…”

Section: Discussionmentioning

confidence: 99%

“…Central intravenous catheters were the most common predisposing factors (10%), followed by chemoradiotherapy (6%) and indwelling urinary catheters (5%). 191 (30,24 -35) 46 (31,(29)(30)(31)(32) 124 (29,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) 134 (26,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) 1023(34,9-58) 0.3914 Comorbidi ties Malignanc y 392 (32,21 -42) 183 (28,22 -33) 52 (35,(33)(34)(35)(36) 71 (16,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 92 (18,(13)(14)…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

Epidemiology and microbiology of Gram-negative bloodstream infections in a tertiary-care hospital in Beijing, China: a 9-year retrospective study

Expert Review of Anti-infective Therapy

et al. 2020

Background Gram-negative bacterial bloodstream infections (BSIs) are serious diseases associated with high morbidity and mortality. The following study examines the incidence, clinical characteristics and microbiological features, drug resistance situations and mortality associated with gram-negative BSIs at a large Chinese tertiary-care hospital in Beijing, China. Methods A retrospective cohort study of patients with gram-negative BSIs was performed between January 1, 2010, and December 31, 2018, at the Chinese People ' s Liberation Army General Hospital. The patients' data were collected and included in the reviewing electronic medical records. Results A total of 6867 episodes of gram-negative BSIs occurred among 3199 patients over 9 years, and there were 3032 signi cant BSI episodes 77% of these cases were healthcare-associated, while 23% were community-associated. The overall incidence of gram-negative BSIs uctuated from 2.30 to 2.55 episodes per 1000 admissions over 9 years. Malignancy was the most common comorbidity and indwelling central intravenous catheter was the most common predisposing factor for gram-negative BSI. Escherichia coli were the major pathogen (34.3%), followed by Klebsiella pneumoniae (23.3%) and other bacterial pathogens (9.9%). The resistance rates of Escherichia coli and Klebsiella pneumoniae to penicillins were more than 90%. and the resistance rates of Acinetobacter baumannii to the most antibiotic were more than 70% include the Carbapenem. The resistance of ESBLs-producing Escherichia coli to the most antibiotic was higher than non-ESBLs producing Escherichia coli but to Carbapenems(0.7% VS 5.1%). The rates of Carbapenems resistance of ESBLs-producing Klebsiella pneumoniae and non-ESBLs producing Klebsiella pneumoniae were 32.8% and 8.1%. The rates of Carbapenems resistance of Enterobacter cloacae and Pseudomonas aeruginosa were 1.4% and 27.8% respectively. Between 2010 and 2018, the overall mortality of gram-negative BSIs decreased from 11.41-9.05%(X 2 = 6.95, P = 0.434). Moreover, the mortality in the ICU decreased from 27.03-14.93%(X 2 = 9.61, P = 0.212), while in the general ward uctuated from 8.85-8.13% that without obvious decrease change(X 2 = 9.29, P = 0.232). Conclusions The mortality of gram-negative BSIs have showed downward trends. carbapenem antibiotics is still consider the best treatment for patients with Gram-negative BSIs except Acinetobacter baumannii.