Evaluation of risk factors for the acquisition of bloodstream infections with extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species in the intensive care unit; antibiotic management and clinical outcome

Cordery, Rebecca; Roberts, Catherine; Cooper, Sian; Bellinghan, Geoff; Shetty, Nandini

doi:10.1016/j.jhin.2007.10.011

Cited by 49 publications

(40 citation statements)

References 17 publications

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“…While in this retrospective analysis we cannot definitively assert that the decrease in 30-day mortality is a direct result of the BC-GN test being implemented, the trend toward more timely administration of effective antibiotic therapy, the significantly decreased length of stay in the ICU, and the significantly fewer deaths associated with MDR organisms suggest that more rapid identification of Gram-negative organisms and major resistance mechanisms played an important role. This finding is also supported by the fact that inappropriate antibiotic coverage has been linked with increased mortality in hospitalized patients with ESBL or MDR organism bacteremia (6,30,31).…”

Section: Discussionmentioning

confidence: 73%

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

et al. 2016

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c Gram-negative bacteremia is highly fatal, and hospitalizations due to sepsis have been increasing worldwide. Molecular tests that supplement Gram stain results from positive blood cultures provide specific organism information to potentially guide therapy, but more clinical data on their real-world impact are still needed. We retrospectively reviewed cases of Gram-negative bacteremia in hospitalized patients over a 6-month period before (n ‫؍‬ 98) and over a 6-month period after (n ‫؍‬ 97) the implementation of a microarray-based early identification and resistance marker detection system (Verigene BC-GN; Nanosphere) while antimicrobial stewardship practices remained constant. Patient demographics, time to organism identification, time to effective antimicrobial therapy, and other key clinical parameters were compared. The two groups did not differ statistically with regard to comorbid conditions, sources of bacteremia, or numbers of intensive care unit (ICU) admissions, active use of immunosuppressive therapy, neutropenia, or bacteremia due to multidrug-resistant organisms. The BC-GN panel yielded an identification in 87% of Gram-negative cultures and was accurate in 95/97 (98%) of the cases compared to results using conventional culture. Organism identifications were achieved more quickly post-microarray implementation (mean, 10.9 h versus 37.9 h; P < 0.001). Length of ICU stay, 30-day mortality, and mortality associated with multidrug-resistant organisms were significantly lower in the postintervention group (P < 0.05). More rapid implementation of effective therapy was statistically significant for postintervention cases of extended-spectrum beta-lactamase-producing organisms (P ‫؍‬ 0.049) but not overall (P ‫؍‬ 0.12). The Verigene BC-GN assay is a valuable addition for the early identification of Gram-negative organisms that cause bloodstream infections and can significantly impact patient care, particularly when resistance markers are detected. Bloodstream infection remains one of the deadliest and costliest conditions in the United States, more than doubling between 2000 and 2008 and becoming the sixth most common reason for hospitalization (1). Gram-negative bacteremia has become an ever more pressing public health concern, as numbers across the globe continue to rise (2, 3). Although Gram-negative organisms are only responsible for ϳ30% of cases of hospitalacquired infections, they account for 70% of such cases in intensive care units (ICU) in the United States (4). These organisms, including multidrug-resistant (MDR) Pseudomonas aeruginosa and extended-spectrum beta-lactamase (ESBL) or carbapenemresistant Enterobacteriaceae (CRE), are associated with higher mortality rates (1, 3, 4).A timely and appropriate antimicrobial therapy selection is of particular importance. Delays in effective therapy and ineffective empirical therapy are associated with increased patient mortality (4-7). Growing evidence suggests that appropriate, early antibiotic therapy can improve patient outcomes (3,4,6,8). New rapid m...

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Section: Discussionmentioning

confidence: 73%

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

et al. 2016

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“…Patients at high risk for developing colonization or infection with ESBL-producing organisms are often seriously ill, have (had) a prolonged hospital stay, or are in need of invasive medical devices [1,2,[5][6][7][8][9]. Several studies have found a relationship between third-generation cephalosporin use and colonization or infections with an ESBL-producing strain [10].…”

Section: Introductionmentioning

confidence: 99%

Risks Factors for Infections with Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care University Hospital in Switzerland

et al. 2010

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Background: There are considerable geographical differences in the occurrence of extended-spectrum beta-lactamase (ESBL)-producing bacteria, both in the community and in the hospital setting. Our aim was to assess risk factors for bloodstream, urinary tract, and vascular catheter-associated infections with ESBL-producing Escherichia coli and Klebsiella pneumoniae at a tertiary care hospital in a low-prevalence country. Methods: We performed a case-control study comparing 58 patients with infections due to ESBL-producing E. coli or K. pneumoniae vs 116 controls with infections due to non-ESBL producing organisms at the University Hospital Zurich, Switzerland, between .28], p = 0.042), antibiotic therapy within the year preceding the isolation of the ESBL-producing strain (OR 2.88, 95% CI 1.13-8.49, p = 0.025), and mechanical ventilation (OR 10.56, 95% CI 1.06-579.10, p = 0.042). Conclusions: The major risk factors for infections due to ESBL-producing bacteria were travel in high-prevalence countries, prior antibiotic use, and mechanical ventilation during a stay in the intensive care unit. Community-acquired infections were documented in 17% of the patients. An early identification of risk factors is crucial to providing the patients an optimal empiric antibiotic therapy and to keep the use of carbapenems to a minimum.

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“…Frequencies as high as 40% have been reported in some regions, and the available data suggest a further increase in the incidence of ESBL-producing isolates (10,23,31,34). Therefore, nosocomial-infection surveillance is necessary in order to collect data that can be used in the prevention and control of Klebsiella infection (8,20).…”

mentioning

confidence: 99%

Analysis of the 16S–23S rRNA Gene Internal Transcribed Spacer Region in Klebsiella Species

Wang

Cao

et al. 2008

J Clin Microbiol

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The 16S-23S rRNA gene internal transcribed spacer (ITS) regions of Klebsiella spp., including Klebsiella pneumoniae subsp. pneumoniae, Klebsiella pneumoniae subsp. ozaenae, Klebsiella pneumoniae subsp. rhinoscleromatis, Klebsiella oxytoca, Klebsiella planticola, Klebsiella terrigena, and Klebsiella ornithinolytica, were characterized, and the feasibility of using ITS sequences to discriminate Klebsiella species and subspecies was explored. Regions with significant interspecies variations but low intraspecies polymorphisms were identified; these may be targeted in the design of probes for the identification of Klebsiella to the species level. Phylogenetic analysis based on ITS regions reveals the relationships among Klebsiella species similarly to that based on 16S rRNA genes.

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Evaluation of risk factors for the acquisition of bloodstream infections with extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species in the intensive care unit; antibiotic management and clinical outcome

Cited by 49 publications

References 17 publications

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

Clinical Impact of Laboratory Implementation of Verigene BC-GN Microarray-Based Assay for Detection of Gram-Negative Bacteria in Positive Blood Cultures

Risks Factors for Infections with Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care University Hospital in Switzerland

Analysis of the 16S–23S rRNA Gene Internal Transcribed Spacer Region in Klebsiella Species

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