Gram-Negative Bacteremia

McCabe, William R.; Jackson, George Gee

doi:10.1001/archinte.1962.03620240029006

Cited by 1,251 publications

(151 citation statements)

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“…org/fileadmin/tx_eauguidelines/2009/Full/Urological_Infections.pdf). For each patient, the evaluated demographic and clinical data were: sex, age, Charlson's score (Charlson et al, 2008), MacCabe's score (MacCabe & Jackson, 1962), prior use of antibiotics (b-lactam antibiotics and fluoroquinolones) in the previous 3 months and death during hospitalization. The presence of a urinary catheter (double pigtail catheter, ureteral catheter, vesical catheter or suprapubic catheter) or history of recurrent infection, as well as occurrence of a previous community or nosocomialacquired infection, were also noted.…”

Section: Methodsmentioning

confidence: 99%

Resistance and virulence potential of uropathogenic Escherichia coli strains isolated from patients hospitalized in urology departments: a French prospective multicentre study

Lavigne

Bruyère

Bernard

et al. 2016

Journal of Medical Microbiology

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We characterized antibiotic resistance and virulence of uropathogenic Escherichia coli (UPEC) strains isolated from urinary tract infections (UTIs) in patients hospitalized in urology departments. A prospective multicentre study was initiated from March 2009 and lasted until February 2010 in French urology units. All patients with asymptomatic bacteriuria (ABU), acute cystitis, acute pyelonephritis or acute prostatitis in whom UPEC was detected were included. Antimicrobial resistance and virulence factors were compared among the different groups. To identify Abbreviations: ABU, asymptomatic bacteriuria; ESBL, extended spectrum b-lactamase; QRDR, quinolone resistance-determining region; rep-PCR, repetitive-PCR ; UPEC, uropathogenic Escherichia coli; UTI, urinary tract infections; VF, virulence factor. 000247 ã 2016 The Authors Printed in Great BritainJournal of Medical Microbiology (2016), 65, 530-537 DOI 10.1099 independent associations between virulence markers and the risk of UTI, we used a multivariate logistic regression. We included 210 patients (mean age: 65.8 years; 106 female). Episode of UTI was community acquired in 72.4 %. ABU was diagnosed in 67 cases (31.9 %), cystitis in 52 cases (24.7 %), pyelonephritis in 35 cases (16.7 %) and prostatitis in 56 cases (26.7 %). ABU was more frequent in patients with a urinary catheter (76.1 vs 23.9 %, P<0.001). The resistance rate was 7.6 and 24.8 % for cefotaxime and ciprofloxacin, respectively. UPEC isolated from infections belonged more frequently to phylotypes B2 and D (P =0.07). The papG allele II and papA, papC, papE, kpsMTII and iutA genes were significantly more frequent in infecting strains (P<0.05). In multivariate analysis, strains susceptible to ciprofloxacin were significantly associated with papG allele II (P=0.007), kpsMTK1 (P<0.001) and hlyA (P<0.001) compared with the ciprofloxacin-resistant strains. To the best of our knowledge, this is the first study evaluating the antibiotic resistance and virulence features of UPEC isolated from patients hospitalized in urology departments. High resistance rates were observed, notably for ciprofloxacin, highlighting the importance of a reinforced surveillance in this setting. INTRODUCTIONUrinary tract infections (UTIs) are among the most common community-acquired and nosocomial infections (Foxman, 2003;Lavigne et al., 2007). These infections are rarely directly associated with a patient's death. However, they are responsible for an increased risk of aggravation of comorbidity and healthcare-associated costs. Such infections are also responsible for significant use of antibiotics, with implications for bacterial ecology and the risk of collateral damage. Among bacterial species implicated in UTIs, uropathogenic Escherichia coli (UPEC) is the most common. In recent decades, multidrug-resistant UPEC has led to major difficulties treating infected patients. Although many recent studies have investigated UPEC virulence, few data are available on antibiotic resistance and the virulence features of these strains di...

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Section: Methodsmentioning

confidence: 99%

Resistance and virulence potential of uropathogenic Escherichia coli strains isolated from patients hospitalized in urology departments: a French prospective multicentre study

Lavigne

Bruyère

Bernard

et al. 2016

Journal of Medical Microbiology

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“…"Immune suppression" referred to use at the time of the sample collection of corticosteroids (Ͼ15 mg/day prednisolone or equivalent), calcineurin inhibitors, other nonbiologics (e.g., mycophenylate and methotrexate), cytotoxic agents, biological agents, or radiation therapy; the Charlson comorbidity index (12) was calculated on the basis of data available from the survey, with the exception of neurological impairment (dementia and hemiplegia), which was inadvertently omitted from the survey questioning. A McCabe score was assigned based on the investigator's estimate of participant survival (Ͻ1 month, 1 month to 2 years, or Ͼ2 years) (13). "International travel" (excluding travel between Australia and New Zealand) was classified into geographical regions as follows: South Pacific islands, southeast Asia, Indian subcontinent, China, Japan, North America, Europe, and Africa/the Middle East.…”

Section: Methodsmentioning

confidence: 99%

Community-Onset Escherichia coli Infection Resistant to Expanded-Spectrum Cephalosporins in Low-Prevalence Countries

Rogers

Ingram

Runnegar

et al. 2014

Antimicrob Agents Chemother

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i By global standards, the prevalence of community-onset expanded-spectrum-cephalosporin-resistant (ESC-R) Escherichia coli remains low in Australia and New Zealand. Of concern, our countries are in a unique position, with high extramural resistance pressure from close population and trade links to Asia-Pacific neighbors with high ESC-R E. coli rates. We aimed to characterize the risks and dynamics of community-onset ESC-R E. coli infection in our low-prevalence region. A case-control methodology was used. Patients with ESC-R E. coli or ESC-susceptible E. coli isolated from blood or urine were recruited at six geographically dispersed tertiary care hospitals in Australia and New Zealand. Epidemiological data were prospectively collected, and bacteria were retained for analysis. In total, 182 patients (91 cases and 91 controls) were recruited. Multivariate logistic regression identified risk factors for ESC-R among E. coli strains, including birth on the Indian subcontinent (odds ratio [OR] ‫؍‬ 11.13, 95% confidence interval [95% CI] ‫؍‬ 2.17 to 56.98, P ‫؍‬ 0.003), urinary tract infection in the past year (per-infection OR ‫؍‬ 1.430, 95% CI ‫؍‬ 1.13 to 1.82, P ‫؍‬ 0.003), travel to southeast Asia, China, the Indian subcontinent, Africa, and the Middle East (OR ‫؍‬ 3.089, 95% CI ‫؍‬ 1.29 to 7.38, P ‫؍‬ 0.011), prior exposure to trimethoprim with or without sulfamethoxazole and with or without an expanded-spectrum cephalosporin (OR ‫؍‬ 3.665, 95% CI ‫؍‬ 1.30 to 10.35, P ‫؍‬ 0.014), and health care exposure in the previous 6 months (OR ‫؍‬ 3.16, 95% CI ‫؍‬ 1.54 to 6.46, P ‫؍‬ 0.02). Among our ESC-R E. coli strains, the bla CTX-M ESBLs were dominant (83% of ESC-R E. coli strains), and the worldwide pandemic ST-131 clone was frequent (45% of ESC-R E. coli strains). In our low-prevalence setting, ESC-R among community-onset E. coli strains may be associated with both "export" from health care facilities into the community and direct "import" into the community from highprevalence regions. Despite a dramatic global rise in the prevalence of expanded-spectrum-beta-lactamase (ESBL)-producing Escherichia coli, infections by expanded-spectrum-cephalosporin-resistant (ESC-R) E. coli in Australia, New Zealand, North America, and selected European countries remain at relatively low levels. Recent Australian national data show that 3.2% of community isolates carry such resistance. Approximately 80% of these harbor a globally dominant bla CTX-M ESBL gene and 12% a plasmid-borne AmpC-type mechanism (1). European surveillance data show that a significant proportion of countries have ESC resistance rates rates below 10% among invasive E. coli isolates (2). In the United States, a recent large sample of E. coli isolates indicated that 3.9% were ESBLproducing strains (3). Although these low rates offer reassurance in the near term, a year-on-year rise in the incidence of community-onset ESC-R E. coli infections in low-prevalence countries is of concern (2, 4).Australia and New Zealand are in a globally unique position. We have low r...

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“…The severity of illness was assessed according to the Simplified Acute Physiology Score II (SAPS II) [19], the modified SAPS II (SAPS II without age) score, the Sequential Organ Failure Assessment (SOFA) score [20], and the Glasgow Coma Scale. Life expectancy was estimated using the McCabe classification [21].…”

Section: Data Collectionmentioning

confidence: 99%

Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study

et al. 2014

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Conflict of interest statement. PLM, AR, EC, MSM, OM, GLG, DS, CC, FF, YM, and PS declare that they have no conflicts of interest. SL has received consulting fees from Viforpharma. KA has received lecturing and consulting fees from Braun, Astellas, and Fresenius. AbstractPurpose: Frailty is a recent concept used for evaluating elderly individuals. Our study determined the prevalence of frailty in intensive care unit (ICU) patients and its impact on the rate of mortality. Methods:A multicenter, prospective, observational study performed in four ICUs in France included 196 patients aged ≥65 years hospitalized for >24 hours during a 6-month study period. Frailty was determined using the frailty phenotype (FP) and the clinical frailty score (CFS). The patients were separated as follows: FP score <3 or ≥3 and CFS < 5 or ≥ 5.Results: Frailty was observed in 41% and 23% of patients based on a FP score ≥3 and a CFS ≥5, respectively. At admission to the ICU, the Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores did not differ between the frail and nonfrail patients. In the multivariate analysis, the risk factors for ICU mortality were FP score ≥3 (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.6-6.6; p<0.001), male gender (HR, 2.4; 95% CI, 1.1-5.3; p=0.026), cardiac arrest before admission (HR, 2.8; 95% CI, 1.1-7.4; p=0.036), SAPS II score ≥ 46 (HR, 2.6; 95% CI, 1.2-5.3; p=0.011), and brain injury before admission (HR, 3.5; 95% CI, 1.6-7.7; p=0.002). The risk factors for 6-month mortality were a CFS ≥5 (HR, 2.4; 95% CI, 1.49-3.87; p<0.001) and a SOFA score ≥7 (HR, 2.2; 95% CI, 1.35-3.64; p=0.002). An increased CFS was associated with significant incremental hospital and 6-month mortalities. Conclusions:Frailty is a frequent occurrence and is independently associated with increased ICU and 6-month mortalities.Notably, the CFS predicts outcomes more effectively than the commonly used ICU illness scores.

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Gram-Negative Bacteremia

Cited by 1,251 publications

References 14 publications

Resistance and virulence potential of uropathogenic Escherichia coli strains isolated from patients hospitalized in urology departments: a French prospective multicentre study

Resistance and virulence potential of uropathogenic Escherichia coli strains isolated from patients hospitalized in urology departments: a French prospective multicentre study

Community-Onset Escherichia coli Infection Resistant to Expanded-Spectrum Cephalosporins in Low-Prevalence Countries

Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study

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