Impact of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) on central line-associated bloodstream infections (CLABSIs) in department of hematology at single university hospital in Japan

Kato, Yukiko; Hagihara, Mao; Kurumiya, Ai; Takahashi, Tomoko; Sakata, Miki; Shibata, Yuichi; Kato, Hideo; Shiota, Arufumi; Watanabe, Hiroki; Asai, Nobuhiro; Koizumi, Yusuke; Yamagishi, Yuka

doi:10.1016/j.jiac.2017.08.013

Cited by 26 publications

(15 citation statements)

References 23 publications

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“…E. coli and Klebsiella sp were the most common GN bacteria isolated in both groups. Our data are consistent with those from previous studies that evaluated the most common causative GN organisms in similar populations [1, 9, 13]. These findings are explained by the fact that MBI increases the risk of translocation of the gut microorganisms, such as E. coli and Klebsiella sp, to the systemic circulation.…”

Section: Discussionsupporting

confidence: 92%

Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

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Khalil

Chaftari

et al. 2019

Open Forum Infectious Diseases

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Objective Gram-negative organisms have become a major etiology of bloodstream infections. We evaluated the effect of central venous catheter management on cancer patients with gram-negative bloodstream infections. Method We retrospectively identified patients older than 14 years with central venous catheters who were diagnosed with gram-negative bloodstream infections to determine the effect of catheter management on outcome. Patients were divided into 3 groups: Group 1 included patients with central line-associated bloodstream infections (CLABSI) without mucosal barrier injury and those whose infection met the criteria for catheter-related bloodstream infection; group 2 included patients with CLABSI with mucosal barrier injury who did not meet the criteria for catheter-related bloodstream infection; and group 3 included patients with non-CLABSI. Results The study included 300 patients, with 100 patients in each group. Only in group 1 was central venous catheter removal within 2 days of bloodstream infection significantly associated with a higher rate of microbiologic resolution at 4 days compared to delayed central venous catheter removal (3–5 days) or retention (98% vs 82%, P = .006) and a lower overall mortality rate at 3-month follow-up (3% vs 19%, P = .01). Both associations persisted in multivariate analyses (P = .018 and P = .016, respectively). Conclusions Central venous catheter removal within 2 days of the onset of gram-negative bloodstream infections significantly improved the infectious outcome and overall mortality of adult cancer patients with catheter-related bloodstream infections and CLABSI without mucosal barrier injury.

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Section: Discussionsupporting

confidence: 92%

Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

Fares

Khalil

Chaftari

et al. 2019

Open Forum Infectious Diseases

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“…So, even if a central line is present and the CDC criteria for primary CLABSI are fulfilled, BSI in these cases may rather origin from the injured gut or oral mucosa rather than from the CVC. As a consequence, this infection usually presents with typical microorganisms from the gut or oral cavity such as Escherichia coli, enterococci or streptococci [37] and "traditional" infection control strategies proposed to prevent CLABSI will fail in these subgroups [38]. However, in our study period coagulase-negative Staphylococci dominated the spectrum of pathogens and, thus, we believe that the bias of false classification of mucositis-induced BSI is rather small in our data.…”

Section: Discussionmentioning

confidence: 71%

Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

et al. 2020

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Non-implanted central vascular catheters (CVC) are frequently required for therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and, thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis. Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (� 1000/ μL), carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs directly attributed to the onset of CLABSI were 8,810 € per case. CLABSI had a significant impact on the overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention is crucial for best clinical practice.

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“…Methotrexate (MTX)-induced mucositis remains a significant and unmet need that is only set to grow as the number of cancer diagnoses increase. Given the increasing recognition of its contribution to deadly treatment complications 20 - 22 and late effects in survivors of childhood cancer, 23 efforts to prevent acute mucosal injury are paramount. Here, we report microbial benefits following a clinically feasible fasting schedule, with paralleled decreases in epithelial proliferation.…”

Section: Discussionmentioning

confidence: 99%

Pre-therapy fasting slows epithelial turnover and modulates the microbiota but fails to mitigate methotrexate-induced gastrointestinal mucositis

et al. 2020

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Background: Recent findings by Tang et al. (2020) show dietary restriction (30%, 2 weeks) prevents methotrexate-induced mortality by modulation of the microbiota, specifically the expansion of Lactobacillus. While fundamentally insightful, upscaling this schedule is a major obstacle to clinical uptake. Here, we evaluate a safe and clinically achievable schedule of pre-therapy fasting for 48 h on microbiota composition, body composition and intestinal proliferation, and assess its impact on the severity of methotrexate-induced gastrointestinal mucositis using a validated preclinical rat model. Methods: Age-and weight-matched male Wistar rats were treated with a sublethal dose of 45 mg/ kg methotrexate with or without pre-therapy fasting. The impact of acute fasting on epithelial proliferation, body composition and the microbiota was assessed using plasma citrulline, Ki67 immunohistochemistry, miniSpec and 16S rRNA sequencing. The severity of gastrointestinal mucositis was evaluated using plasma citrulline and body weight. Results: Whilst pre-therapy fasting slowed epithelial proliferation and increased microbial diversity and richness, it also induced significant weight loss and was unable to attenuate the severity of mucositis in both age-and weight-matched groups. In contrast to Tang et al., we saw no expansion of Lactobacillus following acute fasting. Conclusions: Our findings suggest that the beneficial effects of acute fasting are masked by the detrimental effects on body weight and composition and lacking influence on Lactobacillus. Future studies should consider alternative fasting schedules or aim to induce comparable microbial and mucosal manipulation without compromising body composition using clinically feasible methods of dietary or microbial intervention.

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Impact of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) on central line-associated bloodstream infections (CLABSIs) in department of hematology at single university hospital in Japan

Cited by 26 publications

References 23 publications

Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

Impact of Catheter Management on Clinical Outcome in Adult Cancer Patients With Gram-Negative Bacteremia

Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

Pre-therapy fasting slows epithelial turnover and modulates the microbiota but fails to mitigate methotrexate-induced gastrointestinal mucositis

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