Mortality and associated risk factors in consecutive patients admitted to a UK NHS trust with community acquired bacteraemia

Hounsom, Luke; Grayson, Kate; Melzer, Mark

doi:10.1136/pgmj.2010.116616

Cited by 26 publications

(17 citation statements)

References 22 publications

(25 reference statements)

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“…Although most commonly associated with uncomplicated urinary tract infections, extraintestinal strains of E. coli can also cause a wide variety of serious infections, including meningitis, pneumonia and bacteremia [1]. Previous studies have consistently ranked E. coli as the most common cause of community-onset bacteremia, and a major causative pathogen in nosocomial bacteremia [2-6]. Over the past decade, several countries have described an increase in the incidence of E. coli bloodstream infections (EC-BSI) [7,8].…”

Section: Introductionmentioning

confidence: 99%

Population-based incidence and comparative demographics of community-associated and healthcare-associated Escherichia coli bloodstream infection in Auckland, New Zealand, 2005 – 2011

et al. 2013

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BackgroundEscherichia coli is a major human pathogen, both in community and healthcare settings. To date however, relatively few studies have defined the population burden of E. coli bloodstream infections. Such information is important in informing strategies around treatment and prevention of these serious infections. Against this background, we performed a retrospective, population-based observational study of all cases of E. coli bacteremia in patients presenting to our hospital between January 2005 and December 2011.MethodsAuckland District Health Board is a tertiary-level, university-affiliated institution serving a population of approximately 500,000, within a larger metropolitan population of 1.4 million. We identified all patients with an episode of bloodstream infection due to E. coli over the study period. A unique episode was defined as the first positive E. coli blood culture taken from the same patient within a thirty-day period. Standard definitions were used to classify episodes into community- or healthcare-associated E. coli bacteremia. Demographic information was obtained for all patients, including: age; gender; ethnicity; length of stay (days); requirement for intensive care admission and all-cause, in-patient mortality.ResultsA total of 1507 patients had a unique episode of E. coli bacteremia over the study period. The overall average annual incidence of E. coli bacteremia was 52 per 100,000 population, and was highest in the under one year and over 65-year age groups. When stratified by ethnicity, rates were highest in Pacific Peoples and Māori (83 and 62 per 100,000 population respectively). The incidence of community-onset E. coli bacteremia increased significantly over the study period. The overall in-hospital mortality rate was 9% (135/1507), and was significantly higher in patients who had a hospital-onset E. coli bacteremia.ConclusionsOur work provides valuable baseline data on the incidence of E. coli bacteremia in our locale. The incidence was higher that that described from other developed countries, with significant demographic variation, most notably in ethnic-specific incidence rates. Future work should assess the possible reasons for this disparity.

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Section: Introductionmentioning

confidence: 99%

Population-based incidence and comparative demographics of community-associated and healthcare-associated Escherichia coli bloodstream infection in Auckland, New Zealand, 2005 – 2011

et al. 2013

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“…[1][2][3] BSI is a major cause of community and healthcare-associated infections and is associated with high mortality. [3][4][5][6][7] Infectious diseases are the leading cause of death in the Democratic Republic of the Congo (DRC). [8] In fact, the DRC has a crude mortality rate well above the average for sub-Saharan countries [9] and the highest under-5 mortality rate in Africa, [10] with malaria, pneumonia and diarrhoea the leading causes of death.…”

mentioning

confidence: 99%

Antimicrobial resistance of bacteria isolated from patients with bloodstream infections at a tertiary care hospital in the Democratic Republic of the Congo

et al. 2015

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Corresponding author: L M Irenge (leonid.irenge@uclouvain.be)Background. Bloodstream infection (BSI) is a life-threatening condition that requires rapid antimicrobial treatment. Methods. We determined the prevalence of bacterial isolates associated with BSI at Bukavu General Hospital (BGH), South Kivu Province, Democratic Republic of the Congo, and their patterns of susceptibility to antimicrobial drugs, from February 2013 to January 2014. Results. We cultured 112 clinically relevant isolates from 320 blood cultures. Of these isolates, 104 (92.9%) were Gram-negative bacteria (GNB), with 103 bacilli (92.0%) and one coccus (0.9%). Among GNB, Escherichia coli (51.9%), Klebsiella spp. (20.2%), Enterobacter spp. (6.7%), Shigella spp. (5.8%) and Salmonella spp. (4.8%) were the most frequent agents causing BSIs. Other GNB isolates included Proteus spp., Citrobacter spp. and Pseudomonas aeruginosa (both 2.9%), and Acinetobacter spp. and Neisseria spp. (both 0.9%). High rates of resistance to co-trimoxazole (100%), erythromycin (100%) and ampicillin (66.7 -100%) and moderate to high resistance to ciprofloxacin, ceftazidime, ceftriaxone, cefuroxime and cefepime were observed among GNB. Furthermore, there were high rates of multidrug resistance and of extended-spectrum β-lactamase (ESBL) production phenotype among Enterobacteriaceae. Gram-positive bacteria included three Staphylococcus aureus isolates (2.7%), four oxacillin-resistant coagulase-negative staphylococci (CoNS) isolates (3.6%) and one Streptococcus pneumoniae (0.9%). No oxacillin-resistant S. aureus was isolated. Among clinically relevant staphylococci, susceptibility to co-trimoxazole and ampicillin was low (0 -25%). In addition, 58 contaminant CoNS were isolated from blood cultures, and the calculated ratio of contaminants to pathogens in blood cultures was 1:2. Conclusions. Multidrug-resistant and ESBL-producing GNB are the leading cause of BSI at BGH. Med J 2015;105(9):752-755. S Afr

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“…Of the 46 studies two were large multi-center studies: one including data from USA, Canada and Saudi Arabia; 13 and the second including data from nine European countries. 14 Thirteen studies were from the USA, 12,15-26 eight from Spain, 27-34 five from Italy, 35-39 four from Korea, 40-43 three each from Turkey 44-46 and Israel, 47-49 two each from the Netherlands 50,51 and the UK, 52,53 and single studies from Denmark, 54 Germany, 55 Norway, 56 and Australia. 57 Of the 46 studies 34 were retrospective in design and only three of these studies were case controlled.…”

Section: Resultsmentioning

confidence: 99%

“…The impact of delayed therapy on BSI-associated mortality combined with the analysis of GP and GN organisms were reported in five of the 12 studies and reported a two-fold increase. 15,50,52,56,57 Only two of the twelve studies were case controlled and reported on the impact of Methicillin Resistant Staphylococcus aureus (MRSA) with a delay in therapy of two days, resulting in an odds of mortality of 1.85 (95%CI: 0.094-3.64, P=0.074) 16 and patients with BSI due to ESBL organisms with a delay in therapy of 48 hours resulting in an OR of 25.1 (95%CI: 10.5-60.2, P≤0.001). 49 Overall a greater impact was seen in GN resistant infections ranging from 3 to 25-fold increases in the risk of BSI-associated mortality.…”

Section: Impact Of Delayed Therapymentioning

confidence: 99%

The Use of Bloodstream Infection Mortality to Measure the Impact of Antimicrobial Stewardship Interventions: Assessing the Evidence

Coulter

Roberts

Hajkowicz

et al. 2017

Infectious Disease Reports

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This review sets out to evaluate the current evidence on the impact of inappropriate therapy on bloodstream infections (BSI) and associated mortality. Based on the premise that better prescribing practices should result in better patient outcomes, BSI mortality may be a useful metric to evaluate antimicrobial stewardship (AMS) interventions. A systematic search was performed in key medical databases to identify papers published in English between 2005 and 2015 that examined the association between inappropriate prescribing and BSI mortality in adult patients. Only studies that included BSIs caused by ESKAPE (Enterococcus faecium/faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species) organisms were included. Study quality was assessed using the GRADE criteria and results combined using a narrative synthesis. We included 46 studies. Inappropriate prescribing was associated with an overall increase in mortality in BSI. In BSI caused by resistant gram positive organisms, such as methicillin resistant S. aureus, inappropriate therapy resulted in up to a 3-fold increase in mortality. In BSI caused by gram negative (GN) resistant organisms a much greater impact ranging from 3 to 25 fold increase in the risk of mortality was observed. While the overall quality of the studies is limited by design and the variation in the definition of appropriate prescribing, there appears to be some evidence to suggest that inappropriate prescribing leads to increased mortality in patients due to GN BSI. The highest impact of inappropriate prescribing was seen in patients with GN BSI, which may be a useful metric to monitor the impact of AMS interventions.

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Mortality and associated risk factors in consecutive patients admitted to a UK NHS trust with community acquired bacteraemia

Cited by 26 publications

References 22 publications

Population-based incidence and comparative demographics of community-associated and healthcare-associated Escherichia coli bloodstream infection in Auckland, New Zealand, 2005 – 2011

Population-based incidence and comparative demographics of community-associated and healthcare-associated Escherichia coli bloodstream infection in Auckland, New Zealand, 2005 – 2011

Antimicrobial resistance of bacteria isolated from patients with bloodstream infections at a tertiary care hospital in the Democratic Republic of the Congo

The Use of Bloodstream Infection Mortality to Measure the Impact of Antimicrobial Stewardship Interventions: Assessing the Evidence

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