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Author Yu, W.-L.; Lee, M.-F.; Chen, C.-C.; Tang, H.-J.; Ho, C.-H.; Chuang, Y.-C.
Title Impacts of Hypervirulence Determinants on Clinical Features and Outcomes of Bacteremia Caused by Extended-Spectrum beta-Lactamase-Producing Klebsiella pneumoniae Type Journal Article
Year 2017 Publication Microbial Drug Resistance (Larchmont, N.Y.) Abbreviated Journal Microb Drug Resist
Volume 23 Issue 3 Pages 376-383
Keywords (up) Aged; Anti-Bacterial Agents/therapeutic use; Bacteremia/drug therapy/*microbiology; Bacterial Proteins/genetics; Cross Infection/drug therapy/microbiology; Female; Hospital Mortality; Humans; Klebsiella Infections/drug therapy/*microbiology; Klebsiella pneumoniae/*genetics; Male; Middle Aged; Serogroup; Urinary Tract Infections/drug therapy/microbiology; Virulence Factors/*genetics; beta-Lactamases/*genetics; Esbl; Klebsiella pneumoniae; hypermucoviscosity; hypervirulence; rmpA; virulence
Abstract We investigated the implications of hypervirulence determinants on clinical features of 48 adult patients with bacteremia caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Isolates in the hypervirulence group included any of the following virulence determinants: K1/K2 capsule serotypes, hypermucoviscosity phenotype, rmpA gene, or rmpA2 gene. Nonhypervirulence group isolates were negative for all of the above virulence factors. In this study, all isolates used were non-K1/K2 strains. Statistically significant differences were observed in clinical features of patients between the two groups. The hypervirulent isolates (n = 19), including 11 isolates with the hypermucoviscosity phenotype, 15 with the rmpA gene, and 16 with the rmpA2 gene, were more commonly recovered from diabetic patients and mainly manifested as secondary bacteremia (such as pneumonia, urinary tract infections, or other localized infections). The nonhypervirulent isolates (n = 29) were more commonly recovered from patients after prolonged hospital stays (>30 days) and mostly manifested as primary bacteremia. The overall in-hospital mortality was 56.3%. Hazard ratio (HR) analysis revealed the following positive predictors for mortality: nosocomial infection, stay in an intensive care unit, no removal of the central venous catheter, Charlson comorbidity score, and APACHE II score (>==15). The negative predictors were initial appropriate antibiotic therapy (HR 0.42) and urinary tract infection (HR 0.19). Charlson score was an independent confounder based on multivariate analysis (HR 1.43, 95% confidence interval 1.04-1.99). In conclusion, hypervirulence determinants played a role in causing secondary infections in diabetic patients; however, the presence of morbidity cofactors could themselves influence mortality, despite the absence of hypervirulence determinants.
Address 6 Department of Internal Medicine, Chi Mei Medical Center-Liou Ying , Tainan City, Taiwan
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 1076-6294 ISBN Medium
Area Expedition Conference
Notes PMID:27380450 Approved no
Call Number ref @ user @ Serial 100535
Permanent link to this record
 

 
Author Saleh, H.M.; Tawfik, M.M.; Abouellail, H.
Title Prospective, randomized study of long-term hemodialysis catheter removal versus guidewire exchange to treat catheter-related bloodstream infection Type Randomized Controlled Trial
Year 2017 Publication Journal of Vascular Surgery Abbreviated Journal J Vasc Surg
Volume 66 Issue 5 Pages 1427-1431.e1
Keywords (up) Aged; Anti-Bacterial Agents/therapeutic use; Catheter-Related Infections/blood/diagnosis/microbiology/*therapy; Catheterization, Central Venous/*adverse effects/*instrumentation; Catheters, Indwelling/*adverse effects; Central Venous Catheters/*adverse effects; *Device Removal/adverse effects; Disease-Free Survival; Egypt; Equipment Design; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prospective Studies; Renal Dialysis; Risk Factors; Time Factors; Treatment Outcome
Abstract BACKGROUND: Long-term (tunneled cuffed) hemodialysis catheters are frequently used vascular access in renal failure patients. Catheter-related bloodstream infection (CRBSI) is a common complication of long-term hemodialysis catheters, with severe morbidities and high risk of mortality. Management of CRBSI by systemic antibiotics while keeping the catheter in place is not effective. Among the different modalities of CRBSI management are catheter removal (CR) and guidewire exchange (GE) of the catheter. The aim of this study was to compare the clinical outcome of CRBSI treated with two different strategies: GE vs CR with new catheter insertion 3 to 7 days later. METHODS: This prospective randomized study analyzed the outcomes of all cases of long-term hemodialysis CRBSI during a 5-year period. The catheter infection-free survival time was analyzed in the two groups of patients (GE group, 339 patients; CR group, 339 patients). Three weeks of systemic antibiotic therapy was used according to culture in both groups. The catheter infection-free survival was analyzed using Kaplan-Meier analysis. RESULTS: No statistically significant difference was found in catheter infection-free survival time for GE and CR groups (P = .69), which is not affected by age, sex, presence of diabetes mellitus, or type of causative organism. CONCLUSIONS: Our study did not demonstrate a difference in the clinical outcome of CRBSI treated with GE or CR with new catheter insertion 3 to 7 days later. However, guidewire catheter exchange saves veins for future access, reduces the cost and number of procedures, and avoids complications of new venipuncture.
Address Department of Nephrology, Ain Shams University, El Demerdash Hospital, Cairo, Egypt
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0741-5214 ISBN Medium
Area Expedition Conference
Notes PMID:28822660 Approved no
Call Number ref @ user @ Serial 99317
Permanent link to this record
 

 
Author Saleh, H.M.; Tawfik, M.M.; Abouellail, H.
Title Prospective, randomized study of long-term hemodialysis catheter removal versus guidewire exchange to treat catheter-related bloodstream infection Type Randomized Controlled Trial
Year 2017 Publication Journal of Vascular Surgery Abbreviated Journal J Vasc Surg
Volume 66 Issue 5 Pages 1427-1431.e1
Keywords (up) Aged; Anti-Bacterial Agents/therapeutic use; Catheter-Related Infections/blood/diagnosis/microbiology/*therapy; Catheterization, Central Venous/*adverse effects/*instrumentation; Catheters, Indwelling/*adverse effects; Central Venous Catheters/*adverse effects; *Device Removal/adverse effects; Disease-Free Survival; Egypt; Equipment Design; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prospective Studies; Renal Dialysis; Risk Factors; Time Factors; Treatment Outcome
Abstract BACKGROUND: Long-term (tunneled cuffed) hemodialysis catheters are frequently used vascular access in renal failure patients. Catheter-related bloodstream infection (CRBSI) is a common complication of long-term hemodialysis catheters, with severe morbidities and high risk of mortality. Management of CRBSI by systemic antibiotics while keeping the catheter in place is not effective. Among the different modalities of CRBSI management are catheter removal (CR) and guidewire exchange (GE) of the catheter. The aim of this study was to compare the clinical outcome of CRBSI treated with two different strategies: GE vs CR with new catheter insertion 3 to 7 days later. METHODS: This prospective randomized study analyzed the outcomes of all cases of long-term hemodialysis CRBSI during a 5-year period. The catheter infection-free survival time was analyzed in the two groups of patients (GE group, 339 patients; CR group, 339 patients). Three weeks of systemic antibiotic therapy was used according to culture in both groups. The catheter infection-free survival was analyzed using Kaplan-Meier analysis. RESULTS: No statistically significant difference was found in catheter infection-free survival time for GE and CR groups (P = .69), which is not affected by age, sex, presence of diabetes mellitus, or type of causative organism. CONCLUSIONS: Our study did not demonstrate a difference in the clinical outcome of CRBSI treated with GE or CR with new catheter insertion 3 to 7 days later. However, guidewire catheter exchange saves veins for future access, reduces the cost and number of procedures, and avoids complications of new venipuncture.
Address Department of Nephrology, Ain Shams University, El Demerdash Hospital, Cairo, Egypt
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0741-5214 ISBN Medium
Area Expedition Conference
Notes PMID:28822660 Approved no
Call Number ref @ user @ Serial 100347
Permanent link to this record
 

 
Author Loza-Correa, M.; Kou, Y.; Taha, M.; Kalab, M.; Ronholm, J.; Schlievert, P.M.; Cahill, M.P.; Skeate, R.; Cserti-Gazdewich, C.; Ramirez-Arcos, S.
Title Septic transfusion case caused by a platelet pool with visible clotting due to contamination with Staphylococcus aureus Type Journal Article
Year 2017 Publication Transfusion Abbreviated Journal Transfusion
Volume 57 Issue 5 Pages 1299-1303
Keywords (up) Aged; Anti-Bacterial Agents/therapeutic use; Central Venous Catheters/microbiology; Erythrocyte Transfusion/adverse effects; Female; Humans; Leukemia, Myeloid, Acute/therapy; Platelet Transfusion/*adverse effects; Sepsis/*etiology; Staphylococcal Infections/*transmission; *Staphylococcus aureus; Transfusion Reaction/*microbiology
Abstract BACKGROUND: Contamination of platelet concentrates (PCs) with Staphylococcus aureus is one of the most significant ongoing transfusion safety risks in developed countries. CASE REPORT: This report describes a transfusion reaction in an elderly patient diagnosed with acute myeloid leukemia, transfused with a 4-day-old buffy coat PC through a central venous catheter. The transfusion was interrupted when a large fibrous clot in the PC obstructed infusion pump flow. Shortly afterward, a red blood cell (RBC) unit transfusion started. After septic symptoms were developed, the RBC transfusion was also interrupted. While the RBC unit tested negative for bacterial contamination, the PC and the patient samples were found to be contaminated with a S. aureus strain that exhibited the same phenotypic and genome sequencing profiles. The isolated S. aureus forms biofilms and produces the superantigen enterotoxin-like U, which was detected in a sample of the transfused PCs. The patient received posttransfusion antibiotic treatment and had her original central line removed and replaced. DISCUSSION: As the implicated PC had been tested for bacterial contamination during routine screening yielding negative results, this is a false-negative transfusion sepsis case. Using a point-of-care test could have prevented the transfusion reaction. This report highlights the increasing incidence of S. aureus as a major PC contaminant with grave clinical implications. Importantly, S. aureus is able to interact with platelet components resulting in visible changes in PCs. CONCLUSION: Visual inspection of blood components before transfusion is an essential safety practice to interdict the transfusion of bacterially contaminated units.
Address Canadian Blood Services
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0041-1132 ISBN Medium
Area Expedition Conference
Notes PMID:28205241 Approved no
Call Number ref @ user @ Serial 99087
Permanent link to this record
 

 
Author Loza-Correa, M.; Kou, Y.; Taha, M.; Kalab, M.; Ronholm, J.; Schlievert, P.M.; Cahill, M.P.; Skeate, R.; Cserti-Gazdewich, C.; Ramirez-Arcos, S.
Title Septic transfusion case caused by a platelet pool with visible clotting due to contamination with Staphylococcus aureus Type Journal Article
Year 2017 Publication Transfusion Abbreviated Journal Transfusion
Volume 57 Issue 5 Pages 1299-1303
Keywords (up) Aged; Anti-Bacterial Agents/therapeutic use; Central Venous Catheters/microbiology; Erythrocyte Transfusion/adverse effects; Female; Humans; Leukemia, Myeloid, Acute/therapy; Platelet Transfusion/*adverse effects; Sepsis/*etiology; Staphylococcal Infections/*transmission; *Staphylococcus aureus; Transfusion Reaction/*microbiology
Abstract BACKGROUND: Contamination of platelet concentrates (PCs) with Staphylococcus aureus is one of the most significant ongoing transfusion safety risks in developed countries. CASE REPORT: This report describes a transfusion reaction in an elderly patient diagnosed with acute myeloid leukemia, transfused with a 4-day-old buffy coat PC through a central venous catheter. The transfusion was interrupted when a large fibrous clot in the PC obstructed infusion pump flow. Shortly afterward, a red blood cell (RBC) unit transfusion started. After septic symptoms were developed, the RBC transfusion was also interrupted. While the RBC unit tested negative for bacterial contamination, the PC and the patient samples were found to be contaminated with a S. aureus strain that exhibited the same phenotypic and genome sequencing profiles. The isolated S. aureus forms biofilms and produces the superantigen enterotoxin-like U, which was detected in a sample of the transfused PCs. The patient received posttransfusion antibiotic treatment and had her original central line removed and replaced. DISCUSSION: As the implicated PC had been tested for bacterial contamination during routine screening yielding negative results, this is a false-negative transfusion sepsis case. Using a point-of-care test could have prevented the transfusion reaction. This report highlights the increasing incidence of S. aureus as a major PC contaminant with grave clinical implications. Importantly, S. aureus is able to interact with platelet components resulting in visible changes in PCs. CONCLUSION: Visual inspection of blood components before transfusion is an essential safety practice to interdict the transfusion of bacterially contaminated units.
Address Canadian Blood Services
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0041-1132 ISBN Medium
Area Expedition Conference
Notes PMID:28205241 Approved no
Call Number ref @ user @ Serial 100117
Permanent link to this record