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Rogers, A.E.J.; Eisenman, K.M.; Dolan, S.A.; Belderson, K.M.; Zauche, J.R.; Tong, S.; Gralla, J.; Hilden, J.M.; Wang, M.; Maloney, K.W.; Dominguez, S.R. |
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Title |
Risk factors for bacteremia and central line-associated blood stream infections in children with acute myelogenous leukemia: A single-institution report |
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Journal Article |
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Year |
2017 |
Publication |
Pediatric Blood & Cancer |
Abbreviated Journal |
Pediatr Blood Cancer |
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Volume |
64 |
Issue |
3 |
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Keywords |
Adolescent; Bacteremia/*etiology; Bacteria/isolation & purification; Case-Control Studies; Catheter-Related Infections/*etiology; Catheterization, Central Venous/*adverse effects; Child; Child, Preschool; Cross Infection/*etiology; Female; Follow-Up Studies; Humans; Infant; Intensive Care Units, Pediatric; Leukemia, Myeloid, Acute/*complications/microbiology; Male; Prognosis; Retrospective Studies; Risk Factors; Clabsi; acute myelogenous leukemia; bacteremia; pediatric oncology |
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BACKGROUND: Central line-associated blood stream infections (CLABSIs) are a source of high morbidity and mortality in children with acute myelogenous leukemia (AML). PROCEDURE: To understand the epidemiology and risk factors associated with the development of CLABSI in children with AML. METHODS: We retrospectively reviewed all patients with AML over a 5-year period between 2007 and 2011 at the Children's Hospital Colorado. Cases and controls were classified on the basis of the presence of a CLABSI as defined by the National Healthcare Safety Network. RESULTS: Of 40 patients in the study, 25 (62.5%) developed at least one CLABSI during therapy. The majority of CLABSIs were due to oral or gastrointestinal organisms (83.0%). Skin organisms accounted for 8.5%. In a multivariable analysis, the strongest risk factors associated with CLABSI were diarrhea (odds ratio [OR] 6.7, 95% confidence interval [CI] 1.6-28.7), receipt of blood products in the preceding 4-7 days (OR 10.0, 95%CI 3.2-31.0), not receiving antibiotics (OR 8.3, 95%CI 2.8-25.0), and chemotherapy cycle (OR 3.5, 95%CI 1.4-8.9). CLABSIs led to increased morbidity, with 13 cases (32.5%) versus two controls (1.9%) requiring transfer to the pediatric intensive care unit (P < 0.001). Three (7.5%) of 40 CLABSI events resulted in or contributed to death. CONCLUSIONS: Intensified line care efforts cannot eliminate all CLABSIs in the patients with AML. Exploring the role of mucosal barrier breakdown and/or the use of antibiotic prophylaxis may be effective strategies for further prevention of CLABSIs, supporting ongoing trials in this patient population. |
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Department of Infectious Disease, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado |
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1545-5009 |
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Notes |
PMID:27616655 |
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Call Number |
ref @ user @ |
Serial  |
99291 |
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Author |
Ramirez-Blanco, C.E.; Ramirez-Rivero, C.E.; Diaz-Martinez, L.A.; Sosa-Avila, L.M. |
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Title |
Infection in burn patients in a referral center in Colombia |
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Journal Article |
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Year |
2017 |
Publication |
Burns : Journal of the International Society for Burn Injuries |
Abbreviated Journal |
Burns |
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Volume |
43 |
Issue |
3 |
Pages |
642-653 |
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Keywords |
Acinetobacter Infections/drug therapy/epidemiology/microbiology; Acinetobacter baumannii; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents/therapeutic use; Bacteremia/drug therapy/*epidemiology/microbiology; Burns/*epidemiology; Catheter-Related Infections/drug therapy/*epidemiology/microbiology; Central Venous Catheters; Cephalosporins/therapeutic use; Child; Child, Preschool; Colombia/epidemiology; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections/drug therapy/epidemiology/microbiology; Female; Folliculitis/drug therapy/*epidemiology/microbiology; Humans; Infant; Infant, Newborn; Klebsiella Infections/drug therapy/epidemiology/microbiology; Klebsiella pneumoniae; Male; Middle Aged; Oxacillin/therapeutic use; Pneumonia/drug therapy/*epidemiology/microbiology; Pseudomonas Infections/drug therapy/epidemiology/microbiology; Pseudomonas aeruginosa; Staphylococcal Infections/drug therapy/epidemiology/microbiology; Staphylococcus aureus; Urinary Tract Infections/drug therapy/*epidemiology/microbiology; Wound Infection/drug therapy/*epidemiology/microbiology; Young Adult; Burn wound infection; Burns; Health care related infection; Nosocomial infection; Pneumonia; Urinary tract infection |
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INTRODUCTION: Worldwide, burns are responsible for more than 300,000 deaths annually; infection is a major cause of morbidity and mortality in these patients. Early identification and treatment of infection improves outcome. Toward this end it's necessary to identify the institutions flora and organisms that most frequently produces infection. OBJECTIVES: To characterize infections developed by burn patients hospitalized at the University Hospital of Santander (HUS). METHODOLOGY: Burn patients hospitalized in the HUS from January 1 to December 2014 were followed. Medical information regarding infections, laboratory and pathology reports were obtained. Statistical analysis with measures of central tendency, proportions, global and specific incidence density plus overall and specific incidence was obtained. For the microbiological profile proportions were established. RESULTS: 402 burn patients were included, 234 (58.2%) men and 168 (41.8%) women, aged between 6 days and 83 years, median 12.5 years. The burn agents include scald (52.5%), fire (10.0%), gasoline (9.2%), electricity (7.5%), among others. Burn area ranged from 1% to 80% TBS. Cumulative mortality was 1.5%. 27.8% of burned patients had one or more infections. Identified infections include folliculitis (27.0%), urinary tract infection (19.0%), infection of the burn wound (10.4%), pneumonia (8.6%), Central venous catheter (7.4%), bloodstream infection (7.4%) and skin grafts infection (4.3%) among others. Bacteria were responsible for 88.5% of the cases and fungi 11.5%. The most frequently isolated germs were P. aeruginosa, A. baumannii, E. coli, S. aureus and K. pneumoniae. Most gram-negative bacteria were sensitive to Amikacin, gram positive bacteria were sensitive to multiple antibiotics. CONCLUSION: Burns is a severe trauma that occurs in adult and pediatric patients, has several causative agents and can compromise the patient's life. The burned patient is at risk for a variety of infections. According to the type of infection it is possible to infer the most common causative organisms and their antibiotic sensitivity/resistance which allow a directed early empiric treatment. |
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University Hospital of Santander, Universidad Industrial de Santander, Colombia. Electronic address: lumisosa@gmail.com |
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0305-4179 |
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PMID:28185802 |
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Call Number |
ref @ user @ |
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99267 |
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Author |
Radbel, J.; Boutsikaris, D. |
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Title |
The New Usual Care |
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Journal Article |
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Year |
2017 |
Publication |
Emergency Medicine Clinics of North America |
Abbreviated Journal |
Emerg Med Clin North Am |
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35 |
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1 |
Pages |
11-23 |
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Anti-Bacterial Agents/therapeutic use; Catheterization, Central Venous; Clinical Protocols/standards; Evidence-Based Medicine; Fluid Therapy; Humans; Sepsis/diagnosis/*therapy; ARISE trial; Early goal-directed therapy (EGDT); ProCESS trial; ProMISe trial; Sepsis; Usual care |
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Recent literature continues to refine which components of the early goal-directed therapy (EGDT) algorithm are necessary. Given it utilizes central venous pressure, continuous central venous oxygen saturation, routine blood transfusions, and inotropic medications, this algorithm can be timely, invasive, costly, and potentially harmful. New trials highlight early recognition, early fluid resuscitation, appropriate antibiotic treatment, source control, and the application of a multidisciplinary evidence-based approach as essential components of current sepsis management. This article discusses the landmark sepsis trials that have been published over the past several decades and offers recommendations on what should currently be considered 'usual care'. |
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Department of Emergency Medicine, Saint Peters University Hospital, 254 Easton Ave, New Brunswick, NJ 08901, USA; Division of Pulmonary and Critical Care, Department of Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Johnson Place, New Brunswick, NJ 08903, USA. Electronic address: boutsida@rwjms.rutgers.edu |
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0733-8627 |
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PMID:27908328 |
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Call Number |
ref @ user @ |
Serial |
99263 |
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Author |
Mihu, M.R.; Cabral, V.; Pattabhi, R.; Tar, M.T.; Davies, K.P.; Friedman, A.J.; Martinez, L.R.; Nosanchuk, J.D. |
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Sustained Nitric Oxide-Releasing Nanoparticles Interfere with Methicillin-Resistant Staphylococcus aureus Adhesion and Biofilm Formation in a Rat Central Venous Catheter Model |
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Journal Article |
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Year |
2017 |
Publication |
Antimicrobial Agents and Chemotherapy |
Abbreviated Journal |
Antimicrob Agents Chemother |
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61 |
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1 |
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Animals; Anti-Bacterial Agents/chemistry/*pharmacology; Bacterial Adhesion/drug effects; Biofilms/*drug effects/growth & development; Catheter-Related Infections/*drug therapy/microbiology; Central Venous Catheters; Chitosan/chemistry/pharmacology; Delayed-Action Preparations; Disease Models, Animal; Female; Glucose/chemistry; Humans; Methicillin-Resistant Staphylococcus aureus/*drug effects/growth & development/ultrastructure; Nanoparticles/*administration & dosage/chemistry; Nitric Oxide/chemical synthesis/*pharmacology; Oxidation-Reduction; Plankton/drug effects/growth & development; Rats; Rats, Sprague-Dawley; Sodium Nitrite/chemistry; Staphylococcal Infections/*drug therapy/microbiology; Staphylococcus aureus; antimicrobials; biofilms; nanoparticles; nitric oxide |
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Staphylococcus aureus is frequently isolated in the setting of infections of indwelling medical devices, which are mediated by the microbe's ability to form biofilms on a variety of surfaces. Biofilm-embedded bacteria are more resistant to antimicrobial agents than their planktonic counterparts and often cause chronic infections and sepsis, particularly in patients with prolonged hospitalizations. In this study, we demonstrate that sustained nitric oxide-releasing nanoparticles (NO-np) interfere with S. aureus adhesion and prevent biofilm formation on a rat central venous catheter (CVC) model of infection. Confocal and scanning electron microscopy showed that NO-np-treated staphylococcal biofilms displayed considerably reduced thicknesses and bacterial numbers compared to those of control biofilms in vitro and in vivo, respectively. Although both phenotypes, planktonic and biofilm-associated staphylococci, of multiple clinical strains were susceptible to NO-np, bacteria within biofilms were more resistant to killing than their planktonic counterparts. Furthermore, chitosan, a biopolymer found in the exoskeleton of crustaceans and structurally integrated into the nanoparticles, seems to add considerable antimicrobial activity to the technology. Our findings suggest promising development and translational potential of NO-np for use as a prophylactic or therapeutic against bacterial biofilms on CVCs and other medical devices. |
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Department of Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA |
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0066-4804 |
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PMID:27821454 |
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Call Number |
ref @ user @ |
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99131 |
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Meng, X.; Liu, S.; Duan, J.; Huang, X.; Zhou, P.; Xiong, X.; Gong, R.; Zhang, Y.; Liu, Y.; Fu, C.; Li, C.; Wu, A. |
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Title |
Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital |
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Journal Article |
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Year |
2017 |
Publication |
BMC Infectious Diseases |
Abbreviated Journal |
BMC Infect Dis |
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Volume |
17 |
Issue |
1 |
Pages |
82 |
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Keywords |
Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents/economics/therapeutic use; Anti-Infective Agents; *Carbapenems; Case-Control Studies; Catheterization, Central Venous/statistics & numerical data; Child; Child, Preschool; China/epidemiology; Cross Infection/drug therapy/economics/*epidemiology/microbiology; Drug Costs; *Drug Resistance, Bacterial; Escherichia coli Infections/drug therapy/economics/*epidemiology/microbiology; Female; Health Care Costs; Hemoglobins; Hospitals, Teaching; Humans; Hyperglycemia/epidemiology; Incidence; Infant; Infant, Newborn; Length of Stay/*statistics & numerical data; Logistic Models; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors; Tertiary Care Centers; Tracheostomy/statistics & numerical data; Urologic Diseases/epidemiology; Young Adult; Crec; Csec; Healthcare-associated infection; Risk factors |
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BACKGROUND: The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital. METHODS: We conducted a retrospective, matched case-control-control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection. RESULTS: Multivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26-12.42), tracheostomy (OR:2.24; 95%CI: 1.14-4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31-28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52-95.4), urinary system disease (OR: 16.69; 95%CI: 3.01-89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46-5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89-26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01). CONCLUSION: Many factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality. |
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Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China. xywuanhua@csu.edu.cn |
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1471-2334 |
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Notes |
PMID:28095785 |
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Call Number |
ref @ user @ |
Serial |
99123 |
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