Acquisition Of Resistant Organisms Research Articles

Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children's Oncology Group.

BackgroundTo the authors' knowledge, information regarding whether daily bathing with chlorhexidine gluconate (CHG) reduces central line–associated bloodstream infection (CLABSI) in pediatric oncology patients and those undergoing hematopoietic stem cell transplantation (HCT) is limited.MethodsIn the current multicenter, randomized, double‐blind, placebo‐controlled trial, patients aged ≥2 months and <22 years with cancer or those undergoing allogeneic HCT were randomized 1:1 to once‐daily bathing with 2% CHG‐impregnated cloths or control cloths for 90 days. The primary outcome was CLABSI. Secondary endpoints included total positive blood cultures, acquisition of resistant organisms, and acquisition of cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration.ResultsThe study was stopped early because of poor accrual. Among the 177 enrolled patients, 174 were considered as evaluable (88 were randomized to the CHG group and 86 were randomized to the control group). The rate of CLABSI per 1000 central line days in the CHG group was 5.44 versus 3.10 in the control group (risk difference, 2.37; 95% confidence interval, 0.05‐4.69 [P = .049]). Post hoc conditional power analysis demonstrated a 0.2% chance that the results would have favored CHG had the study fully enrolled. The rate of total positive blood cultures did not differ between groups (risk difference, 2.37; 95% confidence interval, −0.41 to 5.14 [P = .078]). The number of patients demonstrating the new acquisition of resistant organisms did not differ between groups (P = .54). Patients in the CHG group were found to be more likely to acquire cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration (P = .032).ConclusionsThe data from the current study do not support the use of routine CHG bathing in children with cancer or those undergoing allogeneic HCT.

End-of-Life Treatment and Bacterial Antibiotic Resistance: A Potential Association

Great variability exists in the occurrence of antibiotic-resistant bacteria in ICUs around the world. The contribution of specific ICU care variables to these geographic variations is unknown. ICU patients from two ICUs (in Jerusalem and Toronto) who were admitted for > 48 h and who grew a resistant bacteria in any culture during ICU admission were compared with those without resistant organisms across a range of demographic and ICU care interventions. Significant variables were investigated with logistic regression to identify factors predictive of infection/colonization with a resistant organism. Resistant organisms were acquired by 82/423 (19%) patients. Patients acquiring a resistant organism had a higher incidence of diabetes mellitus (21/82, 26% vs 52/341, 15%; P = .026), were more frequently admitted from another ICU (17/82, 21% vs 33/341, 10%; P = .005), received more antibiotics in the ICU (19 +/- 17 vs 14 +/- 14 days; P = .005), and had more ventilator (10 +/- 10 vs 7 +/- 8; P = .031) and central line days (10 +/- 8 vs 7 +/- 8; P < .001). These patients had a lower incidence of limitation-of-therapy orders (9/82, 11% vs 78/341, 23%; P = .015). Only the absence of a limitation-of-therapy order (odds ratio, 2.62; 95% CI, 1.21-5.68; P = .014) was independently associated with the acquisition of resistant organisms. Further, among ICU fatalities, 5/45 (11%) patients acquired a resistant organism prior to withdrawal vs 17/44 (39%) nonwithdrawal fatalities (P = .003). Nonwithdrawal fatalities received significantly more third-line antibiotics (7 +/- 14 vs 2 +/- 4; P = .031) despite similar ICU lengths of stay (15 +/- 21 days for nonwithdrawal fatalities vs 10 +/- 11 for withdraw fatalities; P = .210) End-of-life treatment is independently associated with acquisition of resistant bacteria. Patients dying without withdraw orders receive more antibiotics and develop more resistant organisms. These patients may represent a reservoir of resistant bacteria in the ICU.

Stenotrophomonas Maltophilla Isolated from the Sputum of the Patient with Cystic Fibrosis Mutation I1234V: First Qatari Report

A 17 year old Qatari female of Arab descent with cysticfibrosis (CF) carrying pathogenic mutation I1234V had severe respiratory disease associated with chronic Pseudomonas aeruginosa broncho-pulmonary infection with recurrent episodes of mild hemoptysis. Despite regular courses of intravenous anti-pseudomonal antibiotics, she continued to deteriorate over six months and died. It is suggested that the presence of Stenotrophomonas maltophilia was an important factor in this casey which illustrates the need for continuing vigilance in considering the acquisition of resistant organisms in such patients on long-term antibiotic therapy.