Bloodstream Infections In Adults Research Articles

Salmonella Typhi From Blood Cultures in the Democratic Republic of the Congo: A 10-Year Surveillance

BackgroundThis study gives an overview of a decade (2007–2017) of hospital-based Salmonella Typhi bloodstream infection (BSI) surveillance in the Democratic Republic of the Congo (DRC), at 4 main sampling sites.MethodsBlood cultures were sampled in hospital-admitted patients with suspected BSI, according to standardized clinical indications. The results of the surveillance period 2015–2017 were compiled with those of previous surveillance periods (2007–2010 and 2011–2014). Whole genome sequencing of isolates with decreased ciprofloxacin susceptibility (DCS) was performed.Results Salmonella Typhi was isolated in 1.4% (531/37 388) and 10.3% (531/5177) of suspected and culture-confirmed BSI episodes, respectively. Salmonella Typhi ranked first among the BSI pathogens in adults (n = 220), but was mostly (n = 301 [56.7%]) isolated from children, of which 72.1% (217/301) and 31.6% (95/301) were <10 years and <5 years old, respectively. Multidrug resistance (MDR), DCS, and combined MDR/DCS were found in 38.3% (n = 180), 24.5% (n = 115), and 11.9% (n = 56) of 470 first isolates, respectively. MDR and DCS rates had increased since 2007, but remained stable during 2015–2017 with no geographical clustering at the province level. Most (91/93 [97.8%]) DCS isolates sequenced belonged to Genotyphi genotype 2.5.1, and gyr S83 was the most frequent DCS mutation (76/93 [81.7%]). Infections occurred perennially, but increased during the rainy season.Conclusions Salmonella Typhi was a frequent cause of BSI in adults and children in DRC, with high rates of antibiotic resistance. Sustainable surveillance and implementation of vaccination are compelling.

Catheter-related bloodstream infections in adults receiving parenteral nutrition: does the time taken to report blood cultures impact on clinical management?

This project aimed to evaluate the time taken for formal reporting of blood culture results, the associated impact of this on prescribing appropriate antibiotic therapy and defining the period of starvation while parenteral nutrition (PN) is withheld for patients with catheter-related bloodstream

Catheter-related bloodstream infections in adults receiving parenteral nutrition: does the time taken to report blood cultures impact on clinical management?

This project aimed to evaluate the time taken for formal reporting of blood culture results, the associated impact of this on prescribing appropriate antibiotic therapy and defining the period of starvation while parenteral nutrition (PN) is withheld for patients with catheter-related bloodstream

2322. Reduced Vancomycin Susceptibility Among Pediatric Staphylococcus aureus Bloodstream Infections

BackgroundReduced vancomycin susceptibility (RVS) is considered to be present when the minimum inhibitory concentration (MIC) is equal to 2 µg/mL. RVS Staphylococcus aureus (SA) bloodstream infections (BSI) have been associated with worse outcomes than non-RVS BSI in adults but not been well studied in children.MethodsWe reviewed the electronic medical records of infants and children admitted to Penn State Children’s Hospital with ≥1 blood culture positive for SA from 2005 to 2015. We abstracted demographic information, potential risk factors, laboratory results and clinical outcomes. We defined RVS as a vancomycin MIC = 2 µg/mL as determined by the clinical microbiology laboratory at the time of the infection. We used Chi square and Wilcoxon rank-sum tests to compare patient factors for RVS and non-RVS infections. Using a logistic regression adjusted for year and the presence of an infection-related complication, we calculated the odds of treatment failure for children with RVS and non-RVS BSI. For children with a central line in place at the time of the first positive culture, we also calculated the odds of treatment failure adjusted for year, presence of a complication and line removal. We defined treatment failure as death within 30 days of the first positive culture, recurrence of SA BSI within 30 days or a duration of bacteremia > 3 days.ResultsOf the 216 identified pediatric SA BSI, 139 (64%) had RVS: RVS was present in 63% of MSSA BSI and 65% of MRSA BSI, P = 0.835. There was no difference in age, sex, and racial distributions among children with RVS vs. non-RVS BSI. Similarly, hospitalization in the prior year, surgery within the prior 30 days, the presence of an underlying comorbidity or use of immunosuppressing medications were not more common for RVS vs. non-RVS BSI. RVS was not associated with an increased risk of treatment failure overall, odds ratio (OR)=1.34 (95% confidence interval: 0.71, 2.55), but did increase the odds of treatment failure if an indwelling central venous catheter was present and not removed, OR=3.14 (1.16, 8.54).ConclusionRVS is common among pediatric SA BSI. For central line associated SA BSI, RVS was associated with increased odds of treatment failure compared with non-RVS infections if the line was retained.Disclosures All authors: No reported disclosures.

LB3. Daptomycin Plus Fosfomycin vs. Daptomycin Monotherapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: A Multicenter, Randomized, Clinical Trial

BackgroundDaptomycin plus fosfomycin combination has demonstrated synergistic and bactericidal effect in animal models of methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but there is lack of data in humans.MethodA randomized (1:1), open-label, clinical trial involving adults with MRSAB was conducted at 18 medical centers in Spain. Patients were assigned to receive daptomycin, 10 mg/kg IV daily plus fosfomycin, 2 g IV/6 hour (combination therapy) or to receive daptomycin 10 mg/kg/24 h IV (monotherapy) during 10 up to 14 days for uncomplicated bacteremia and 28 up to 42 days for complicated bacteremia. The primary efficacy endpoints were: (a) treatment success at Test-of-Cure visit (ToC: 6 weeks after end of therapy) and (b) treatment success at 7 days (defined as alive at day 7 and clearance of bacteremia without relapse from 8 to 90 days after randomization), according with the proposed primary endpoints for use in clinical trials in bloodstream infections in adults.ResultBetween December 2013 and November 2017, 674 patients with MRSAB were evaluated and 155 patients were randomized: 74 received combination therapy and 81 monotherapy. In intention-to-treat analysis, (a) at ToC visit successful outcome was achieved in 40 of 74 patients (54,1%) who received combination therapy as compared with 34 of 81 patients (42%) who were given monotherapy (54.1% vs. 42.0%; absolute difference, 12.1%; 95% confidence interval, 0%-27.0%); (b) at 7 days after starting the therapy: a successful outcome was achieved in 69 of 74 patients who received combination therapy as compared with 62 out of 81 patients who received monotherapy (93.2% vs. 76.5%; absolute difference, 16.7%; 95% confidence interval, 5.4%–27.7%). Combination therapy was associated with lower rates of microbiologic failure than monotherapy at ToC visit (0 vs. 9 patients, P = 0.009). Combination therapy, as compared with daptomycin monotherapy, was associated with a nonsignificantly higher rate of adverse events due to study medication leading to treatment failure and discontinuation of therapy: 6/74 (8.1%) vs. 3/81 (3.7%) (P = 0.31).ConclusionThe combination of daptomycin plus fosfomycin was more effective than daptomycin alone for treating MRSAB (NCT01898338).Disclosures All authors: No reported disclosures.

Interventions to reduce unnecessary central venous catheter use to prevent central-line-associated bloodstream infections in adults: A systematic review.

To identify, describe, and evaluate interventions to reduce unnecessary central venous catheter (CVC) use to prevent central-line-associated bloodstream infections (CLABSIs) in adults. Systematic review. The review has been registered in PROSPERO, an international prospective register of systematic reviews. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cumulative Index to Nursing and Allied Health (CINAHL) from inception until August 28, 2018, to collect experimental and observational studies. We included all studies that implemented interventions to reduce unnecessary CVC use, defined as interventions aimed at improving appropriateness, awareness of device presence, or prompt removal of devices. In total, 1,892 unique citations were identified. Among them, 1 study (7.1%) was a randomized controlled trial, 9 studies (64.3%) were quasi-experimental studies, and 4 studies (28.6%) were cohort studies. Furthermore, 13 studies (92.9%) demonstrated a decrease in CVC use after intervention despite different reporting methods, and the reduction rate varied from 6.8% to 85%. Also, 7 studies (50.0%) that reported the incidence of CLABSI described a reduction in CLABSIs ranging from 24.4% to 100.0%. Data on secondary outcomes were limited, and results of the descriptive analysis showed 70%-84% compliance with these interventions, less catheter occlusion, shorter duration of hospitalization, and cost savings. Interventions to reduce unnecessary CVC use significantly decrease the rate of CLABSI. Healthcare providers should strongly consider implementing these interventions for prevention of CLABSI in adults.

Considerations for Clinical Trials of Staphylococcus aureus Bloodstream Infection in Adults.

Clinical trials for Staphylococcus aureus bloodstream infections (SAB) are broadly grouped into 2 categories: registrational trials intended to support regulatory approval of antibiotics for the treatment of SAB and strategy trials intended to inform clinicians on the best treatment options for SAB among existing antibiotics. Both types of SAB trials are urgently needed but have been limited by cost, complexity, and regulatory uncertainty. Here, we review key SAB trial design considerations for investigators, sponsors, and regulators.

Towards a Definition for Health Care-Associated Infection.

BackgroundHealth care–associated infection (HcAI) is a term frequently used to describe community-onset infections likely to be caused by multidrug-resistant organisms (MDROs). The most frequently used definition was developed at Duke University Medical Center in 2002 (Duke-2002). Although some professional societies have based management recommendations on Duke-2002 (or modifications thereof), neither Duke-2002 nor other variations have had their performance measured.MethodsA case–control study was conducted at Assaf Harofeh Medical Center (AHMC) of consecutive adult bloodstream infections (BSIs). A multivariable model was used to develop a prediction score for HcAI, measured by the presence of MDRO infection on admission. The performances of this new score and previously developed definitions at predicting MDRO infection on admission were measured.ResultsOf the 504 BSI patients enrolled, 315 had a BSI on admission and 189 had a nosocomial BSI. Patients with MDRO-BSI on admission (n = 100) resembled patients with nosocomial infections (n = 189) in terms of epidemiological characteristics, illness acuity, and outcomes more than patients with non-MDRO-BSI on admission (n = 215). The performances of both the newly developed score and the Duke-2002 definition to predict MDRO infection on admission were suboptimal (area under the receiver operating characteric curve, 0.76 and 0.68, respectively).ConclusionsAlthough the term HcAI is frequently used, its definition does not perform well at predicting MDRO infection present on admission to the hospital. A validated score that calculates the risk of MDRO infection on admission is still needed to guide daily practice and improve patient outcomes.

Bloodstream infections in adults undergoing extracorporeal membrane oxygenation: Epidemiology and risk factors

Detection of nosocomial infections (NIs) occurring during extracorporeal membrane oxygenation (ECMO) is difficult and their related side effects appear to contribute to the high mortality rates (40–50%) of these patients. The most common ones are ventilator-associated pneumonia and bloodstream infections (BSI). Thus we empirically developed a standardized protocol with systematic blood cultures on days 2, 6, 10 and 15. The objectives of this study were to analyze BSI incidence, distribution of microorganisms, risk factors in adult undergoing ECMO support and to evaluate the efficiency of our protocol. We prospectively included all adult patients who underwent veinoarterial (VA-ECMO) or veinovenous extracorporeal membrane oxygenation (VV-ECMO) between May 2014 and March 2016. Anamnestic data and blood culture results using the protocol and additional blood samples were analyzed. Among the 81 patients who underwent ECMO support for more than 48 hours, 10 patients in the VA-ECMO group ( n = 10/56; 17.9%) and 3 patients in the VV-ECMO group ( n = 3/25; 12%) developed 18 BSI, corresponding to a global rate of 22.4 BSI per 1000 ECMO days. Microorganisms associated with these infections were most frequently gram-negative bacilli. Only the duration of ECMO was significantly correlated with BSI occurrence, with a median duration of 6.5 days for “patients without BSI” and of 14 days for “patients with BSI” ( P = 0.0170). The efficiency of the protocol in diagnosing BSI was roughly 5% (5/96) for the VA-ECMO group and around 6% (3/49) for the VV-ECMO group. Probability of developing BSI in adults undergoing ECMO increases with ECMO duration. Systematic blood cultures do not appear to be an effective way of improving BSI detection.

One Year Incidence of Infection in Intestine Transplant Recipients at a Single Center

Introduction: This study reports the infection rate, location of infection, and pathogen causing bacterial, fungal, or viral infections in intestine transplant recipients during the first year post-transplant at an active transplant center. Additional risk for infection was assessed based on simultaneous inclusion of the liver or colon as a part of the intestine transplant. Methods: Records from a single transplant center were reviewed for patients receiving an intestine transplant. Positive cultures and pathology reports were used to diagnose bacterial, fungal, and viral infections and also to determine location and infectious agent. For analysis, patients were grouped by age (pediatric or adult). Results: During the study period, 236 intestine transplants were performed, 184 adults and 52 pediatric patients. In adults, one year bacterial, fungal, and viral infection rates were 91%, 47%, and 29%, respectively. The most commonly infected sites were the urinary tract and bloodstream. Coagulase-negative Staphylococcus was the most commonly isolated pathogen and found in 48% of patients. Candida species were the most common fungal pathogens and seen in 42% of all patients, and in 89% of patients who developed a fungal infection. Cytomegalovirus infections were present in 15% of transplant recipients. Bacterial and fungal bloodstream infections (BSI) developed in 72% of patients with a median time to first infection of 30 days. Among pediatric patients, bacterial, fungal, and viral infection rates were 90%, 25%, and 75%, respectively. Vancomycin susceptible enterococci were the most common pathogens and isolated from 52% of patients. Candida species were the most common fungal pathogens and observed in 23% of patients. Upper respiratory viral infections were common (44%) and cytomegalovirus infection rate was 17%. The most common sites of infection were bloodstream, urinary, and upper respiratory tract. The median days to the first BSI was 38 days. Conclusion: Overall, 91% of adult and 90% of pediatric intestine transplant patients had a bacterial infection in the first year post-transplant. Opportunistic fungal and viral infections were also common. Age, gender, race, or liver inclusion did not have a significant impact on the development of a BSI or median time to first BSI. Colon inclusion significantly (p < .05) decreased the risk of developing a BSI in pediatric patients, while not having a significant impact on median days to first BSI or development of a BSI in adults. The two tables below represent a portion of the data analyzed.FigureFigure

Proposed primary endpoints for use in clinical trials that compare treatment options for bloodstream infection in adults: a consensus definition

ObjectivesTo define standardized endpoints to aid the design of trials that compare antibiotic therapies for bloodstream infections (BSI). MethodsProspective studies, randomized trials or registered protocols comparing antibiotic therapies for BSI, published from 2005 to 2016, were reviewed. Consensus endpoints for BSI studies were defined using a modified Delphi process. ResultsDifferent primary and secondary endpoints were defined for pilot (small-scale studies designed to evaluate protocol design, feasibility and implementation) and definitive trials (larger-scale studies designed to test hypotheses and influence clinical practice), as well as for Staphylococcus aureus and Gram-negative BSI. For pilot studies of S. aureus BSI, a primary outcome of success at day 7 was defined by: survival, resolution of fever, stable/improved Sequential Organ Failure Assessment (SOFA) score and clearance of blood cultures, with no microbiologically confirmed failure up to 90 days. For definitive S. aureus BSI studies, a primary outcome of success at 90 days was defined by survival and no microbiologically confirmed failure. For pilot studies of Gram-negative BSI, a primary outcome of success at day 7 was defined by: survival, resolution of fever and symptoms related to BSI source, stable or improved SOFA score and negative blood cultures. For definitive Gram-negative BSI studies, a primary outcome of survival at 90 days supported by a secondary outcome of success at day 7 (as previously defined) was agreed. ConclusionsThese endpoints provide a framework to aid future trial design. Further work will be required to validate these endpoints with respect to patient-centred clinical outcomes.

The development of current strategies for the nursing and management of bloodstream infections from short-term placed central venous catheters

Center vein puncture is important to the clinical infusion technology, however, its correlation infection rates rising trend year by year, especially catheter-related bloodstream infections have become one of the main reasons for primary bacteremia, seriously affected the patients survival rate, and the processing method of catheter-related bloodstream infections are intricate. The treatment and nursing of adult bloodstream infections caused by short-term central venous catheter (including peripheral central venous catheter placement) according to the provisions of the Infectious Diseases Society of America to update the catheter related infections of diagnosis and treatment guidelines are reviewed in this paper, to provide reference for management of adult short-term central venous catheter. Key words: Catheterization, central venous; Nursing care; Catheter related bloodstream infections

Trends in paediatric and adult bloodstream infections at a Ghanaian referral hospital: a retrospective study.

BackgroundBloodstream infections (BSI) are life-threatening emergencies. Identification of the common pathogens and their susceptibility patterns is necessary for timely empirical intervention.MethodsWe conducted a 4-year retrospective analysis of blood cultures from all patients excluding neonates at the Korle-Bu Teaching hospital, Ghana, from January 2010 through December 2013. Laboratory report data were used to determine BSI, blood culture contamination, pathogen profile, and antimicrobial resistance patterns.ResultsOverall, 3633 (23.16 %) out of 15,683 blood cultures were positive for various organisms. Pathogen-positive cultures accounted for 1451 (9.3 %, 95 % CI 8.5–9.8 %). Infants recorded the highest true blood culture positivity (20.9 %, n = 226/1083), followed by the elderly (13.3 %, n = 80/601), children (8.9 %, n = 708/8000) and adults (7.2 %, n = 437/6000) (p = 0.001 for Marascuilo’s post hoc). Overall occurrence of BSI declined with increasing age-group (p = 0.001) but the type of isolates did not vary with age except for Citrobacter, Escherichia coli, Klebsiella, Salmonella, and Enterococcus species. Gram negative bacteria predominated in our study (59.8 %, n = 867/1451), but the commonest bacterial isolate was Staphylococcus aureus (21.9 %, n = 318/1451)—and this trend run through the various age-groups. From 2010 to 2013, we observed a significant trend of yearly increase in the frequency of BSI caused by cephalosporin-resistant enterobacteria (Chi square for trend, p = 0.001). Meropenem maintained high susceptibility among all Gram-negative organisms ranging from 96 to 100 %. Among Staphylococcus aureus, susceptibility to cloxacillin was 76.6 %.ConclusionOur study shows a significantly high blood culture positivity in infants as compared to children, adults and the elderly. There was a preponderance of S. aureus and Gram-negative bacteria across all age-groups. Meropenem was the most active antibiotic for Gram-negative bacteria. Cloxacillin remains a very useful anti-staphylococcal agent.Electronic supplementary materialThe online version of this article (doi:10.1186/s12941-016-0163-z) contains supplementary material, which is available to authorized users.

Decrease in Candida bloodstream infections in veterans in Atlanta

Despite the recent focus on prevention of health care-associated infections, rates of Candida bloodstream infections in adults have remained unchanged until recently. We report a decline of Candida bloodstream infections, not explained by changes in broad-spectrum antibiotic use, but coinciding with infection control policies aimed at central venous catheter maintenance.

Decrease in Candida Bloodstream Infections in Veterans in Atlanta

Despite the recent focus on prevention of health care–associated infections, rates of Candida bloodstream infections in adults have remained unchanged until recently. We report a decline of Candida bloodstream infections, not explained by changes in broad-spectrum antibiotic use, but coinciding with infection control policies aimed at central venous catheter maintenance.

First case of pregnant women bacteraemia and probable early-onset neonatal infection due to Aerococcus urinae.

First case of pregnant women bacteraemia and probable early-onset neonatal infection due to Aerococcus urinae.

The One Million Global Catheters PIVC worldwide prevalence study

British Journal of NursingVol. 23, No. Sup8 Research and GuidelinesThe One Million Global Catheters PIVC worldwide prevalence studyEvan AlexandrouEvan AlexandrouSearch for more papers by this authorEvan AlexandrouPublished Online:6 May 2014https://doi.org/10.12968/bjon.2014.23.Sup8.S16AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Ahlqvist M, Berglund B, Nordstrom G, Klang B, Wirén M, Johansson E (2010) A new reliable tool (PVC assess) for assessment of peripheral venous catheters. J Eval Clin Pract 16(6): 1108–15. doi: https://doi.org/10.1111/j.1365-2753.2009.01278.x Crossref, Medline, Google ScholarKagel EM, Rayan GM (2004) Intravenous catheter complications in the hand and forearm. J Trauma 56(1): 123–7. doi: https://doi.org/10.1097/01.TA.0000058126.72962.74 Crossref, Medline, Google ScholarMaki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81(9): 1159–71. http://bit.ly/R9JTjG Google ScholarWebster J, Clarke S, Paterson Det al. (2008) Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. BMJ 337: a339. doi: https://doi.org/http://dx.doi.org/10.1136/bmj.a339 Crossref, Medline, Google ScholarZingg W, Pittet D (2009) Peripheral venous catheters: an under-evaluated problem. Int J Antimicrob Agents 34(Suppl 4): S38–42. doi: https://doi.org/10.1016/S0924-8579(09)70565-5 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetailsCited byThe effects of ultrasound guidance on first-attempt success for difficult peripheral intravenous catheterization: a systematic review and meta-analysis20 January 2023 | European Journal of Emergency Medicine, Vol. 30, No. 2Ultraschallgesteuerte periphere Venenpunktion bei schlechtem Venenstatus8 February 2023 | Die Anaesthesiologie, Vol. 23The effect of clinical guideline education on the knowledge and practice of nurses for peripheral intravenous catheter placement based on short message service: A quasi-experimental study30 May 2022 | The Journal of Vascular Access, Vol. 24Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Reduces Use of Midline Catheters in Hospitalized Patients With Difficult Intravenous Access27 September 2021 | Journal of Patient Safety, Vol. 18, No. 3The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial2 February 2021 | The Journal of Vascular Access, Vol. 23, No. 2Development of a Three-Dimensionally Printed Ultrasound-Guided Peripheral Intravenous Catheter PhantomCureus, Vol. 23The Role of Ultrasound in the Ambulatory Setting9 March 2021Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department19 August 2020 | Journal of the American College of Emergency Physicians Open, Vol. 1, No. 6Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews24 August 2020 | PLOS ONE, Vol. 15, No. 8Nurse-Performed Ultrasound-Guided Technique for Difficult Peripheral Intravenous Access in Critically Ill Patients: A Randomized Controlled Trial3 April 2020 | Journal of the Association for Vascular Access, Vol. 25, No. 2Better With UltrasoundChest, Vol. 157, No. 2Accès veineux central en radiologie interventionnelleLa Presse Médicale, Vol. 48, No. 10Vessel health and preservation: An integrative review14 November 2018 | Journal of Clinical Nursing, Vol. 28, No. 7-8Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care6 October 2016 | Journal of Paediatrics and Child Health, Vol. 53, No. 2Indications for Peripheral, Midline, and Central Catheters: Summary of the Michigan Appropriateness Guide for Intravenous Catheters RecommendationsJournal of the Association for Vascular Access, Vol. 21, No. 3Ultrasonography Versus Landmark for Peripheral Intravenous Cannulation: A Randomized Controlled TrialAnnals of Emergency Medicine, Vol. 68, No. 1Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborativeJournal of Infection Prevention, Vol. 17, No. 2Effectiveness of a training program in compliance with recommendations for venous lines care30 July 2015 | BMC Infectious Diseases, Vol. 15, No. 1 23 April 2014Volume 23Issue Sup8ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 6 May 2014 Published in print 23 April 2014 Information© MA Healthcare LimitedPDF download

Treatment considerations in vancomycin-resistant enterococcal bacteremia: daptomycin or linezolid? A review

Vancomycin resistant enterococcal bloodstream infections are an important cause of morbidity and mortality in hospitalized patients. A search of the literature was undertaken to determine the optimal antimicrobial therapy for the management of vancomycin resistant enterococcal bloodstream infections. MEDLINE, EMBASE, and the Cochrane Library (unrestricted to time or language) were searched for studies of vancomycin resistant enterococcal bloodstream infections in adults reporting outcomes of direct comparisons of linezolid versus daptomycin on November 26, 2012. Studies of basic science, reviews, commentaries, pharmacologic, epidemiologic, or pediatric studies, and those studies examining conditions other than enterococcal bacteremia, a single antimicrobial agent or other antimicrobials were excluded. 226 studies were screened for eligibility and yielded eight studies evaluating a total of 807 patients. Inter-rater agreement was 100 %. Qualitative evaluation of the studies was performed using the Newcastle-Ottawa scale. No randomized controlled trials were identified. All studies were retrospective cohorts and non-randomized. 458 (57 %) patients treated with linezolid and 349 (43 %) with daptomycin were analyzed. Variable comorbidities and severity of illness were described in the included studies and reported here for comparison. The optimal treatment of vancomycin resistant enterococcal bloodstream infections is yet to be determined. Well-designed prospective studies are needed to lend more convincing evidence regarding choice of antimicrobial therapy for this important multidrug resistant organism.

Incidence of and Risk Factors for Nosocomial Bloodstream Infections in Adults in the United States, 2003

Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported. The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample. This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and case-fatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI. The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R(2) was 0.22. The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.

CANDIDA ALBICANS AND NON-ALBICANS BLOODSTREAM INFECTIONS IN ADULT AND PEDIATRIC PATIENTS

We compared length of stay, inpatient costs, and mortality associated with Candida albicans and non-albicans bloodstream infections in adults and children. Compared with adults, children with Candida bloodstream infections had longer lengths of stay (36.7 vs. 20.7 days; P < 0.001) and higher inpatient costs ($133,871 vs. $56,725; P < 0.001) but lower mortality (28.3% vs. 43.5%; P < 0.001).