Incidence Of Bloodstream Infections Research Articles

Analysis and risk factors of deep vein catheterization-related bloodstream infections in neonates.

To investigate the incidence, risk factors, and pathogenic characteristics of catheter-related bloodstream infection caused by peripherally inserted central venous catheter in neonates, and to provide references for reducing the infection rate of peripherally inserted central venous catheter. The clinical data of 680 neonates who underwent peripherally inserted central catheter (PICC) in the neonatal intensive care unit from June 2020 to June 2023 were retrospectively analyzed. The risk factors and independent risk factors of catheter-related bloodstream infection caused by PICC were determined by univariate and multivariate analysis, respectively. Catheter-related bloodstream infection occurred in 38 of 680 neonates who underwent PICC. The infection rate was 4.74%. The proportions of fungi, gram-positive bacteria, and gram-negative bacteria were 42.11%, 36.84%, and 21.05%, respectively. Candida parapsilosis was the main fungus (18.42%), coagulase negative Staphylococcus was the main gram-positive bacteria (23.68%), and Klebsiella pneumoniae and Escherichia coli were the main gram-negative bacteria (7.89%). Univariate analysis showed that gestational age ≤32 weeks, birth weight ≤1500 g, congenital diseases, nutritional support, catheterization time, 5-minute APGAR score ≤7, and neonatal respiratory distress syndrome were associated with catheter-related bloodstream infection caused by PICC. Multivariate analysis showed that premature delivery, low birth weight, parenteral nutrition, long catheterization time, and 5-minute APGAR score ≤7 were associated with catheter-related bloodstream infection caused by PICC. Among the pathogens detected, there were 6 cases of K pneumoniae, 5 cases of coagulase negative staphylococci, and 2 cases of fungi. Low birth weight, premature delivery, off-site nutrition, long catheterization time, and 5-minute APGAR score ≤7 are independent risk factors for catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. The pathogenic bacteria are fungi and multidrug-resistant bacteria.

Incidence of Catheter-Associated Bloodstream Infections in Stem Cell Recipients-Should We Be "PICCy"?

The management of patients undergoing HSCT requires a multipurpose central venous catheter. Peripheral catheters (PCs), such as peripherally inserted central catheters (PICCs) and MidLine catheters (MLCs), appear to be adequate vascular catheters to be used for stem cell infusion, although their utilization in this indication is not yet common. We analyzed the infectious complications such as blood stream infection (BSI), febrile neutropenia (FN) and central line-associated bloodstream infection (CLBSI) in patients undergoing stem cell infusion through PC and conventionally inserted central catchers (CICCs), and evaluated their impacts on transplantation outcomes. Our results reveal no statistically significant differences between different types of catheter in terms of FN, BSI and CLABSI. Moreover, transplantation outcomes were comparable between the groups. Interestingly, according to our data, there were no differences in terms of abovementioned infectious complications between individuals who received antibiotic prophylaxis and those who did not. Our study has shown that infection complications are independent of the intravenous device and antibiotic prophylaxis. Considering that PCs are not associated with life-threatening complications, they should be considered more frequently in the stem cell transplantation setting.

The impact of discontinuing single-room isolation of patients with vancomycin-resistant enterococci: a quasi-experimental single-centre study in South Korea

There is limited data on the effects of discontinuing single-room isolation while maintaining contact precautions, such as the use of gowns and gloves. In April 2021, our hospital ceased single-room isolation for patients with vancomycin-resistant enterococci (VRE) because of single-room unavailability. This study assessed the impact of this policy by examining the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). This retrospective quasi-experimental study was conducted at a tertiary-care hospital in Seoul, South Korea. Time-series analysis was used to evaluate HA-VRE BSI incidence at the hospital level and in the haematology unit before (phase 1) and after (phase 2) the policy change. At the hospital level, HA-VRE BSI incidence level (VRE BSI per 1000 patient-days per month) and trend did not change significantly between phase 1 and phase 2 (coefficient -0.015, 95% confidence interval (CI): -0.053 to 0.023, P=0.45 and 0.000, 95% CI: -0.002 to 0.002, P=0.84, respectively). Similarly, HA-VRE BSI incidence level and trend in the haematology unit (-0.285, 95% CI: -0.618 to 0.048, P=0.09 and -0.018, 95% CI: -0.036 to 0.000, P= 0.054, respectively) did not change significantly across the two phases. Discontinuing single-room isolation of VRE-colonized or infected patients was not associated with an increase in the incidence of VRE BSI at the hospital level or among high-risk patients in the haematology unit. Horizontal intervention for multi-drug-resistant organisms, including measures such as enhanced hand hygiene and environmental cleaning, may be more effective at preventing VRE transmission.

Hemodialysis-Related Infections: A 4-Year Surveillance

Objective: To analyze the results from the surveillance of hemodialysis-related infections.Material and Methods: Data was prospectively gathered from outpatients attending a hemodialysis unit from April 2019 until March 2023. The National Healthcare Safety Network (NHSN) Dialysis Event Surveillance was used to identify three types of infection-related dialysis events. Event rates were calculated and stratified by vascular access type, standardized infection ratios for bloodstream infections (BSI), intravenous antimicrobial starts, and described pathogens identified among BSI.Results: A total of 2,288 patient-month follow-ups were included. There were 79 infection-related dialysis events (24 BSI; 46 intravenous antimicrobial starts, nine pus, redness, or increased swelling at the vascular access site). The incidence of BSI per 100 patient-months was 1.05 (0.59 arteriovenous fistula, 0.83 arteriovenous graft, and 2.22 central venous catheter). Seventeen BSI were vascular access-related. Access-related BSI per 100 patient-months was 0.74 (0.39 arteriovenous fistula, 0.41 arteriovenous graft, and 1.85 central venous catheter). Intravenous antimicrobial starts per 100 patient-months was 2.01 (0.98 arteriovenous fistula, 2.62 arteriovenous graft, and 3.14 central venous catheter). Most events occurred in patients with a central venous catheter. When benchmarked with the 2014 NHSN, the standardized infection ratio of BSI, access-related BSI, and intravenous antimicrobial starts were 1.40, 1.26, and 0.55, respectively. The most serious outcome was BSI; resulting in 83.3% hospitalizations, 25% loss of vascular access, and 15.8% deaths. Conclusion: Surveillance of infection-related dialysis events is important for prevention. These events were highest among patients with a central venous catheter compared with other vascular access types.

The Natural History of Carbapenemase-Producing Enterobacterales: Progression From Carriage of Various Carbapenemases to Bloodstream Infection.

Little is known about the risk of progression from carbapenemase-producing Enterobacterales (CPE) carriage to CPE bloodstream infection (BSI) outside of high-risk settings. We aimed to determine the incidence of CPE BSI among CPE carriers and to assess whether the incidence differs by carbapenemase, species, and setting. We conducted a nationwide population-based retrospective cohort study using national databases. The cohort consisted of all patients in Israel with CPE detected by screening from 1 January 2020 to 10 October 2022. We calculated the cumulative incidence of CPE BSI within 1 year among CPE carriers. We used a competing-risks model with BSI as the outcome and death as the competing risk. The study included 6828 CPE carriers. The cumulative incidence of CPE BSI was 2.4% (95% confidence interval [CI], 2.1-2.8). Compared with Klebsiella pneumoniae carbapenemase (KPC), the subhazard of BSI was lower for New Delhi metallo-β-lactamase (NDM) (adjusted subhazard ratio [aSHR], 0.72; 95% CI, .49-1.05) and oxacillinase-48-like (OXA-48-like) (aSHR, 0.60; 95% CI, .32-1.12) but these differences did not reach statistical significance. Compared with K. pneumoniae, the subhazard of BSI was lower for carriers of carbapenemase-producing Escherichia coli (aSHR, 0.33; 95% CI, .21-.52). The subhazard of BSI was higher among patients with CPE carriage first detected in intensive care units (aSHR, 2.10; 95% CI, 1.27-3.49) or oncology/hematology wards (aSHR, 3.95; 95% CI, 2.51-6.22) compared with medical wards. The risk of CPE BSI among CPE carriers is lower than previously reported in studies that focused on high-risk patients and settings. The risk of BSI differs significantly by bacterial species and setting, but not by carbapenemase.

14-Year Epidemiologic study of Pseudomonas aeruginosa bloodstream infection incidence and resistance in the Veterans Health Administration system, 2009-2022.

Multidrug resistant Pseudomonas aeruginosa (PA) represents a serious threat to hospitalized patients. Characterizing the incidence of PA infection and degree of resistance can inform empiric treatment and preventative measures. We sought to describe trends in incidence and resistance characteristics of PA bloodstream infections (BSI) observed within the Veterans Health Administration (VHA) system and identify factors contributing to higher observed mortality within this population. We characterized demographic and clinical features of unique patients among the VHA population presenting with their first episode of PA-BSI between 2009 and 2022 and summarized trends related to mortality and resistance phenotype based on year and geographical location. We additionally used logistic regression analysis to identify predictors of 30-day mortality among this cohort. We identified 8039 PA-BSIs during the study period, 32.7% of which were hospital onset. Annual PA-BSI cases decreased by 35.8%, and resistance among all antimicrobial classes decreased during the study period, while the proportion of patients receiving early active treatment based on susceptibility testing results increased. Average 30-day mortality rate was 23.3%. Higher Charlson Comorbidity Index, higher mAPACHE score, VHA facility complexity 1b and hospital-onset cases were associated with higher mortality, and early active treatment was associated with lower mortality. PA-BSI resistance decreased across the VHA system during the study period. Further investigation of antimicrobial stewardship measures possibly contributing to the observed decreased resistance in this cohort and identification of measures to improve on the high mortality associated with PA-BSI in the VHA population is warranted.

Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study.

Post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria (CRGNB) is a life-threatening complication. This study aimed to assess the current practices and clinical outcomes of intravenous (IV) combined with intraventricular (IVT)/intrathecal (ITH) polymyxin B in treating CRGNB intracranial infection. A retrospective study was conducted on patients with post-neurosurgical intracranial infection due to CRGNB from January 2013 to December 2020. Clinical characteristics and treatment outcomes were collected and described. Kaplan-Meier survival and multivariate logistic regression analyses were performed. The study included 114 patients, of which 72 received systemic antimicrobial therapy combined with IVT/ITH polymyxin B, and 42 received IV administration alone. Most infections were caused by carbapenem-resistant Acinetobacter baumannii (CRAB, 63.2%), followed by carbapenem-resistant Klebsiella pneumoniae (CRKP, 31.6%). Compared with the IV group, the IVT/ITH group had a higher cerebrospinal fluid (CSF) sterilization rate in 7 days (p < 0.001) and lower 30-day mortality (p = 0.032). In the IVT/ITH group, patients with CRKP infection had a higher initial fever (p = 0.014), higher incidence of bloodstream infection (p = 0.040), lower CSF sterilization in 7 days (p < 0.001), and higher 30-day mortality (p = 0.005) than those with CRAB infection. Multivariate logistic regression analysis revealed that the duration of IVT/ITH polymyxin B (p = 0.021) was independently associated with 30-day mortality. Intravenous combined with IVT/ITH polymyxin B increased CSF microbiological eradication and improved clinical outcomes. CRKP intracranial infections may lead to more difficult treatment and thus warrant attention and further optimized treatment.

Bloodstream infections: trends and evolution of incidence and etiology in a 12-year period (2010–2021)

Introduction The epidemiological evolution of bloodstream infections (BSIs) in the last decade is not clearly defined. Our aim was to analyze the changes in the workload in our institution and to describe the evolution of the incidence and etiology of BSIs in a 12-year period, including the COVID-19 pandemic. Methods All blood cultures received in the laboratory of a tertiary general hospital between 2010 and 2021 were analyzed. Bloodstream infection episodes refer to each episode of bacteremia or fungemia in each patient. Incidence rates per 1000 admissions and per 100,000 population were calculated. Results No significant changes in the incidence of BSI episodes/1000 admissions were observed (mean, 31.1), while estimated population-based incidences showed declining trends (mean, 182.8/100,000 inhabitants). There was a slight increase in BSI episodes per 1000 admissions caused by Gram-negatives (mean, 16.6/1000 admissions) and E. coli was the most frequent pathogen (mean, 8.5/1000 admissions). There was no significant rise in episodes caused by ESBL- and carbapenemase-producing E. coli or K. pneumoniae, with a decline in those caused by methicillin-resistant S. aureus. A spike in BSI episodes, fungal BSIs and catheter-related infections was detected in 2020, during the COVID-19 outbreak. Conclusions No clear increase in the incidence of BSI episodes was detected in our center over this period. Gram-negatives are the most frequent etiology, with no clear rise in antimicrobial resistance phenotypes. The COVID-19 pandemic accounted for a small increase in BSI episodes in 2020, probably related to the increase of catheter-related infections.

Fever at Time of Leukemia Diagnosis in Children: Predictor of Bloodstream Infection or Catheter Removal?

PurposeTo assess the incidence of fever at diagnosis in children with leukemia and determine if fever at diagnosis is a predictor of bloodstream infection (BSI) or central venous access device (CVAD) removal for infection either within the first 30 days or between 30 and 90 days after CVAD insertion. Materials and MethodsOne hundred fifty-one patients with acute leukemia (July 1, 2018, to December 31, 2020) who underwent a CVAD insertion within 2 weeks of diagnosis were included. Patient data included demographic characteristics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1,000 catheter days, and need for catheter removal after CVAD insertion within 30 days and between 30 and 90 days. ResultsPatients with fever at diagnosis had a significantly higher incidence of BSI within the first 30 days after CVAD insertion (17/23) than that among patients without fever (6/23) (P = .046) at diagnosis. No statistically significant difference was observed in the incidence of BSI between 30 and 90 days after CVAD insertion between patients with fever (5/11) and those without fever at diagnosis (6/11) (P = .519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients required CVAD removal; 7/9 had fever and 2/9 had no fever) (P = .181) or between 30 and 90 days (4 patients required CVAD removal; 1/4 had fever and 3/4 had no fever at diagnosis) (P = .343) after insertion. ConclusionsFever at diagnosis in patients with leukemia is not a predictor of CVAD removal for infection.

Prevention of Catheter-Associated Bloodstream Infections in Hemodialysis Patients

This study aimed to assess the efficacy of preventive measures against catheter-associated bloodstream infections in hemodialysis patients. Seventy patients undergoing hemodialysis treatment at our hospital from January 2020 to January 2023 were recruited and randomly assigned in a 1:1 ratio to receive either conventional nursing (control group) or targeted preventive nursing (observation group), with 35 cases in each group. Outcome measures for nursing effects assessment included nursing outcomes, the incidence of catheter-related bloodstream infections, patient stress, and quality of life. Targeted preventive nursing demonstrated a significantly lower incidence of catheter-related bloodstream infection and adverse catheter events compared to conventional care (P &lt;0.05). Moreover, targeted preventive nursing significantly reduced catheter retention duration in comparison to conventional care (P &lt;0.05). The higher quality of nursing associated with targeted preventive nursing was evident in the elevated nursing quality scores (P &lt;0.05). Patients who underwent targeted preventive nursing exhibited milder stress compared to those receiving routine care, as indicated by lower hemodialysis stress scale (HSS) scores (P &lt;0.05). Furthermore, the observation group, receiving targeted preventive nursing, reported higherWorld Health Organization quality of life (WHOQOL-BREF) scores than the control group, suggesting an improved quality of life (P &lt;0.05). Targeted preventive care for catheter-associated bloodstream infections in hemodialysis patients not only fortifies the rigor and standard of care but also effectively reduces the infection rate, shortens catheter retention time, alleviates patient stress, and enhances their overall quality of care and survival.

Evaluation of microbiological epidemiology and clinical characteristics of maternal bloodstream infection: a 10 years retrospective study.

Although the incidence of bloodstream infection (BSI) during pregnancy is relatively low, it can lead to unfavorable outcomes. The aim of our study was to analyze the clinical and microbiological characteristics of maternal bacteremia and to assess maternal and fetal outcomes. Our study was a retrospective study conducted in a tertiary women and children's hospital in Guangzhou, China, from 2013 to 2022. Data were extracted from medical records and the laboratory information system. The participants were divided into groups, and the difference between the groups was analyzed. The incidence of maternal BSI during the 10 years study period was 10.2 cases/10,000 maternities, with a peak found from 2014 to 2016. Escherichia coli (48%) was the predominant causative pathogen, followed by Streptococcus agalactiae (13%). Gestational diabetes mellitus (GDM) (15%) was the most common underlying condition among maternal BSI episodes. Urinary tract (13%) and genital tract (28%) were the predominant source of BSI. About 14% of neonates were infected, and BSI was the most common type of infection. E. coli was the predominant pathogen in mother-neonate pairs with concurrent BSI. Premature rupture of membranes (PROM, OR:4.68) and preterm birth (OR:3.98) were the risk factors predicting neonatal infection. More than 85% of the E. coli were resistant to ampicillin (AMP) and 50% of the E. coli were extended-spectrum β-lactamase (ESBL)-producing bacteria. Maternal BSI is a rare event, but continuous monitoring on the aspects of pathogen composition, antimicrobial resistance characteristics, and risk factors for adverse outcomes remains necessary to further reduce poor outcomes and mitigate bacterial resistance.

Antibiotic use at planned central line removal in reducing neonatal post-catheter removal sepsis: a systematic review and meta-analysis.

Post-catheter removal sepsis (PCRS) is a notable complication of indwelling central venous catheters (CVCs) in neonates, which is postulated to be secondary to the disruption of biofilms formed along catheter tips up on CVCs removal. It remains controversial whether this could be prevented by antibiotic use upon CVCs removal. We aimed to evaluate the protective effect of antibiotic administration at the time of CVCs removal. We searched through PubMed, EMBASE, Cochrane databases and reference lists of review articles for studies comparing the use of antibiotics versus no use within 12 h of CVCs removal. Risk of bias was assessed using the modified Newcastle-Ottawa Scale and Cochrane risk-of-bias tool accordingly. Results of quantitative analyses were presented as mean differences (MD) or odds ratio (OR). Subgroup and univariate meta-regression analyses were performed to identify heterogeneity. The review included 470 CVCs in the antibiotic group and 658 in the control group. Antibiotic use within 12 h of CVCs removal did not significantly reduce the incidence of PCRS (OR = 0.35, 95% CI: 0.08-1.53), but was associated with a lower incidence of post-catheter removal blood stream infection (OR = 0.31, 95% CI: 0.11-0.86). Dosage of vancomycin and world region were major sources of heterogeneity. Antibiotic administration upon CVCs removal does not significantly reduce the incidence of PCRS but offers less post-catheter removal blood stream infection. Whether this will be converted to better clinical outcomes lacks evidential support. Further randomized controlled studies with longer follow-up are needed. Results of our meta-analysis suggest that antibiotic use at planned central line removal removal does not significantly reduce the incidence of PCRS but offers less blood stream infection, which might contribute to future management of central lines in neonates. https://www.crd.york.ac.uk/, PROSPERO (CRD42022359677).

Corticosteroid Dosing Level, Incidence and Profile of Bacterial Blood Stream Infections in Hospitalized COVID-19 Patients.

COVID-19 patients with severe or critical symptoms are often treated with corticosteroids, per contemporary guidelines. Due to their immunosuppressive and immunomodulatory properties, corticosteroids are associated with the development of superinfections. We aimed to retrospectively assess patterns of corticosteroid use and the profiles of bacterial blood stream infections associated with exposure to different dosing levels, in a cohort of 1558 real-life adult COVID-19 patients. A total of 1391 (89.3%) patients were treated with corticosteroids, with 710 (45.6%) patients receiving low, 539 (34.6%) high and 142 (9.1%) very high corticosteroid doses. Bacteremia developed in a total of 178 (11.4%) patients. The risk of bacteremia was of similar magnitude between the no and low-dose corticosteroid treatments (p = 0.352), whereas it progressively increased with high (OR 6.18, 95% CI (2.66-14.38), p < 0.001) and very high corticosteroid doses (OR 8.12, 95% CI (3.29-20.05), p < 0.001), compared to no corticosteroid treatment. These associations persisted after multivariate adjustments and were present independently of sex, comorbidity burden, and mechanical ventilation. The profiles of individual bacterial pathogens differed depending on the used corticosteroid doses. High and very high corticosteroid doses are frequently used for real-life COVID-19 patients with severe and critical clinical presentations and are associated with a higher risk of bacteremia independently of sex, comorbidity burden, and mechanical ventilation use.

An analysis of central venous catheter-related bloodstream infections in patients treated in a Swedish Covid-19 intensive care unit.

Catheter-related bloodstream infection is a well-known, severe complication of central venous catheter insertion. Studies that have evaluated the coronavirus disease 2019 pandemic's influence on the incidence of catheter-related bloodstream infection in intensive care units are limited. Therefore, we conducted a retrospective study on catheter-related bloodstream infection in coronavirus disease 2019 intensive care unit with previously documented low incidence rates to evaluate the pandemic's impact. To evaluate the impact of the coronavirus disease 2019 pandemic on catheter-related bloodstream infection incidence in the intensive care unit. All central venous catheter-inserted patients aged ⩾18 years admitted to the intensive care unit with coronavirus disease 2019 pneumonia were included. The primary outcome was the incidence of catheter-related bloodstream infection, and the secondary outcome was the detection of catheter-related bloodstream infection-causative microorganisms. During the pandemic's first year, 124 patients were admitted, and 203 central venous catheters were inserted. Two patients developed catheter-related bloodstream infection. The incidence of catheter-related bloodstream infection was 0.79/1000 catheter days. The microorganisms responsible for catheter-related bloodstream infection were Staphylococcus epidermidis and Escherichia coli. This study revealed a low incidence of catheter-related bloodstream infection in the coronavirus disease 2019-intensive care unit, thus suggesting that coronavirus disease 2019 is not a risk factor for catheter-related bloodstream infection and indicating the high resilience of well-established routines aimed at catheter-related bloodstream infection prevention.

Analysis of the Integrated Management Model of Medical Care and Medication in Intravenous Treatment for Critically Ill Patients.

To explore the effect of the Integrated Management Model of Doctor-Nurse-Pharmacist Collaboration on the Safety of Intravenous Therapy in Critically Ill Patients. 1587 patients who were hospitalized in the Intensive Care Department of the Fourth Hospital of Hebei Medical University in China from January 2021 to December 2022 were selected. 768 patients before the implementation of the integrated medical, nursing, and drug management model were selected as the control group, and 819 patients who implemented the integrated medical, nursing, and drug management model were selected as the observation group. Compared with the control group, the incidence of drug compatibility contraindications in the observation group decreased from 3.5% to 1.5% (χ2=6.957 P=0.008), the central venous catheter (CVC) blockage rate decreased from 2.5% to 1.0% (χ2=5.249 P=0.022), the daily incidence of catheter related bloodstream infections decreased from (1.84 ± 2.17) to (0.91 ± 1.19)(t=6.988 P=0.015), and the incidence of peripheral venous treatment related complications decreased from 10.3% to 2.9% (χ2=16.663 P=0.000). Among them, the incidence of phlebitis decreased from 5% to 1.6% (χ2=4.817 P=0.028). The incidence of drug exudation decreased from 3.4% to 0.8% (χ2=0.031 P=0.019). The incidence of extravasation has decreased from 2.5% to 0.4% (χ2=0.044 P=0.027). The differences were statistically significant (P<0.05). The Integrated Management Model of Doctor-Nurse-Pharmacist Collaboration significantly reduced the incidence of catheter-related bloodstream infections (CRBSI), drug incompatibility, and other intravenous therapy-related complications, thereby enhancing the safety of intravenous therapy in critically ill patients.

Pattern of bacterial infections in neutropenic febrile patients (experience of the Specialized BMT center - Medical city complex - Baghdad, Iraq)

Abstract: BACKGROUND: Infectious complications occur in most of the patients undergoing hemopietic stem cell transplantation (HSCT), these carry high risk of mortality mainly due to Gram-negative bacteria unless effective antibiotic treatment is provided. OBJECTIVES: The aims of the study were to review bacterial isolates from different samples in febrile neutropenic patients underwent HSCT in terms of incidence, types, and antimicrobial resistance, and to assess the efficacy of infection control measures used in transplantation ward. PATIENTS AND METHODS: This is retrospective study. The medical records of a total of 82 patients who underwent HSCT in the Specialized BMT Center, Baghdad Medical City, in 2021 and 2022 were reviewed; for any patient with neutropenic fever (NF), the clinical assessment was made, and samples were taken for culture any sensitivity before starting empirical antibiotics. The study was reviewed by the ethical committee of the hematology transplant center in the Medical City Complex, and since the study is retrospective, no consent is needed from the patient. RESULTS: There were 57 patients who developed NF, two at the time of collection, while 55 patients during transplant. In 16 patients, there was a clinical focus for NF, most commonly respiratory. From 175 samples sent for culture and sensitivity, bacterial growth was detected in 103 samples, and the incidence of bloodstream infection was 53%. Polymicrbial bacterial growth was detected in 6 patients with NF. Gram-positive bacteria were slightly more common than Gram negative. Staphylococcus epidermidis and Burkholderia cepacia were the most common Gram positive and Gram negative, respectively. An increasing number of patients admitted to transplant centers were associated with more infections. Ten out of 13 bacteria were multidrug resistant (MDR). Only two patients died from infection posttransplant. CONCLUSIONS: The predominance of Gram-positive cocci and Burkholderia cepacia complex supported the need to review the adherence to infection control policy. The empirical antibiotic protocol should be guided by local antibiogram, and since the high rate of blood stream infection (BSI) with MDR pathogens, a de-escalating strategy utilizing carbapenems – as advised by the ECIL-4 guidelines – would be more appropriate while awaiting culture result. The ability to quickly identify infections and their susceptibility profile is still crucial for choosing antibiotic therapy.

Effectiveness of oral vancomycin as prophylaxis against Clostridioides difficile infection in hematopoietic stem cell transplant patients

Abstract Objective: Patients receiving hematopoietic stem cell transplants (HSCT) are at increased risk for Clostridioides difficile infection (CDI). The purpose of this study was to assess the effectiveness of oral vancomycin prophylaxis (OVP) for CDI in HSCT patients. Design: Single-center, retrospective cohort. Setting: Tertiary care academic medical center in New Jersey. Patients: Patients ≥18 years old during admission for the HSCT were included. Patients who were admitted &lt;72 hours or who had an active CDI prior to HSCT day 0 were excluded. Methods: Medical records of patients admitted between January 2015 and August 2022 to undergo an allogeneic or autologous HSCT were reviewed. The primary end point was the incidence of in-hospital CDI. Secondary end points included the incidence of vancomycin-resistant enterococci (VRE) bloodstream infections, VRE isolated from any clinical culture, gram-negative bloodstream infections, hospital survival, and hospital length of stay. Exploratory end points, including 1-year survival, relapse, and incidence of graft-versus-host disease, were also collected. Results: A total of 156 HSCT patients were included. There was 1 case of CDI (1 of 81, 1.23%) in the OVP group compared to 8 CDI cases (8 of 75, 10.67%) in the no OVP group (P = .0147). There were no significant (P &gt; .05) between-group differences in incidence of gram-negative bloodstream infections, hospital survival, and length of stay. There were zero clinical cultures positive for VRE. Conclusions: In-hospital incidence of CDI in HSCT patients was significantly decreased with OVP. Randomized controlled trials are needed in this high-risk population to assess the efficacy and risks of OVP for CDI.

Increased Peripheral Venous Catheter Bloodstream Infections during COVID-19 Pandemic, Switzerland.

Studies suggest that central venous catheter bloodstream infections (BSIs) increased during the COVID-19 pandemic. We investigated catheter-related BSIs in Switzerland and found peripheral venous catheter (PVC) BSI incidence increased during 2021-2022 compared with 2020. These findings should raise awareness of PVC-associated BSIs and prompt inclusion of PVC BSIs in surveillance systems.

Bloodstream infections after solid organ transplantation: clinical epidemiology and antimicrobial resistance (2016-21).

Solid organ transplant (SOT) recipients are at risk of bloodstream infections (BSIs) with MDR organisms (MDROs). To describe the epidemiology of BSI in the year after several types of SOT, as well as the prevalence of MDRO infections in this population. We conducted a single-centre, retrospective study of kidney, liver, heart, and multi-organ transplantation patients. We examined BSIs ≤1 year from SOT and classified MDRO phenotypes for Staphylococcus aureus, enterococci, Enterobacterales, Pseudomonas aeruginosa and Candida spp. We compared BSI characteristics between SOT types and determined risk factors for 90 day mortality. We included 2293 patients [1251 (54.6%) kidney, 663 (28.9%) liver, 219 (9.6%) heart and 160 (7.0%) multi-organ transplant]. Overall, 8.5% of patients developed a BSI. BSIs were most common after multi-organ (23.1%) and liver (11.3%) transplantation (P < 0.001). Among 196 patients with BSI, 323 unique isolates were recovered, 147 (45.5%) of which were MDROs. MDROs were most common after liver transplant (53.4%). The most frequent MDROs were VRE (69.8% of enterococci) and ESBL-producing and carbapenem-resistant Enterobacterales (29.2% and 27.2% of Enterobacterales, respectively). Mortality after BSI was 9.7%; VRE was independently associated with mortality (adjusted OR 6.0, 95% CI 1.7-21.3). BSI incidence after SOT was 8.5%, with a high proportion of MDROs (45.5%), especially after liver transplantation. These data, in conjunction with local antimicrobial resistance patterns and prescribing practices, may help guide empirical antimicrobial selection and stewardship practices after SOT.

Bloodstream infections in cardiac intensive care units from a tertiary care center

Blood stream infections (BSIs) occur more frequently in patients hospitalized in Intensive care units (ICUs). Intravascular devices are the most frequent predisposing factor causing BSI. To compare the proportion, risk factors, microbiological profile of Blood stream Infections and Central line associated bloodstream infection in Cardiology Intensive care units (CICU) and Cardiothoracic Intensive care units (CTICU).This is a prospective study conducted by the Dept. of Microbiology along with Cardiology Intensive care unit(CICU), and Cardiothoracic Intensive care unit (CTICU) of a tertiary care centre, from June 1st 2017-Oct 312018.Laboratory confirmed BSIs (LCBSI’s), occurring more than 48hrs after ICU admission were included in the study. Identification of pathogens were done by standard methods.A total of 1640 blood cultures were analyzed (CICU=890,CTICU=750).73 Primary BSIs were observed with male preponderance.68/73 diagnosed to have non CLABSI (CTICU=35/68 51.4%, CICU=33/68, 48.5%) and 5/73 cases diagnosed to have CLABSI (CTICU=5/73, 6.84% CICU=0%) 47.94% of our isolates were Gram negative pathogens with as the predominant followed by 35.6% of Gram positive with as the major pathogen &amp; 16.4% were Candida spp. 20.5% were multi drug resistant and 10% were ESBL producers. Prevalence and incidence rates were high in CTICU (5.3% &amp; 1.5%) compared to CICU (3.7% &amp; 0%) of BSI &amp; CLABSI respectively.BSI is preventable costly complication that occur with greater frequency in the ICU settings. Strict adherence to Infection control measures such as hand hygiene, aseptic precautions during blood culture collection and bundle care measures can decrease the BSI and CLABSI incidence rates.