Nosocomial Bloodstream Infections Research Articles

Is Fluconazole or an Echinocandin the Agent of Choice for Candidemia

Candidemia is among the most common nosocomial bloodstream infections and is associated with high mortality, increased length of hospital stay, and significant economic burden. The introduction of the echinocandins in the 2000s has expanded the armamentarium against Candida spp and provides therapeutic options that are effective, safe, and tolerable. Although the Infectious Diseases Society of America favors echinocandins as treatment for candidemia in selected settings (at least as initial therapy), there remain divergent opinions about whether an echinocandin or fluconazole is the preferred agent for candidemia, and clinical practice guidelines are in flux. In this review, the currently available laboratory and clinical data are summarized and critically evaluated. A MEDLINE search of the English language literature was performed using the search terms echinocandin, fluconazole, and candidemia. References of review articles and guidelines were also screened for inclusion. Studies whose primary goal was to compare echinocandins with fluconazole were evaluated as well as studies that differentiated pharmacological and pharmacokinetic properties between agents. It is clear that echinocandins and fluconazole each have roles in the management of candidemia. Specific recommendations are provided that will hopefully optimize outcomes in candidemia while incorporating stewardship concepts of cost-effectiveness and limiting the emergence of resistance. Despite the advantages brought by the echinocandins and fluconazole, outcomes among patients with candidemia remain suboptimal. Improved treatment of candidemia may ultimately be achieved by optimizing the use of antifungal agents rather than the development of new drugs.

Central venous catheter-related nosocomial bloodstream infections in children on long-term parenteral nutrition : the impact of the move to a new university hospital.

Methods This retrospective study covered from April 2007 to March 2014, starting a year prior to move the children to a new hospital in April 2008, and continuing for 6 years following the move. During this observational period, data from all children hospitalized in a hepato-gastroenterology and nutrition unit of a paediatric tertiary hospital who received parenteral nutrition (PN) for more than 15 days were analysed.

Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality

Background:Data on nosocomial bloodstream infection (BSI) rates, pathogens, mortality and antimicrobial resistance in African neonates are limited.Methods:Nosocomial neonatal BSI at Tygerberg Hospital, Cape Town were retrospectively reviewed between 1 January 2009 and 31 December 2013. Laboratory and hospital data were used to determine BSI rates, pathogen profile, mortality and antimicrobial resistance in selected nosocomial pathogens.Results:Of 6521 blood cultures taken over 5 years, 1145 (17.6%) were culture-positive, and 717 (62.6%) discrete nosocomial BSI episodes were identified. Nosocomial BSI rates remained unchanged over time (overall 3.9/1000 patient days, 95% CI 3.6–4.2, χ2 for trend P = 0.23). Contamination rates were relatively high (5.1%, 95% CI 4.6–5.7%). Among BSI pathogens, Gram-negatives predominated (65% vs 31% Gram-positives and 4% fungal); Klebsiella pneumoniae (235, 30%), Staphylococcus aureus (112, 14%) and Enterococci (88, 11%) were most prevalent. Overall crude BSI mortality was 16% (112/717); Gram-negative BSI was significantly associated with mortality (P = 0.007). Mortality occurred mostly in neonates of very low (33/112, 29%) or extremely low (53/112, 47%) birthweight. Deaths attributed to nosocomial BSI declined significantly over time (χ2 for trend P = 0.01). The prevalence of antibiotic-resistant pathogens was high: methicillin-resistant Staphylococcus aureus 66%, multidrug-resistant A. baumanni 90% and extended-spectrum β-lactamase-producing K. pneumoniae 73%.Conclusion:The burden of nosocomial neonatal BSI at this middle-income country referral neonatal unit is substantial and remained unchanged over the study period, although attributable mortality declined significantly. Nosocomial BSI pathogens exhibited high levels of antimicrobial resistance.

Nosocomial bloodstream infection caused by staphylococcus haemolyticus antimicrobial resistance and molecular characterization

Nosocomial bloodstream infection caused by staphylococcus haemolyticus antimicrobial resistance and molecular characterization

Epidemiology and microbiology of nosocomial bloodstream infections in a traditional Chinese medicine hospital: Analysis of 482 cases from a retrospective surveillance study

Epidemiology and microbiology of nosocomial bloodstream infections in a traditional Chinese medicine hospital: Analysis of 482 cases from a retrospective surveillance study

Neonatal Hypoplastic Left Heart Syndrome: Effects of Bloodstream Infections on Outcomes and Costs

Hypoplastic left heart syndrome (HLHS) is not only a devastating disease, but also the most expensive birth defect managed in the US. Nosocomial bloodstream infections (NBIs) are common in neonates with HLHS. We examined the effects of NBIs on in-hospital mortality, length of stay, and costs for late preterm and term infants with HLHS undergoing stage 1 palliation, at both individual patient and hospital levels. We conducted a retrospective study of infants 35 weeks or greater gestation with HLHS, admitted to our institution January 1, 2003 to January 1, 2013. Children with other cardiac abnormalities, major comorbid conditions, or perinatal infections were excluded. Univariable and multivariable analyses were performed. To estimate the effects of reduced NBI incidence on resource utilization, predictive models were used. One hundred forty-three children met inclusion criteria. In-hospital mortality was 9.1% (n = 13). Postoperative infection was observed in 12.6% (n = 18). Median length of stay was 23 days for survivors (IQR, 17 to 40; range, 9 to 132). Median costs were $83,000 for survivors, in 2013 dollars (IQR, $62,000 to $123,000; range, $17,000 to $517,000). NBIs were not associated with changes in mortality. In multivariable analyses, at a patient level NBIs were associated with a 74% increase in length of stay (95% confidence interval [CI], 31% to 132%, p < 0.001) and a 65% increase in costs (95% CI, 28% to 114%, p < 0.001). On a hospital level, in this cohort a 50% reduction in the incidence of NBIs would be expected to yield a 4.3% decrease in average length of stay and a 3.8% decrease in average in-patient costs. Nosocomial bloodstream infections in neonates with HLHS are associated with large increases in lengths of stay and costs on a patient level, but not a hospital level. For hospitals without particularly high incidences, studies are needed to identify additional targets for quality improvement.

Mortality due to bloodstream infections and necrotizing enterocolitis in very low birth weight infants.

We evaluated the mortality due to nosocomial bloodstream infection (BSI) and necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants in 229 neonatal departments participating in the German national neonatal infection surveillance system between 2000 and 2011. For each infection type, we conducted a retrospective cohort study and a case-control study. In the cohort studies, the mortality risk due to BSI and/or NEC was estimated by calculating adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) using Cox proportional hazard regression with time the dependent variable infection. In the matched case-control studies, the attributable mortality was calculated. A total of 43,116 VLBW infants, of which 6911 patients had at least 1 BSI and 1271 patients had at least 1 NEC, were analyzed. Overall mortality was 6.6%. Patients with at least 1 BSI had a mortality of 5.6%, and patients with at least 1 NEC had a mortality of 19.2%. The cohort studies revealed that BSI (AHR=1.83; 95% CI: 1.61-2.08) and NEC (AHR=6.35; 95% CI: 5.47-7.37) are independently associated with increased mortality. In the case-control study for BSI, 5187 (75.1%) patients with BSI were matched. Attributable mortality was 1.4% (95% CI: 0.7-2.2). In the case-control study for NEC, 1092 (85.9%) patients with NEC were matched. Attributable mortality was 14.7% (95% CI: 12.2-17.1). Nosocomial BSI and NEC increased mortality in VLBW infants. BSI, however, was associated with a relatively small attributable mortality of 1.4%, whereas NEC had a high attributable mortality of 14.7%.

Biofilm as a virulence marker in Candida species in Nosocomial blood stream infection and its correlation with antifungal resistance

Nosocomial blood stream infections (BSI) due to fungi especially Candida is increasing steadily. A two year prospective study was conducted in the S.C.B. Medical College with an aim to evaluate the species distribution, antifungal susceptibility and biofilm formation of Candida spp. isolated from nosocomial BSIs. 34 Candida spp. were isolated from 359 blood cultures. Antifungal susceptibility was performed by microbroth dilution technique and both visual and spectrophotometric method were used for biofilm detection. C. tropicalis was the common spp. isolated followed by C. parapsilosis and others. Most (92%) of the isolates were susceptible to Amphoterecin-B and highest resistance was observed against Flucytosine (37%) and Fluconazole(35%). Biofilm production and antifungal resistance was observed more in nonalbicans Candida spp.

English

In this study 2500 children admitted to tertiary care hospital Gulbarga were observed for nosocomial bactaeremia for 1 year. The blood sample for culture is collected from patient who developed fever 48 hours or more after admission. Incidence of nosocomial bacteremia is 101(4%). The following microorganisms are isolated (Table-1). Staphylococcus aureus is commonest 34(34%) followed by Klebsiella pneumoniae 27(27%), coagulase negative staphylococcus 18(18%), Escherichia coli 14(14%), Pseudomonas aeruginosa 8(8%). Intravenous catheters are a major source of nosocomial blood stream infection. The risk factors for nosocomial bacteraemia are intravenous catheters and mechanical ventilation.

Haemodialysis catheter-related bloodstream infections at Universitas Academic Hospital, Bloemfontein: should we change our empiric antibiotics?

Nosocomial bloodstream infections are only second to cardiovascular disease in causing mortality in patients with end-stage renal disease. The majority of these infections relate to haemodialysis catheters. Empiric antimicrobial treatment is instituted on the clinical suspicion of a catheter-related bloodstream infection (CRBSI) while awaiting the blood culture results. There is a paucity of local data on microbial resistance patterns to guide empiric antibiotic use. This prompted our study. A retrospective survey was performed of cultured organisms and their antibiograms from patients with haemodialysis catheters in the Nephrology Unit at Universitas Academic Hospital, Bloemfontein, between January and December 2012. A list of all blood cultures performed during 2012 at the nephrology unit was compiled from the National Health Laboratory Service's electronic record system. All positive blood cultures associated with CRBSI were included in this study. Duplicate cultures, as well as negative cultures, were...

Assessment of bloodstream infections and risk factors in an intensive care unit

Nosocomial bloodstream infection (BSI) increases mortality rates, duration of stay in hospital, and treatment costs. This study was conducted to determine the rate and the risk factors of BSIs among intensive care unit patients. Sixty-four patients with BSIs (patient group) and 79 patients without a nosocomial infection (control group) were enrolled in the study. Centers for Disease Control and Prevention criteria were used for diagnosing BSIs. Potential risk factors were evaluated by multivariate logistic regression model. The BSI development rate was 15.7% (64/407), with an incidence rate of 18.2/1000 patient days. Distribution of pathogens among BSI patients were as follows: gram-positive cocci, 42.18% (27/64); gram-negative cocci, 34.3% (22/64); and Candida spp., 23.4% (15/64). Risk factors were determined as intubation, arterial catheter, tracheostomy, duration of intubation, duration of catheter use, duration of nasogastric catheter, underlying diseases of chronic renal failure and diabetes mellitus, implemented treatments of sedation and enteral nutrition, and APACHE II score. : BSIs are the leading cause of mortality and morbidity in intensive care unit patients. Determination of the local risk factors is important and necessary for decreasing the rate of BSIs and the mortality rates.

Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study.

In many traditional Chinese medicine (TCM) hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. A retrospective surveillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions. Escherichia coli (25.5%) was the most common Gram-negative and coagulase-negative staphylococcus (CoNS) (14.1%) was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsiella pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glycopeptide were the most frequently used for nBSI therapy. Only about one-third of patients (157/482) received appropriate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score >4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.

Candida glabrata candidemia: An emerging threat in critically ill patients.

Background:Candidemia is an important nosocomial blood stream infection in critically ill patients. Although several studies have addressed candidemia, very few have reviewed the impact of Candida glabrata candidemia in Intensive Care Unit (ICU) patients.Materials and Methods:The medical records of ICU patients between 2006 and 2010 were reviewed retrospectively. The epidemiology, clinical features and mortality related risk factors among our adult ICU patients were seen.Results:Among 144 episodes of candidemia, C. glabrata (n = 26; 18.05%) was the third most common species isolated. The incidence of C. glabrata candidemia was 0.21/1000 ICU admissions. The most common risk factors were prior exposure to broad spectrum antibiotics (100%), central venous catheter (100%), mechanical ventilation (76.9%), diabetes mellitus (50%), age >65 years (46.15%). Urine (23%) was the most common source of C. glabrata candidemia. Overall in hospital 30 days mortality rate due to C. glabrata fungemia was 53.8%. Patients who were treated with fluconazole showed better outcome than patients treated with amphotericin B. Renal failure requiring hemodialysis was the significantly associated with mortality in our study.Conclusion:Candida glabrata was the 3rd most common Candida causing candidemia in our ICUs with a incidence of 0.21/1000 ICU admissions. The outcome of ICU acquired C. glabrata candidemia was poor with 30 days mortality rate of 53.8%. Renal failure requiring hemodialysis was the only risk factor associated with mortality. Further studies are required to identify the other risk factors associated with mortality in C. glabrata candidemia.

Epidemiology of Candidaemia: A Prospective Comparison between Invasive Candidiasis in Italy and All Over the World

Candida is an important cause of bloodstream infections (BSI), causing significant mortality and morbidity in health care settings [1]. Invasive candidiasis (IC) is a serious disease in hospitalized critically ill and immune-compromised patients [2]. The advances of the supportive therapies, of the complexity of surgical procedures, of the number of elderly people in our society and of the changes in patient demographic characteristics have progressively expanded the population at high risk for fungal diseases. Consequently, the prevalence of Candida infection has increased leading to a higher frequency of invasive candidiasis and candidaemia [3,4]. Bloodstream infections sustained by Candida species are a major cause of morbidity, hospital length of stay, cost of care and mortality in hospitalized patients, the latter ranking 20-30% of all nosocomial BSIs [5,6] or even more [7].

Investigation of possible virulence factors in Candida strains isolated from blood cultures.

The Candida species, which are one of the most common causes of nosocomial bloodstream infections, present with high mortality and morbidity rates. This study aims to investigate the production of esterase, phospholipase, proteinase, and biofilm formation ability of the Candida strains isolated from the blood cultures. Between June 2011 and July 2012, the Candida strains, which were isolated from blood cultures of a total of 50 patients, were studied. The esterase activity was analyzed in the Tween-80 agar, while phospholipase activity was studied in the egg yolk agar. The proteinase activity and biofilm formation were identified by using the petri dish method and microplate method, respectively. Of 50 specimens obtained from individual patients, 17 (34%) were identified as C. albicans, 14 (28%) as C. glabrata, 9 (18%) as C. parapsilosis, 5 (10%) as C. krusei, 4 (8%) as C. kefyr, and 1 (2%) as C. tropicalis. The rate of proteinase, phospholipase, and esterase positivity was higher in the C. albicans isolates. Biofilm formation was the highest in the C. parapsilosis strains. Higher rate of virulence factors in the most commonly isolated Candida species than other species indicates that these virulence factors play a crucial role in the pathogenesis.

Impact of conversion from an open ward design paediatric intensive care unit environment to all isolated rooms environment on incidence of bloodstream infections and antibiotic resistance in Southern Israel (2000 to 2008).

We studied the epidemiology, microbiology, clinical aspects and outcome of bloodstream infections (BSI) in a tertiary paediatric intensive care unit. All BSI episodes were prospectively identified and analysed. The paediatric intensive care unit moved in 2006 from an open-plan unit to a new (all single room) unit. Three hundred and fifty-three BSI episodes occurred in 299 of 4162 patients. Overall, BSI incidence was 85 per 1000 hospitalised children. Fewer BSI episodes occurred during the last two years of the study (2007 to 2008), compared with 2000 to 2006 (70 of 1061 admissions, 6.5% versus 283 of 3101 admissions, 9.1%, respectively, P=0.01). There were 127 of 340 (37.4%) community-acquired and 213 of 340 (62.6%) nosocomial BSI episodes (31 of 1000 and 51 of 1000, respectively). Nosocomial BSI episodes decreased during 2007 to 2008 versus 2000 to 2006 (37.7% versus 55.8%, P=0.03). In 448 instances, pathogens were isolated, 231 (52%) Gram-positive and 188 (42%) Gram-negative. Coagulase-negative Staphylococci, S. pneumoniae and S. aureus (41.1%, 19.9% and 11.7%, respectively) were the most common Gram-positive and Enterobacteriaceae spp. the most frequent Gram-negative organisms (45.2%, of them Klebsiella spp. and E. coli 40% and 29.4%, respectively). A significant decrease was recorded during 2007 to 2008 in Enterobacteriaceae resistance to piperacillin, gentamicin and ciprofloxacin. Thirty of 299 (10%, 9 with S. pneumoniae-BSI) patients died. A significant decrease in BSI and nosocomial incidence and Enterobacteriaceae spp. antibiotic resistance was recorded following the conversion of the paediatric intensive care unit from an open ward to an all isolated rooms environment.

Candidemia-induced pediatric sepsis and its association with free radicals, nitric oxide, and cytokine level in host

Candida species has become the seventh most frequent causal microorganisms of nosocomial sepsis. Prematurity and low birth weights are strongly associated with the development of neonatal nosocomial bloodstream infections. Candida albicans has been the species most often associated with neonatal infections, but recently, there has been a changing pattern in the isolates recovered from neonates with invasive candidiasis, which poses resistance to the existing class of azoles such as fluconazole antifungals along with cross resistance to newer triazoles, which results in a therapeutic challenge in invasive fungal infections causing high incidence of mortality.Candida species was isolated from blood of neonates and children younger than 15 years admitted to hospital and susceptible for Candida-induced sepsis. Polymerase chain reaction–based identification and confirmation of individual Candida species were done using DNA sequencing. Antibiotic susceptibility assay and resistance pattern for fluconazole, voriconazole, and amphotericin were done for all the isolates. Furthermore, the change in free radical, cytokine release, and nitric oxide synthase expression and nitric oxide release from polymorphonuclear leukocytes isolated from control and pediatric sepsis cases were also performed.The present study probably for the first time reports the change in increasing incidence of nonalbicans Candida-induced sepsis in neonates and children admitted to the intensive care unit of hospital, and current antibiotics load posing resistance for antifungal treatment strategy and provide serious threats in future treatment. The increase in free radicals in polymorphonuclear leukocytes and increase in expression of nitric oxide synthase expression and nitric oxide release in Candida-infected pediatric sepsis cases underlie the role of host factor in dissemination and invasiveness of infection from exogenous sources and pathogenesis of systemic inflammation during sepsis.

914A Single-Center 10-Year Analysis of Neurosurgical Patients with Nosocomial Bloodstream Infections: Incidence, Resistance Rates and Risk Factors for Mortality

914A Single-Center 10-Year Analysis of Neurosurgical Patients with Nosocomial Bloodstream Infections: Incidence, Resistance Rates and Risk Factors for Mortality

Treatment of bloodstream infections in ICUs.

Bloodstream infections (BSIs) are frequent in ICU and is a prognostic factor of severe sepsis. Community acquired BSIs usually due to susceptible bacteria should be clearly differentiated from healthcare associated BSIs frequently due to resistant hospital strains. Early adequate treatment is key and should use guidelines and direct examination of samples performed from the infectious source. Previous antibiotic therapy knowledge, history of multi-drug resistant organism (MDRO) carriage are other major determinants of first choice antimicrobials in heathcare-associated and nosocomial BSIs. Initial antimicrobial dose should be adapted to pharmacokinetic knowledge. In general, a high dose is recommended at the beginning of treatment.If MDRO is suspected combination antibiotic therapy is mandatory because it increase the spectrum of treatment. Most of time, combination should be pursued no more than 2 to 5 days.Given the negative impact of useless antimicrobials, maximal effort should be done to decrease the antibiotic selection pressure. De-escalation from a broad spectrum to a narrow spectrum antimicrobial decreases the antibiotic selection pressure without negative impact on mortality. Duration of therapy should be shortened as often as possible especially when organism is susceptible, when the infection source has been totally controlled.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-489) contains supplementary material, which is available to authorized users.

Biofilm formation by Candida albicans is inhibited by 4,4-dichloro diphenyl diselenide (pCl-PhSe)2.

Candida species are the fourth most common cause of nosocomial bloodstream infections. An increase in the frequency of infections which have become refractory to standard antifungal therapyhave been observed. Recently, the effect of different organochalcogenide compounds reducing both growth and germ tube formation by Candida albicans was demonstrated. This work studied the effect of the organochalcogenide compound (pCl-PhSe)2 on both growth and biofilm formation by Candida albicans. A decrease in C. albicans growth in the presence of crescent concentrations of (pCl- PhSe)2 was observed, in a cell density dependent manner. The inhibition of Candida growth by 10µM (pCl-PhSe)2 was ~60, 57, 47 and 24%, in cell densities of 10(3), 10(4), 10(5) and 10(6) cells/ml, respectively. The compound (pCl-PhSe)2 was able to inhibit biofilm formation by Candida albicans, when biofilm was performed using a cell density of 10(6) cells/ml. In addition, an increase in both ROS production (96%) and cell membrane permeability (1.107-fold) by 10 µM (pCl-PhSe)2 was observed in C. albicans.These results demonstrate that the organochalcogenide compound (pCl-PhSe)2 presents a great potential to inhibit both growth and biofilm formation by C. albicans.