Previous Antibiotic Use Research Articles

Designing strategies for eradication of Helicobacter pylori based on prevalence patterns of infection and antibiotic resistance in a low-income, medically underserved community in the United States.

Regional variation in Helicobacter pylori resistance patterns is a significant contributing factor for the ineffectiveness of traditional treatments. To improve treatment outcomes, we sought to create an individualized, susceptibility-driven therapeutic approach among our patient population, which is one of the poorest in the nation. It is medically underserved, minority-predominant and has high incidence of H pylori infection. We compiled various factors involved in the antibiotic resistance of H pylori from literature. We then created a predictive model to customize therapies based on analyzed data from 2,014 H pylori patients with respect to several of these factors. The predictions of the model were further tested with analysis of patient stool samples. A clear pattern of H pylori prevalence and antibiotic resistance was observed in our patients. We observed that majority of H pylori patients were women (62%) and over the age of 40years (80%). 30% and 36% of the H pylori patients were African American and Hispanic, respectively. A median household income of less than $54,000, past H pylori infection, previous use of certain antibiotics for any infection decreased the chance of eradication. Results of the stool testing were consistent with model predictions (90% accuracy). This model demonstrates the predictive accuracy of H pylori infection and antibiotic resistance based on patient attributes and previous treatment history. It will be useful to formulate customized treatments with predicted outcomes to minimize failures. Our community attributes may contribute toward broad applicability of model for other similar communities.

Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Enterobacterales Intestinal Carriage Among Outpatients: Microbiological and Epidemiological Differences Between Private Dwelling Residents and Nursing Home Residents.

The aim of this work was to assess the prevalence of carbapenemase-producing and extended-spectrum β-lactamase-producing Enterobacterales (ESBLPE) intestinal carriage among private dwelling residents (PDR) and nursing home residents (NHR) from the catchment area of Hospital Verge de la Cinta (Tortosa. North-Eastern Spain), and to depict clinicoepidemiological features of colonized individuals. Prevalence of ESBLPE carriage amid 762 PDR (0-94 years) who had feces collected for routine culture was 7.3% and 31% among 71 NHR (68-98 years) screened upon hospital admission. The mean age of colonized and noncolonized subjects was 30 and 32.8 years in PDR (p = 0.58) and 85 and 87 years in NHR (p = 0.32). The predominant ESBLPE was CTX-M-15-producing Escherichia coli (42.8% in PDR and 68.2% in NHR [25% and 86.7% belonging to O25b-ST131 clone; p < 0.0001]), followed by CTX-M-9-group- and SHV-producing E. coli and by CTX-M-15-producing Klebsiella pneumoniae. Overall, 72.7% of ESBLPE were multidrug resistant and 46.2% carried transferable quinolone determinants. Institutionalization in a nursing home was a risk factor for ESBLPE and extended-spectrum β-lactamase (ESBL)-producing O25b-ST131 E. coli carriage in individuals over 67 years (odds ratio 7.7 and 14.1). Previous antibiotic use and skin ulcers were significantly associated with ESBLPE carriage in NHR. Age <25 years in PDR and amoxicillin/clavulanate exposure in NHR protected against ESBL-producing O25b-ST131 E. coli colonization. Only two PDR, with known risk factors, bore OXA-48-producing isolates. These results highlight the role of nonhospitalized intestinal carriers, particularly NHR, as ESBLPE reservoirs and the preponderance of CTX-M-15, mainly linked to O25b-ST131 clone, as well as the emergence of carbapenemase-producing Enterobacterales carriers.

Microbial ecology and predicted metabolic pathways in various oral environments from patients with acute endodontic infections.

To assess in a cross-sectional clinical study the effect of antibiotics on the diversity, structure and metabolic pathways of bacterial communities in various oral environments in patients with acute primary infections. Samples of saliva (SA), supragingival biofilm (SB) and from the pulp cavity (PC) were collected from teeth with acute primary infections and then grouped according to previous use of antibiotics (NoAtb=no antibiotics [n=6]; Atb=antibiotics [n=6]). DNA sequencing was conducted using MiSeq (Illumina, San Diego, CA, USA). The V1-V3 hyper-variable region of the 16S rRNA gene was amplified. A custom Mothur pipeline was used for 16S rRNA processing. Subsequent analyses of the sequence dataset were performed in R (using vegan, phyloseq and ggplot2 packages) or QIIME. Twelve patients aged from 22 to 56years were recruited. Participants in the Atb group had taken the beta-lactamics amoxicillin (5/6) or cephalexin (1/6) for 2-3days. A total of 332 bacterial taxa (OTUs) were identified, belonging to 120 genera, 60 families and nine phyla. Firmicutes (41%) and Bacteroidetes (38%) were the most abundant phyla in all samples. Taxa clustered significantly by oral site (PCoA analysis; P<0.05, ANOSIM). Use of antibiotics had little effect on this clustering. However, SA, SB and PC had different degrees of richness, diversity and evenness. The greatest diversity was observed in SB samples and the least diversity was observed in PC samples. Metabolic prediction identified 163 pathways and previous use of antibiotics had a major effect on the estimated functional clustering in SA and PC samples. The ecological niche had a strong influence on the bacterial content of samples from various oral sites. Previous exposure to antibiotics may exert an effect on the phylogenetic composition of SA. Metabolic pathways appear to be modulated by antimicrobial agents in SA and PC samples. The dynamics of host/microbial interactions in the apical region and the functional ecology of the infected pulp cavity should be revisited.

Antibiotics during childhood and development of appendicitis-a nationwide cohort study.

Appendicitis is a common disease with a lifespan risk of approximately 8%. The full range of specific causes for the disease remains elusive, but an aberrant microbiota have been identified as a potential risk factor. To investigate if use of antibiotics in a paediatric population increases the risk of appendicitis in childhood and adolescence METHODS: We conducted a cohort study from 1 January 1995 to 31 December 2014. A total of 1385707 children (0-19years of age) including 7406397 antibiotic prescriptions and 11861 cases of appendicitis were included. Primary outcome was appendicitis requiring appendectomy according to previous use of antibiotics. Appendicitis and appendectomy were identified from nationwide hospital records, and exposure to antibiotics was identified from nationwide prescription register. Rate ratios (RRs) with 95% confidence intervals were estimated from Poisson and logistic regression models. Children who received at least one course of antibiotics were at increased risk of developing appendicitis compared to unexposed children (adjusted RR 1.72 [95% confidence interval 1.61-1.85]), mean age of developing appendicitis was 9.8years (SD 4.1years). The RR of appendicitis increased by 1.04 (1.04-1.04) per antibiotic course. A higher risk of appendicitis was observed in children exposed to antibiotics within the first 6months of life (RR 1.46 [1.36-1.56]) and children exposed to broad-spectrum antibiotics (RR 1.33 [1.27-1.39]). After adjustment for number of antibiotic courses, the association between early age of antibiotic exposure and risk of appendicitis and the association between exposure to broad-spectrum antibiotics and the risk of appendicitis both disappeared. Children who receive antibiotics are at increased and dose-dependent risk of appendicitis. The underlying mechanisms merit further investigation.

Previous antibiotic use and the development of Kawasaki disease: a matched pair case-control study.

Kawasaki disease (KD) is an acute febrile illness with systemic vasculitides, mostly affecting infants and young children. The etiology of KD is still unclear; however, altered gut microbiota have been recently implicated as a contributing factor for the development of vasculitis. We conducted an age- and gender-matched case-control study on 50 patients and 200 control subjects to search for potential factors leading to intestinal dysbiosis associated with KD. Data were analyzed using conditional multivariable logistic regression. Previous antibiotic administration was associated with the patients who developed KD (odds ratio [OR] 11.7, 95% confidence interval [CI] 4.7-29.1, P < 0.0001), but not other variables, including breastfeeding and group nursery. In subgroup analyses, cesarean birth was indicated as an associated factor in addition to previous antibiotic administration in infants under 12months of age (OR: 8.0, 95% CI: 1.8-34.4, P = 0.005), but not in older children. The association between previous antibiotic administration and the onset of KD was demonstrated. Antibiotics may contribute to the development of KD by affecting the intestinal microbiota in infants and young children.

Bloodstream infections by gram-negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome.

Kidney transplant recipients (KTRs) are at increased risk of infections. The aims of this study were to describe the incidence of bloodstream infections (BSIs) by gram-negative bacteria in a cohort of KTRs, the risk factors for BSI due to multi-drug-resistant (MDR) gram-negative bacteria, and the predictors for unfavorable outcome, defined as death or nephrectomy or return to dialysis, within 30days from BSI. We conducted a retrospective cohort study at the renal transplant unit of a tertiary care hospital in Athens, Greece. In a total of 1962 KTRs, we recorded 195 BSI episodes in 182 single patients (male/female=97/85), with a median (interquartile range) age of 57.2 (44-64.9) years. The incidence was 1.393/100 patient-years. The most common source of infection was urinary tract (70.9%), and Escherichia coli (63.7%) was the most common pathogen. 19.2% of the infecting organisms were MDR; previous antibiotic use (OR 8.2; CI 2.1-32.9) and previous stay in the intensive care unit (OR 34.2; CI 1.6-730.2) were associated with MDR BSIs. 6% of patients died, and 2.2% underwent nephrectomy, while no patients had to return to dialysis. Diabetes mellitus (OR 8.1; 95% CI 1.3-50.3), Pseudomonas aeruginosa BSI (OR 46.1; 95% CI 3.9-552.3), and septic shock (OR 46.7; 95% CI 1.7-1304.9) were independent predictors of unfavorable outcome. Bloodstream infections in KTRs have a significant impact on allograft and patients outcome.

Short- and long-term predictors of spontaneous bacterial peritonitis in Singapore.

Spontaneous bacterial peritonitis (SBP) is the commonest complication of liver cirrhosis. Timely and appropriate treatment of SBP is crucial, particularly with the rising worldwide prevalence of multidrug-resistant organisms (MDROs). We aimed to investigate the clinical outcomes of SBP in Singapore. All cirrhotic patients with SBP diagnosed between January 2014 and December 2017 were included. Nosocomial SBP (N-SBP) was defined as SBP diagnosed more than 48 hours after hospitalisation. Clinical outcomes were analysed as categorical outcomes using univariate and multivariate analysis. There were 33 patients with 39 episodes of SBP. Their mean age was 64.5 years and 69.7% were male. The commonest aetiology of cirrhosis was hepatitis B (27.3%). The Median Model for End-stage Liver Disease (MELD) score was 17; 33.3% had acute-on-chronic liver failure and 60.6% had septic shock at presentation. N-SBP occurred in 25.6% of SBP cases. N-SBP was more commonly associated with MDROs, previous antibiotic use in the past three months (p = 0.014) and longer length of stay (p = 0.011). The 30-day and 90-day mortality among SBP patients was 30.8% and 51.3%, respectively. MELD score > 20 was a predictor for 30-day mortality. N-SBP and MELD score > 20 were predictors for 90-day mortality. N-SBP was significantly associated with recent antibiotic use, longer hospitalisation, more resistant organisms and poorer survival among patients with SBP. N-SBP and MELD score predict higher mortality in SBP. Judicious use of antibiotics may reduce N-SBP and improve survival among cirrhotic patients.

Bacteremias por staphylococcus aureus: factores de riesgo asociados a la resistencia a meticilina

Introducción: El objetivo del trabajo ha sido identificar los factores de riesgo que podrían favorecer la aparición de resistencia a meticilina en aislamientos de Staphylococcus aureus y aquellos que influirían en la mortalidad por las bacteriemias producidas por este patógeno.Métodos: Se realizó un estudio observacional de casos y controles en los 57 pacientes diagnosticados de bacteriemia por Staphylococcus aureus en el Hospital de Barbastro. Para el análisis se utilizaron los test estadísticos de Chi cuadrado de Pearson, test de Fisher y regresión logística múltiple.Resultados: Del total de bacteriemias, 63,15% correspondieron a Staphylococcus aureus sensible a meticilina y 36,84% a Staphylococcus aureus resistente a meticilina. Se asociaron a resistencia a meticilina, la adquisición nosocomial de la infección, el uso previo de antibióticos y la edad mayor de 65 años. La mortalidad de los casos de bacteriemia por SARM y SAMS fue respectivamente del 28,57% y del 36,11%, siendo estas diferencias estadísticamente no significativas. Todos los aislamientos fueron sensibles in vitro a vancomicina.Conclusiones: En nuestro sector sanitario, las estrategias más efectivas para disminuir la incidencia de bacteriemias por SARM serían el control y uso adecuado de antimicrobianos y la aplicación de programas de prevención de infecciones nosocomiales. En los pacientes con bacteriemia por Staphylococcus aureus, la resistencia a meticilina no se asocia a más mortalidad.

P1801RISK FACTORS FOR URINARY TRACT INFECTION CAUSED BY EXTENDED-SPECTRUM BETA-LACTAMASE GRAM NEGATIVE BACTERIA IN INFANT

Abstract Background and Aims Community-acquired extended-spectrum beta-lactamase (ESBL) producing bacterial infections are an evolving public health problem. Urinary tract infections (UTIs) due to ESBL-producing bacteria are increasing even in infants rarely exposed to antibiotic. We aimed to identify risk factors for UTI caused by ESBL-positive bacteria in infants. Method We retrospectively analyzed the medical records of hospitalized infants with first episode of UTI from March 2018 to August 2019. Data includes demographic characteristics, birth history, previous use of antibiotic, febrile event, urinalysis results, and urine isolated organisms and their ESBL status. Multivariate regression analysis was used to quantify independent risks associated with ESBL-positive UTI. Results UTIs were diagnosed in 266 patients at median age of 3.6 (interquartile range (IQR) 2.3-5.4) months. Sixty-two (30.4%) patients were diagnosed with UTI caused by ESBL-producing bacteria. When we divided patients according to ESBL status, there was no difference in gender, age, birth history, milk type, and use of postpartum care center. Maternal use of antibiotic during pregnancy and previous antibiotic exposure to patients were higher in ESBL-positive group than in ESBL-negative group (32.3% vs. 10.3%, P &amp;lt;0.001 and 22.6% vs. 12.3%, P =0.044, respectively). Klebsiella species was more frequently identified in ESBL-positive group than in ESBL-negative group (19.4% vs. 4.9%, P =0.002). In multivariate analysis, maternal use of antibiotic during pregnancy (odds ratio (OR), 3.817; 95% confidence interval (CI) 1.812-8.040, P &amp;lt;0.001), previous antibiotic exposure to patients (OR 2.418; 95% CI 1.071-5.461, P =0.034), and Klebsiella species as a causative organism (OR 6.222; 95% CI 2.396-16.158, P &amp;lt;0.001) were associated with ESBL positivity. In comparison of clinical courses of patients, ESBL-positive group showed severe leukocytosis (WBC 16,795 (IQR 12,210-20,270)/μL vs. WBC 14,620 (IQR 12,000-18,330)/μL, P =0.04), and stayed longer in hospital than ESBL-negative group (7.0 (IQR 5.5-8.5) days vs. 4.5 (IQR 3.7-5.1) days, P &amp;lt;0.001). Conclusion In this study, high rate of ESBL positivity was detected in infantile UTI. Antibiotics exposure on both patients and mothers was associated with UTI caused by ESBL producing bacteria. Identification of underlying risk factors could improve treatment and preventive strategies.

Abordaje actualizado sobre la neumonía adquirida en la comunidad en adultos

La Neumonía adquirida en la comunidad (NAC), es una de las principales patologías infecciosas a nivel respiratorio, con una amplia distribución y morbimortalidad a nivel mundial. Se caracteriza por un compromiso del parénquima pulmonar, causado por agentes externos al ámbito hospitalario, como bacterias, virus u hongos. La incidencia promedio es de 9.2 a 33 por cada mil habitantes, con mayor afectación en la población mayor a 65 años. Se estima que, al menos, 10% a 20% de casos, requerirán manejo en una unidad de cuidados intensivos, de acuerdo con la estratificación de riesgo individual. El diagnóstico es clínico y se confirma con estudios de imagen, análisis bioquímicos y microbiológicos. El tratamiento inicial se instaura empíricamente, de acuerdo con el historial clínico, uso previo de antibiótico y al patrón de sensibilidad del país o del centro.

Epidemiology of the colonization and acquisition of methicillin-resistant staphylococci and vancomycin-resistant enterococci in dogs hospitalized in a clinic veterinary hospital in Spain

Antibiotic resistance is one of the biggest threats to human and animal health. Methicillin-resistant Staphylococcus spp. (MRS) and vancomycin-resistant Enterococcus spp. (VRE) are of increasing importance in hospital and/or nosocomial infections and represent a potential risk of transmission to humans from infected or colonized companion animals. Studies on the risk factors associated with colonization by multiresistant bacteria in animals are scarce. The present study aimed to estimate the prevalence and incidence of MRS and VRE in canine patients hospitalized in a veterinary hospital and to identify the risk factors for its acquisition and persistence.Nasal and perianal swabs were obtained from 72 dogs. Antimicrobial susceptibility assays and molecular detection of mecA and van genes were performed.A prevalence of 13.9% and incidence of 26.5% was observed in dogs colonized by MRS at hospital admission and release, respectively, higher values than those described in most veterinary studies. Thirty-five Staphylococcus isolates had mecA gene and showed higher resistance levels to most of the antimicrobials evaluated. Previous and concomitant use of antibiotics and corticosteroids has been associated with an increase in MRS colonization. The use of antibiotics in other animals living with the canine patients has also been identified as an associated factor, suggesting cross transmission. The presence of van-resistant genes from Enterococcus spp. was not detected.Pets should be considered possible vehicles of transmission and reservoirs for MRS bacteria and veterinary hospitals should be considered high-risk environments for the occurrence and spread of nosocomial infections and resistant bacteria.

Kodamaea ohmeri infections in humans: A systematic review.

Kodamaea ohmeri, previously known as Pichia ohmeri or Yamadazyma ohmeri, belongs to the Saccharomycetaceae family and the Ascomycetae class, is the telomorphic form of Cguilliermondii var. membranaefaciens and is frequently mistaken for Candida, as they belong to the same family. It has been isolated from environmental sources, such as sand, pools, seawater and fruits, while the last decades it is recognised as a rare pathogen that causes life-threatening infections in humans. The purpose of this study was to systemically review all published cases of Kohmeri infections in the literature and describe the epidemiology, microbiology, antimicrobial susceptibility, treatment and outcomes of these infections in humans. Systematic review of PubMed (through 27th December 2019) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of Kohmeri infections. A total of 35 studies, containing data of 44 patients, were included in the analysis. The most common Kohmeri infections were those of the bloodstream, infective endocarditis and onychomycosis. Previous antibiotic use, presence of a central venous catheter, parenteral nutrition and cancer were very common among patients. Mortality was high in the case of fungemias but low for other types of infections. Amphotericin B and fluconazole are the most common agents used for treatment, even though alarming MICs for fluconazole were noted. This systematic review thoroughly describes infections by Kohmeri and provides information on their epidemiology, clinical presentation, microbiology, antibiotic resistance patterns, treatment and outcomes.

Antimicrobial resistance and extended spectrum beta-lactamases in urinary tract infections: A serious problem in Northern Mexico

Objective: To describe the causal agents, prevalence of antimicrobial resistance, and risk factors associated with extended spectrum beta-lactamase (ESBL)-producing agents in urinary tract infections (UTIs).&#x0D; Materials and methods: A retrospective study was conducted at a tertiary care hospital in Monterrey, Mexico. Inclusion criteria were patients that clinically presented with a UTI and had a positive urine culture, within the time frame of March to October 2017. The association with ESBL-producing agents was determined through the Χ2 test for categorical variables. Statistical significance was set at a p &lt;0.05, utilizing SPSS version 20.0 software.&#x0D; Results: A total of 353 positive urine cultures were confirmed. ESBL production was found in 21.5% of the strains. There was a high level of resistance (&gt;50%) to amoxicillin-clavulanate, ciprofloxacin, levofloxacin, fosfomycin, and trimethoprim-sulfamethoxazole and moderate resistance (10-50%) to gentamicin and ceftriaxone. Amikacin, ertapenem, nitrofurantoin, and colistin had the lowest resistance rates (&lt;10%). The ESBL-producing agents were associated with complicated UTI (p≤0.0001). The comorbidities associated with ESBL-positive UTIs were diabetes mellitus (p=0.02) and immunodeficiency (p=0.008), as was having undergone radiotherapy (p=0.025) and previous antibiotic use (p≤0.001).&#x0D; Limitations: The clonal relationship of isolates, especially of E. coli, was not analyzed. We could not establish whether there was a high level of genetic diversity between the isolates or whether independent acquisition or cross-transmission occurred.&#x0D; Value: We evaluated the epidemiologic characteristics of the ESBL-producing agents in UTIs at a Mexican tertiary care hospital.&#x0D; Conclusions: One out of every five UTIs was caused by ESBLs in our study population. There was a high level of resistance to the antibiotics used as first-line empiric therapy in the patients studied.

Resistencia antibiótica y agentes beta-lactamasa de espectro extendido en las infecciones del tracto urinario: un problema grave en el norte de México

Objective: To describe the causal agents, prevalence of antimicrobial resistance, and risk factors associated with extended spectrum beta-lactamase (ESBL)-producing agents in urinary tract infections (UTIs).&#x0D; Materials and methods: A retrospective study was conducted at a tertiary care hospital in Monterrey, Mexico. Inclusion criteria were patients that clinically presented with a UTI and had a positive urine culture, within the time frame of March to October 2017. The association with ESBL-producing agents was determined through the Χ2 test for categorical variables. Statistical significance was set at a p &lt;0.05, utilizing SPSS version 20.0 software.&#x0D; Results: A total of 353 positive urine cultures were confirmed. ESBL production was found in 21.5% of the strains. There was a high level of resistance (&gt;50%) to amoxicillin-clavulanate, ciprofloxacin, levofloxacin, fosfomycin, and trimethoprim-sulfamethoxazole and moderate resistance (10-50%) to gentamicin and ceftriaxone. Amikacin, ertapenem, nitrofurantoin, and colistin had the lowest resistance rates (&lt;10%). The ESBL-producing agents were associated with complicated UTI (p≤0.0001). The comorbidities associated with ESBL-positive UTIs were diabetes mellitus (p=0.02) and immunodeficiency (p=0.008), as was having undergone radiotherapy (p=0.025) and previous antibiotic use (p≤0.001).&#x0D; Limitations: The clonal relationship of isolates, especially of E. coli, was not analyzed. We could not establish whether there was a high level of genetic diversity between the isolates or whether independent acquisition or cross-transmission occurred.&#x0D; Value: We evaluated the epidemiologic characteristics of the ESBL-producing agents in UTIs at a Mexican tertiary care hospital.&#x0D; Conclusions: One out of every five UTIs was caused by ESBLs in our study population. There was a high level of resistance to the antibiotics used as first-line empiric therapy in the patients studied.

Risk factors for candidaemia in hospitalized patients with liver cirrhosis: a multicentre case–control–control study

ObjectivesThe aim of this study was to evaluate the risk factors for candidaemia in patients with liver cirrhosis. MethodsThis was a case–control–control (1:2:2) study performed in four Italian tertiary centres from 2006 to 2015. Cases were patients with liver cirrhosis developing candidaemia. For every case of candidaemia we enrolled two additional patients undergoing blood cultures for suspected infection yielding isolation of a bacterial pathogen (control A) and two additional patients undergoing blood cultures for suspected infection yielding negative results (control B). Patients were matched according to age, sex and model for end stage liver disease at hospital admission. ResultsDuring the study period 90 cases, 180 controls A and 180 controls B were included. At multivariate analysis assessed by means of multinomial conditional regression models, factors independently associated with candidaemia were previous (<30 days) acute-on-chronic liver failure (relative risk ratio (RRR) 2.22 (95% confidence interval (CI) 1.09–4.54), p = 0.046), previous(<30 days) gastrointestinal endoscopy (RRR 2.38 (95% CI 1.19–4.78) p = 0.014), previous(<30 days) antibiotic treatment for at least 7 days (RRR 2.74 (95% CI 1.00–7.48), p = 0.049), presence of central venous catheter (RRR 2.77 (95% CI 1.26–6.09, p = 0.011), total parenteral nutrition (RRR 3.90 (95% CI 1.62–9.40), p = 0.002) at infection onset and length of in-hospital stay >15 days (RRR 4.63 (95% CI 2.11–10.18), p <0.001] Conversely, rifaximin treatment was associated with lower rate of candidaemia (RRR 0.38 (95% CI 0.19–0.77), p = 0.007). Multivariable analysis for 30-day mortality showed that patients with isolation of Candida spp. from blood cultures had worse outcome when compared with controls even though the difference did not reach a statistical significance (hazard ratio 1.64 (95% 0.97–2.75) p = 0.06). ConclusionsWe identified previous antibiotic use, gastrointestinal endoscopy or acute-on-chronic liver failure and presence of central venous catheter especially for parenteral nutrition as independent factors associated with candidaemia. Surprisingly, chronic rifaximin use was a protective factor.

Acinetobacter baumannii Resistance: A Real Challenge for Clinicians.

Acinetobacter baumannii (named in honor of the American bacteriologists Paul and Linda Baumann) is a Gram-negative, multidrug-resistant (MDR) pathogen that causes nosocomial infections, especially in intensive care units (ICUs) and immunocompromised patients with central venous catheters. A. baumannii has developed a broad spectrum of antimicrobial resistance, associated with a higher mortality rate among infected patients compared with other non-baumannii species. In terms of clinical impact, resistant strains are associated with increases in both in-hospital length of stay and mortality. A. baumannii can cause a variety of infections; most involve the respiratory tract, especially ventilator-associated pneumonia, but bacteremia and skin wound infections have also been reported, the latter of which has been prominently observed in the context of war-related trauma. Cases of meningitis associated with A. baumannii have been documented. The most common risk factor for the acquisition of MDR A baumannii is previous antibiotic use, following by mechanical ventilation, length of ICU/hospital stay, severity of illness, and use of medical devices. Current efforts focus on addressing all the antimicrobial resistance mechanisms described in A. baumannii, with the objective of identifying the most promising therapeutic scheme. Bacteriophage- and artilysin-based therapeutic approaches have been described as effective, but further research into their clinical use is required

Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

BackgroundAvailable data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs.MethodologyWe conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018.ResultsOver the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively.The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus.ConclusionWe demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.

Impact of Difficult-to-Treat Resistance in Gram-negative Bacteremia on Mortality: Retrospective Analysis of Nationwide Surveillance Data.

Clinically relevant categorization of antimicrobial resistance is critical to mitigating the threat it poses. Difficult-to-treat resistance (DTR) is a recently proposed category defined as nonsusceptibility to all first-line antibiotic agents. A retrospective study was conducted with nonduplicate cases of gram-negative bloodstream infection (GNBSI) caused by 4 major taxa (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter species) identified from a nationwide surveillance database. DTR was defined as nonsusceptibility to all the β-lactams and fluoroquinolones tested. Patient characteristics and mortality were compared between DTR GNBSI and GNBSI caused by carbapenem-resistant but not DTR and extended-spectrum cephalosporin-resistant but not DTR isolates using Centers for Disease Control and Prevention definitions. Adjusted odds ratios (aORs) for 30-day in-hospital mortality were examined for DTR in overall and in propensity score-matched cohorts. A total of 1167 episodes of monomicrobial GNBSI were identified, and 147 (12.6%) of the isolates were DTR. The majority of DTR isolates were Acinetobacter species (79.6%) and P. aeruginosa (17.7%). DTR infections were associated with previous antibiotic use, healthcare contact, ventilator use, and lower respiratory tract infection. Crude mortality for GNBSI caused by DTR was 50.3%. A multivariable model showed that only DTR, but not other categories, was significantly associated with mortality (adjusted odds ratio [aOR], 3.58 [95% confidence interval {CI}, 1.27-10.19]). DTR was also a significant predictor for mortality in the analysis of propensity score-matched cohorts (aOR, 3.48 [95% CI, 1.82-6.79]). In patients with GNBSI, DTR was associated with higher mortality than those in other resistance categories. Our findings suggest that DTR could be useful for surveillance and prognostication.

Antibacterial Prophylaxis before Autologous Hematopoietic Stem Cell Transplant and Risk of Clostridium Difficile-Associated Diarrhea

Clostridium difficile is the leading cause of infectious diarrhea among hospitalized patients and is a major concern for patients undergoing hematopoietic cell transplantation (HCT). Risk factors and the natural history of C. difficile infection (CDI) are poorly understood in this population. The objective of this study is to determine the incidence of CDI during and after auto-HCT and to identify risk factors for the development of CDI including diagnosis. Methods: We performed a retrospective study to describe the epidemiology, timing, and risk factors for CDI among adult patients who received autologous HCTs at our center from January 2007 through December 2018. CDI was defined any stool C. difficile toxin positive test after the day of stem cell infusion. Results: Overall, 516 patients received auto-HCT for Multiple Myeloma (MM) and lymphoma during the study period, 271 and 245, respectively. Overall, the 1-year incidence of CDI was 6.2% (n=30). Seventy two percent of the patients who developed CDI had lymphoma and 18% had MM (p=0.001). The median time from day of stem cell infusion to CDI positive test was 5 days (range 1:228) for lymphoma pts and 10.5 days (rage 4-42) for MM pts (p-value: 0.269). Median age for MM pts was 54 years and 58 for lymphoma pts (p-value: 0.328). Given the different patient population and therapy history between MM and lymphoma patients, we limit our analysis to MM subset to assess the potential risk factors impacting CDI occurrence after transplant. Previous antibiotic use (i.e., other than acyclovir), co-morbidities and other variables were assessed (Figure-1). Among MM patients, prophylactic antibiotics or corticosteroid use before transplant were not statistically significant associated with CDI. Twenty seven percent of patients with CDI had history of previous CDI vs. only 5% in no-CDI cohort (p-value: 0.001). Lymphopenia was present in 54% of CDI cohort at diagnosis whereas 29% of no-CDI cohort had lymphopenia (p-value: 0.031). Furthermore, chronic kidney disease (CKD) was associated significantly with CDI occurrence (p-value: 0.001). Conclusion: These results suggest lymphoma patients undergoing auto-HCT are at higher risk of developing CDI than MM patients which is different from older reports (Alonso, et al. Clinical infectious diseases. 2012). Our data illustrates pre-transplant prophylactic antibiotics or corticosteroid use is not associated with higher CDI incidence after transplant for MM patients undergoing transplant, while history of previous CDI in the year before transplant, lymphopenia and CKD may be significant predictors. This findings merits further confirmations in larger series.

Association Between Bisphosphonates and Hospitalized Clostridioides difficile Infection Among Frail Older Adults

ObjectivesClostridioides difficile infection is a major source of morbidity and mortality among frail older adults, especially those in nursing homes (NHs). Safety reports have signaled that bisphosphonate use may be a contributing cause. We therefore evaluated the risk of C difficile hospitalization associated with oral bisphosphonate use in the NH. DesignObservational, retrospective new-user cohort study. SettingThe cohort included US NH residents aged ≥65 years who became a long-stay resident (>100 days in the NH) between January 1, 2008 and December 31, 2009. MethodsWe conducted a study of NH residents using linked Medicare claims and Minimum Data Set records. Residents were new users of an oral bisphosphonate 1:1 matched to new calcitonin users (“active” comparator) on propensity scores controlling for more than 100 covariates. The outcome was risk of hospitalization for C difficile infection in a Cox proportional hazards model adjusted for previous antibiotic and proton pump inhibitor use. ResultsOur final analytical cohort included 17,753 bisphosphonate and 5348 calcitonin users. In the matched cohort, 84/5209 (1.6%) vs 71/5209 (1.4%) C difficile–related hospitalizations occurred in bisphosphonate and calcitonin users, respectively. We observed no significant difference in the risk of hospitalization among bisphosphonate users (hazard ratio: 1.11, 95% confidence interval: 0.80-1.51). Antibiotic and proton pump inhibitor exposure before and after osteoporosis treatment was also similar between bisphosphonate and calcitonin users. Conclusions and ImplicationsC difficile infection should not be a consideration when prescribing bisphosphonates to frail older adults given the lack of a significant association.