Primary Bacteremia Research Articles

Emergence of Streptococcus pneumoniae serotype 19A (Spn19A) in the pediatric population in Bogotá, Colombia as the main cause of invasive pneumococcal disease after the introduction of PCV10

ABSTRACT Introduction: With the use of pneumococcal conjugate vaccines(PCV), the behavior of invasive pneumococcal disease(IPD) has changed relative to serotype distribution. The introduction of these vaccines in national immunization programs has reduced the incidence of IPD, with a marked decrease in the circulation of the serotypes included in the vaccine used in each country. However, the subsequent emergence of other serotypes not included in the vaccine, such 19A in case of PCV7 and PCV10, has been documented. Materials and methods: This was case series study (2008–2017) in pediatric patients admitted to 10 hospitals in Bogota who were diagnosed with IPD. It was conducted during the transitional period of implementing the PCV10 vaccine in Colombia in 2012. Cases of bacteremic pneumococcal pneumonia, meningitis, primary bacteremia and osteoarticular infection were included. A descriptive analysis of the demographic, clinical and laboratory variables of patients with IPD by Spn19A, its trend over time, profiles of antimicrobial susceptibility and clinical outcomes was performed. Results: There were 463 cases of IPD, 315(68%) with known serotypes. The prevalence of IPD by Spn19A was 17.7%(56 cases), tending to increase over time. During 2008–2011, the prevalence was 4.4%, and during 2014–2017, it was 32.4%, The most frequent diagnosis was pneumonia(80.4%). In nonmeningeal isolates, 39.6% were not susceptible to penicillin. An increase in the resistance was observed over time. Conclusion: Spn19A is a prevalent cause of IPD in the pediatric population of the analyzed cohort, with an increasing trend of this serotype during the surveillance period after the introduction of PCV10, being the most common serotype identified in recent years.

Clinical Experience with Ceftazidime-Avibactam for the Treatment of Infections due to Multidrug-Resistant Gram-Negative Bacteria Other than Carbapenem-Resistant Enterobacterales.

Background: Experience in real clinical practice with ceftazidime-avibactam for the treatment of serious infections due to gram−negative bacteria (GNB) other than carbapenem-resistant Enterobacterales (CRE) is very limited. Methods: We carried out a retrospective multicenter study of patients hospitalized in 13 Italian hospitals who received ≥72 h of ceftazidime-avibactam for GNB other than CRE to assess the rates of clinical success, resistance development, and occurrence of adverse events. Results: Ceftazidime-avibactam was used to treat 41 patients with GNB infections other than CRE. Median age was 62 years and 68% of them were male. The main causative agents were P. aeruginosa (33/41; 80.5%) and extended spectrum beta lactamase (ESBL)-producing Enterobacterales (4/41, 9.8%). Four patients had polymicrobial infections. All strains were susceptible to ceftazidime-avibactam. The most common primary infection was nosocomial pneumonia (n = 20; 48.8%), primary bacteremia (n = 7; 17.1%), intra-abdominal infection (n = 4; 9.8%), and bone infection (n = 4; 9.8%). Ceftazidime-avibactam was mainly administered as a combination treatment (n = 33; 80.5%) and the median length of therapy was 13 days. Clinical success at the end of the follow-up period was 90.5%, and the only risk factor for treatment failure at multivariate analysis was receiving continuous renal replacement therapy during ceftazidime-avibactam. There was no association between clinical failures and type of primary infection, microbiological isolates, and monotherapy with ceftazidime-avibactam. Only one patient experienced recurrent infection 5 days after the end of treatment. Development of resistance to ceftazidime-avibactam was not detected in any case during the whole follow-up period. No adverse events related to ceftazidime-avibactam were observed in the study population. Conclusions: Ceftazidime-avibactam may be a valuable therapeutic option for serious infections due to GNB other than CRE.

Health Care–Associated Infection in Solid Organ Transplant Recipients

BackgroundHealth care–associated infection (HAI) represent a global health problem with an increase in hospital stays, deaths, and monetary costs. Recipients of solid organ transplants are a population at risk. The objectives of the study were to characterize the incidence of HAI in renal and hepatic transplant recipients as well as to compare them with the population without transplants in intensive care units (ICU). MethodsThe data on the incidence of HAI, localization, microorganisms, and demographics were taken from the patients admitted between the years 2013 to 2018 (n = 4307) from the registration of the Project for the Reduction of Nosocomial Infection in Intensive Care Units. The variables were compared with those of renal transplant (n = 96) and liver transplants (n = 68) recipients. ResultsRenal transplant recipients showed 26% incidence of HAI. The most frequent were surgical site infection (SSI), urinary tract infection, and primary bacteremia; the most frequent microorganism was Staphylococcus spp, mortality 3.8%. Liver transplant recipients showed 41% incidence of HAI. The most frequent were tracheobronchitis associated with mechanical ventilation, SSI, and primary bacteremia; the most frequent microorganism was Staphylococcus spp, mortality 37%. The population without transplants in the ICU showed 17% incidence of HAI. The most frequent were respiratory infections associated with mechanical ventilation, primary bacteremia, and SSI; the most frequent microorganism was Acinetobacter spp, mortality 21%. ConclusionsHAI in recipients of solid organ transplants (renal and hepatic) have a higher incidence than in a population without transplants. The location and causal microorganisms have particularities that must be taken into account for the development of prevention protocols.

Time to appropriate antibiotic therapy is a predictor of outcome in patients with bloodstream infection caused by KPC-producing Klebsiella pneumoniae

BackgroundBloodstream infections (BSIs) by Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (Kp) are associated with high mortality. The aim of this study is to assess the relationship between time to administration of appropriate antibiotic therapy and the outcome of patients with BSI due to KPC-Kp hospitalized in intensive care unit (ICU).MethodsAn observational study was conducted in the ICUs of two academic centers in Italy. Patients with KPC-Kp bacteremia hospitalized between January 2015 to December 2018 were included. The primary outcome was the relationship between time from blood cultures (BC) collection to appropriate antibiotic therapy and 30-day mortality. The secondary outcome was to evaluate the association of different treatment regimens with 30-day mortality and a composite endpoint (30-day mortality or nephrotoxicity). A Cox regression analysis to identify factors independently associated with 30-day mortality was performed. Hazard ratio (HR) and 95% confidence interval (CI) were calculated.ResultsA total of 102 patients with KPC-Kp BSI were included. The most common sources of infection were intra-abdominal (23.5%), urinary tract (20.6%), and skin and skin structure (17.6%). The 30-day mortality was 45%. Median time to appropriate antibiotic therapy was shorter in patients who survived (8.5 h [IQR 1–36]) versus those who died (48 h [IQR 5–108], p = 0.014). A propensity score matching showed that receipt of an in vitro active therapy within 24 h from BC collection was associated with lower 30-day mortality (HR = 0.36, 95% CI: 0.188–0.690, p = 0.0021). At Cox regression analysis, factors associated with 30-day mortality were primary bacteremia (HR 2.662 [95% CI 1.118–6.336], p = 0.027), cardiovascular disease (HR 2.196 [95% CI 1.082–4.457], p = 0.029), time (24-h increments) from BC collection to appropriate therapy (HR 1.382 [95% CI 1.132–1.687], p = 0.001), SOFA score (HR 1.122 [95% CI 1.036–1.216], p = 0.005), and age (HR 1.030 [95% CI 1.006–1.054], p = 0.012). Ceftazidime-avibactam-containing regimens were associated with reduced risk of composite endpoint (30-day mortality OR nephrotoxicity) (HR 0.231 [95% CI 0.071–0.745], p = 0.014) compared to colistin-containing regimens.ConclusionsTime to appropriate antibiotic therapy is an independent predictor of 30-day mortality in patients with KPC-Kp BSI. Appropriate antibiotic therapy should begin within 24 h from the collection of BC.

Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.

To determine the trends of infection sites and outcome of sepsis using a national population-based database. Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality. During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%). The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.

Clinical and Microbiologic Profile of Patients With Staphylococcus aureus Infection

Background Invasive Staphylococcus aureus infection (ISA) is increasingly being recognized as an important cause of morbidity and mortality in developing countries. This problem is confounded by the increasing prevalence of antibiotic-resistant S. aureus. The aim of the study was to describe the clinical presentation and antibiotic susceptibility profile of ISA infection in a tertiary hospital in North West Nigeria. Materials and Methods This study was a prospective cohort study carried out on patients with ISA infection who were seen at a regional referral tertiary hospital in North West Nigeria. One hundred forty patients with ISA infection were studied. Clinical evaluation and relevant laboratory investigations were conducted. Antibiotic susceptibility tests were carried out by disk diffusion method according to Clinical and Laboratory Standard Institute guidelines. Results The mean age of the patients was 40.7 ± 15.6 years, with male-to-female ratio of 1.4:1. Skin and soft tissue infections (108 [77.1%]) and primary bacteremia (17 [12.1%]) were the most common diagnoses. Most infections were community-acquired infections (94 [67.1%]). Risk factors were identified in 112 (80%), of which diabetes mellitus (40 [35.7%]) and chronic kidney diseases (33 [29.5%]) predominate. Eighty-two (52.2%) of the isolates were methicillin-sensitive S. aureus, and 75 (47.8%) were methicillin-resistant S. aureus (MRSA). More cases of MRSA compared with methicillin-sensitive S. aureus were seen among patients with pneumonia and primary bacteremia. The overall mortality was 25 (19.7%) at 1-month follow-up. On multiple logistic regression analysis, the only factors predictive of mortality were sepsis (odds ratio, 6.723; 95% confidence interval, 1.431–31.585) and infection with MRSA (odds ratio, 5.523; 95% confidence interval, 1.506–20.250). Conclusions This study shows high burden of ISA with high prevalence of MRSA. This underscores the need for antimicrobial stewardship program and strengthening of infection control practices in our hospital.

Real-World Experience With Ceftazidime-Avibactam for Multidrug-Resistant Gram-Negative Bacterial Infections.

BackgroundWe conducted this study to describe the clinical characteristics, microbiology, and outcomes of patients treated with ceftazidime-avibactam (CZA) for a range of multidrug-resistant Gram-negative (MDR-GN) infections.MethodsThis is a multicenter, retrospective cohort study conducted at 6 medical centers in the United States between 2015 and 2019. Adult patients who received CZA (≥72 hours) were eligible. The primary outcome was clinical failure defined as a composite of 30-day all-cause mortality, 30-day microbiological failure, and/or failure to resolve or improve signs or symptoms of infection on CZA.ResultsIn total, data from 203 patients were evaluated. Carbapenem-resistant Enterobacteriaceae (CRE) and Pseudomonas spp were isolated from 117 (57.6%) and 63 (31.0%) culture specimens, respectively. The most common infection sources were respiratory (37.4%), urinary (19.7%), and intra-abdominal (18.7%). Blood cultures were positive in 22 (10.8%) patients. Clinical failure, 30-day mortality, and 30-day recurrence occurred in 59 (29.1%), 35 (17.2%), and 12 (5.9%) patients, respectively. On therapy, CZA resistance developed in 1 of 62 patients with repeat testing. Primary bacteremia or respiratory tract infection and higher SOFA score were positively associated with clinical failure (adjusted odds ratio [aOR] = 2.270, 95% confidence interval [CI] = 1.115–4.620 and aOR = 1.234, 95% CI = 1.118–1.362, respectively). Receipt of CZA within 48 hours of infection onset was protective (aOR, 0.409; 95% CI, 0.180–0.930). Seventeen (8.4%) patients experienced a potential drug-related adverse effect (10 acute kidney injury, 3 Clostridioides difficile infection, 2 rash, and 1 each gastrointestinal intolerance and neutropenia)ConclusionsCeftazidime-avibactam is being used to treat a range of MDR-GN infections including Pseudomonas spp as well as CRE.

Fatality of Staphylococcus aureus infections in a Greek university hospital: role of inappropriate empiric treatment, methicillin resistance, and toxin genes' presence.

The aim of the present study was to identify predictors of fatality among patients with S. aureus infections requiring hospitalization. Cases hospitalized with S. aureus infections at the University General Hospital of Patras, Greece, during a 4-year period (2013-2016) were studied. mecA, lukS/lukF-PV (Panton-Valentine leukocidin, PVL), tst (toxic shock syndrome toxin), fnbA (fibronectin-binding protein A), eta, and etb (epidermolytic toxins) genes' carriage was detected by PCR in 149 selected patients. Among 464 patients, 346 were included (118 with missing data). Primary bacteremia predominated (44.2%), followed by lower respiratory tract infections (13.6%), deep seated infections (9.8%), osteoarticular (9.5%), and catheter-related bloodstream infections (6.1%). Methicillin-resistant S. aureus (MRSA) represented 33.8% of infections and were less likely to receive appropriate empiric treatment (79.5% versus 97.4%; P < 0.001). Thirty-day fatality was 14.5%. Multivariate analysis revealed that development of septic shock, Charlson Comorbidity Index, lower respiratory tract infection, bacteremia (primary or secondary), MRSA, and CRP was significantly associated with fatality. Appropriate empiric treatment was a predictor of good prognosis. Thirty-two out of 149 S. aureus (21.5%) carried lukS/lukF-PV genes, whereas, 14 (9.4%), 133 (78.7%), four (2.7%), and one (0.7%) carried tst, fnbA, eta, and etb genes, respectively. No difference was found among toxin genes' presence and mortality. PVL was significantly more frequently found among MRSA as compared to MSSA (45.1% versus 9.2%; P < 0.001). MRSA represented one third of the infections requiring hospitalization and were independently associated with fatality, probably since were more likely to receive inappropriate antibiotic treatment as compared to MSSA.

647. Diagnoses Associated with Temperature ≥104°F in Adults

BackgroundTemperature ≥104°F (T ≥ 104) is uncommon in adults. The diagnoses and clinical characteristics were reviewed for patients with T ≥ 104.MethodsInfectious disease physicians reviewed charts of patients with T ≥ 104 seen at the Washington DC Veterans Affairs Medical Center from 2009 to 2018. The following was collected: demographics, past medical history, medications, WBC, maximum temperature, time to defervescence, etiology of T ≥ 104, and death.ResultsLess than 0.01% of all patient encounters were associated with T ≥ 104. Of the 60 most recent patients with T ≥ 104 (from 2014 to 2018), the median age was 63.5 years (range 23–97), 65% were African American, 88% were male. 82% of those with T ≥ 104 were hospitalized; 76% of those had the T ≥ 104 on or within 72 hours of admission. 25% of the 60 patients had underlying cancer, 10% HIV, 30% DM, 13% CKD, and 13% were on steroids/immunosuppressants/biologics. The median peak temperature was 104.3°F (interquartile range 104.0 – 104.7); maximum was 106.8°F. 82% had T ≥ 104 for only 1 day and the median time to defervescence was 2 days. There were 55 diagnoses amongst 48 patients; 12 had no identifiable etiology of T ≥ 104. Of the identifiable diagnoses, there were 45 (81.8%) infections, 4 (7.3%) metastatic malignancies (1 Hodgkin’s lymphoma, 1 small cell carcinoma, 1 squamous cell carcinoma, 1 unknown primary), 2 (3.6%) intracranial bleeds, 2 (3.6%) GI bleeds, 1 (1.8%) mixed collagen vascular disease, and 1 (1.8%) neuroleptic malignant syndrome. The most common infections were 15 cases of pneumonia including 2 Legionella, 8 complicated UTI/pyelonephritis, 3 primary bacteremia, 2 West Nile virus, 2 influenza, and 2 cholangitis with bacteremia. The median WBC of infectious diagnoses (9.8) was significantly higher than noninfectious diagnoses (5.8, P = 0.006, T-test). Of the 60 patients, 20% died within 30 days of T ≥ 104 including 2 patients who died of sepsis. 67% of those who died were receiving hospice care.Conclusion T ≥ 104 is rare in adults and is usually associated with bacterial infections such as pneumonia (including Legionella), complicated UTIs/pyelonephritis, and primary bacteremia but may also be seen with viral infections such as West Nile virus and influenza. Mortality is high.Disclosures All authors: No reported disclosures.

145. Liver Steatosis as a Risk Factor for Invasive Group B Streptococcus Infection in Non-Pregnant Adults

BackgroundNonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease associated with metabolic syndrome and systemic changes in immune response. However, the impact of NAFLD on bacterial infections is unknown. Group B Streptococcus (GBS) infection is a significant cause of invasive disease among adult non-pregnant patients with high mortality rates, associated with diabetes mellitus and obesity as the most common underlying conditions. The aim of this study was to analyze the association of liver steatosis with invasive GBS disease outcomes.MethodsA retrospective, cohort study of all non-pregnant adult patients diagnosed with invasive GBS infection (GBS isolated from the normally sterile site) was conducted at the University Hospital for Infectious Diseases Zagreb during a 14-year period.ResultsOf the 127 patients with invasive GBS, 90 had complete data and were included in the study. Disease primarily presented as bacteremia without focus (34; 37.8%), cellulitis/erysipelas (27; 30.0%), pneumonia (11; 12.2%) and endocarditis (8; 8.9%). The most common co-morbidities were diabetes (36; 40.0%), dyslipidemia (35; 38.9%), cardiovascular (32; 35.6%), peripheral vascular disease (18; 20.0%) and malignancy (16; 17.8%). Based upon the results of abdominal US the patients were divided into two groups: with steatosis (39; 43.3%) and without steatosis (51; 56.6%). The patients with liver steatosis were younger (63 ± 13 vs. 71 ± 14 years, P = 0.01), had higher AST (45.0; IQR 30–71 vs. 28.5; IQR 20–71, P = 0.047) and ALT (38; 25.5–55.5 vs. 21.5; 14–40, P = 0.009). There were no differences in clinical presentation and comorbidities between groups. The in-hospital mortality was 43.5% in patients with steatosis (17/39) and 17.6% (9/51) in control group (P = 0.009). Logistic regression analysis showed that endocarditis (OR 200.8; 95% CI 11.5–3512.5), primary bacteremia (6.5; 1.7–25.0), qSOFA ≥2 (20.2; 4.2–97.6) and liver steatosis (8.4; 2.0–35.1) were associated with in-hospital mortality.ConclusionOur findings showed that invasive GBS disease has significant mortality, which is independently associated with liver steatosis.Disclosures All authors: No reported disclosures.

135. Clinical and Microbiologic Analysis of Risk Factors for Mortality in Patients with Carbapenem-Resistant Acinetobacter baumannii Bacteremia

BackgroundCarbapenem-resistant Acinetobacter baumannii (CRAB) infection is an emerging clinical issue and shows high mortality rates. There are a few studies that have evaluated the microbiologic risk factors for mortality in CRAB bacteremia. Aim of this study is to identify the clinical and microbiologic risk factors for mortality in CRAB bacteremia.MethodsAdult patients with monomicrobial CRAB bacteremia at a 2,700-bed tertiary hospital between December 2012 and December 2018 were retrospectively enrolled in the study. Risk factors for 30-day mortality were evaluated through a detailed clinical and microbiological analysis of study patients. All isolates collected on the first day of bacteremia were subjected to colistin susceptibility testing by broth microdilution and genotyping by multilocus sequence typing (MLST).ResultsA total of 164 patients were enrolled and 90 (55%) died within 30 days. Of the 164 patients, 111 (68%) were male and median age was 66.5 years. The most common MLST genotype was ST191 (80 isolates, 49%), followed by ST451 (14%) and ST784 (13%), and 12 (7%) isolates were resistant to colistin (MIC ≥4 mg/L). Deceased patients were more likely to have hematologic malignancy, neutropenia, pneumonia, and primary bacteremia; less likely to have solid tumor, catheter-related infection, and biliary tract infection; more likely to have a high Pitt bacteremia score; and less likely to receive appropriate antibiotic treatment, colistin, and combination therapy with colistin and tigecycline, compared with surviving patients (Table 1). Genotype, colistin MIC, and colistin resistance were not associated with mortality (Figure 1 and 2). In multivariable analysis, neutropenia (aOR, 3.25; 95% CI, 1.18–8.95), catheter-related infection (aOR, 0.33; 95% CI, 0.11–0.99), biliary tract infection (aOR, 0.20; 95% CI, 0.04–0.99), a high Pitt bacteremia score (aOR,1.42; 95% CI, 1.20–1.67), and combination therapy with colistin and tigecycline (aOR, 0.36; 95% CI, 0.14–0.92) were independent risk factors for mortality (Table 2).ConclusionClinical factors such as the site of infection, severity of bacteremia, and specific combination therapy rather than microbiologic factors contributed to mortality in CRAB bacteremia. Appropriate combination therapy may help improving outcomes in CRAB bacteremia. Disclosures All authors: No reported disclosures.

130. Clinical Presentation and Molecular Epidemiology Characterization of Invasive GBS Infection in Nara, Japan from 2007 to 2016

Background Streptococcus agalactiae (GBS), a leading cause of neonatal infections, also occurs as an invasive infection in elderly people. The aim of this study was to evaluate the clinical aspect of invasive infections and the phenotypic and genetic diversity of GBS isolates to develop better antibiotics treatment and curb the increasing rate of antibiotic resistance in Nara, Japan.MethodsGBS strains sequentially collected from blood and cerebrospinal fluid cultures between 2007 and 2016 were identified and evaluated for capsular types, multilocus sequence typing (MLST), antibiotic susceptibility, resistant gene, and pulsed-field gel electrophoresis (PFGE). Clinical characteristics were retrospectively collected.ResultsA total of 42 GBS isolates (12 from children and 30 from adults) were collected. In adults, common underlying conditions were malignancy and diabetes, and primary bacteremia was the most common source of infection. In children, 6 were early-onset diseases, 4 were late-onset diseases, and 2 were school children. Overall, the mortality rate was 0% in children and 17% in adults. The serotypes and main clonal complex are summarized in Table 1. Minimum inhibitory concentrations of the antibiotics were also determined (Table 2). The serotypes and resistant genes are shown in Table 3. PFGE revealed serotypes V and VI belonging to ST1, and serotype III belonging to ST335 were highly identical.ConclusionIn clinical aspects, neonates with early-onset diseases experienced certain disorders during the perinatal period. In adults, serotype Ib, which tends to exhibit levofloxacin resistance, was the most common, followed by serotypes V and VI belonging to ST1; however, they were not observed in children. Contrastingly, serotype III belonging to ST335, which tends to exhibit macrolide resistance, was mainly observed in children. Quinolone among adults and macrolide among the younger generation are widely used as oral antibiotics in Japan. A tendency to use antibiotics affects bacterial flora and induces selectivity of specific clones, thereby causing diseases in the local community. Continuous surveillance is warranted in local areas for appropriate antibiotics treatment and prevent increasing antibiotic-resistant isolates. Disclosures All authors: No reported disclosures.

158. Invasive Group B Streptococcal Diseases in Adults: A Retrospective Study in Thailand (2013–2017)

BackgroundGroup B Streptococcus (GBS) has been increasingly associated with invasive diseases in nonpregnant adults. This study aims to describe the epidemiology of invasive GBS (iGBS) diseases in adult patients.MethodsA retrospective cohort study was conducted at Siriraj Hospital between January 1, 2013 and December 31, 2017. We included adult patients with a positive culture of GBS isolated from sterile sites.ResultsAmong 224 patients recruited to the study, 170 patients (75.9%) had bacteremia. The median age of all patients was 63 years (IQR 53–73 years) and 52.7% were female. Approximately 80% of all patients had comorbid diseases. Diabetes mellitus (38.8%), cancer (18.8%) and heart disease (12.5%) were the three most common comorbidities. Skin and soft-tissue infection (30.8%), septic arthritis (21.4%), primary bacteremia (21%), and meningitis (7.1%) were the four most common presenting syndrome of iGBS diseases. Overall mortality within 30 days of infection was 12%. Non-survived patients were older, had chronic kidney disease, bacteremia, pneumonia and had at least one comorbidity than survived patients. However, only pneumonia was found independently associated with the 30-day overall mortality, with adjusted odd ratio (aOR) of 24.96 (95% confidence interval [CI]: 5.95–104.75). Antimicrobial susceptibility testing of 69 isolates demonstrated that 7 (10%) and 9 (13%) were resistant to erythromycin and clindamycin, respectively. All isolates remain susceptible to penicillin.ConclusionInvasive GBS is an emerging disease in non-pregnant adults particularly in elderly and diabetes mellitus patients. Two-thirds of iGBS patients have concomittant bacteremia. Even though the overall mortality was 12% but a significant morbidity was observed.Disclosures All authors: No reported disclosures.

MoS2-Modified Curcumin Nanostructures: The Novel Theranostic Hybrid Having Potent Antibacterial and Antibiofilm Activities against Multidrug-Resistant Hypervirulent Klebsiella pneumoniae.

The recent emergence of hypervirulent clinical variants of Klebsiella pneumoniae (hvKP) causing community-acquired, invasive, metastatic, life-threatening infections of lungs, pleura, prostate, bones, joints, kidneys, spleen, muscles, soft-tissues, skin, eyes, central nervous system (CNS) including extrahepatic abscesses, and primary bacteremia even in healthy individuals has posed stern challenges before the existing treatment modalities. There is therefore an urgent need to look for specific and effective therapeutic alternatives against the said bacterial infection or recurrence. A new type of MoS2-modified curcumin nanostructure has been developed and evaluated as a potential alternative for the treatment of multidrug-resistant isolates. The curcumin quantum particles have been fabricated with MoS2 via a seed-mediated hydrothermal method, and the resulting MoS2-modified curcumin nanostructures (MQCs) have been subsequently tested for their antibacterial and antibiofilm properties against hypervirulent multidrug-resistant Klebsiella pneumoniae isolates. In the present study, we found MQCs inhibiting the bacterial growth at a minimal concentration of 0.0156 μg/mL, while complete inhibition of bacterial growth was evinced at concentration 0.125 μg/mL. Besides, we also investigated their biocompatibility both in vitro and in vivo. MQCs were found to be nontoxic to the SiHa cells at a dose as high as 1024 μg/mL on the basis of the tested adhesion, spreading of the cells, and also on the various serological, biochemical, and histological investigations of the vital organs and blood of the Charles Foster Rat. These results suggest that MQCs have potent antimicrobial activities against hvKP and other drug resistant isolates and therefore may be used as broad spectrum antibacterial and antibiofilm agents.

Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone (The Metabolic Resuscitation Protocol) on Early Weaning from Vasopressors in Patients with Septic Shock. A Descriptive Case Series Study

Objectives: The aim of this study was to assess the efficacy of intravenous vitamin C, hydrocortisone, and thiamine in early weaning (within 48 hours) from vasopressor support in patients with septic shock. We also aimed to assess mortality and intensive care unit (ICU) stay.Study Design: We conducted a descriptive case series study of 50 patients with septic shock who were admitted in the ICU of the Combined Military Hospital Rawalpindi in Pakistan from August 2017 until April 2018.Materials and Methods: The study included men and women (16 to 80 years of age) who were admitted to the ICU with septic shock. Data were analysed using the IBM Statistical Package for Social Sciences (SPSS), version 18.0 (IBM Corp., Armonk, NY, USA). Inferential analysis was done with the help of simple and multivariate binary logistic regression that generated unadjusted and adjusted odds ratios (OR), respectively.Results: Of the 50 patients, 56% (N = 28) were male with a mean age of the respondents being 46.7 ± 18.4. Eighty-four percent were successfully weaned off vasopressors within 48 hours. Median days in the ICU were reported as 8.3 (interquartile range (IQR) = 5). Primary bacteremia (34%) was the most reported cause of ICU admission. The most common vasopressor was norepinephrine and its mean dose was 21.6 ± 10.7 microgram/min. The ICU mortality was observed at 52% (N = 26). Unadjusted OR showed a dose of norepinephrine, Sequential Organ Failure Assessment (SOFA) score, plasma procalcitonin, and plasma lactate to be significant predictors (p-value < 0.05), while the adjusted odds ratio (AOR) showed only a dose of norepinephrine to be a statistically significant predictor (AOR = 0.804, 95% CI = 0.674 - 0.960; p-value = 0.016).Conclusion: The administration of intravenous vitamin C, hydrocortisone, and thiamine to patients with septic shock was successful in early weaning from vasopressors. There was also a reduction in procalcitonin and lactate levels, as well as the SOFA score. Further trials are needed to determine whether the metabolic resuscitation protocol can become part of the treatment for septic shock.

Nutritionally Variant Streptococcal Bacteremia in the 21st Century

Abstract We report the results of a 12-year retrospective study of nutritionally variant streptococcal (NVS) bacteremia in a 510-bed, a large medical school-affiliated teaching hospital. Twenty-six episodes of NVS bacteremia were identified in this institutional review board—approved study of all positive blood cultures for NVS from January 1, 2006, to December 31, 2017. Most patients with NVS bacteremia were 50 years and older. Detection of bacteremia in the microbiology laboratory took from 2 to 11 days of incubation with an average of 4.65 days. Endocarditis was the most common source of bacteremia (7 patients), followed by primary bacteremia, skin and soft tissue infections, bone and joint infections, and device-associated infections. The mortality of patients in the study was 15% despite all but 1 patient who died receiving appropriate antimicrobial therapy immediately upon hospital admission. Nutritionally variant streptococcal bacteremia is uncommon, is frequently associated with infective endocarditis, is often detected late in the hospital course because of delayed growth of NVS organisms in blood culture media, and had a 15% mortality rate.

Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study

bloodstream infections (BSI) due to multidrug-resistant (MDR) Acinetobacter baumannii (AB) have been increasingly observed among hospitalized patients. prospective, observational study conducted among 12 large tertiary-care hospitals, across 7 Italian regions. From June 2017 to June 2018 all consecutive hospitalized patients with bacteremia due to MDR-AB were included and analyzed in the study. During the study period 281 episodes of BSI due to MDR-AB were observed: 98 (34.8%) episodes were classified as primary bacteremias, and 183 (65.2%) as secondary bacteremias; 177 (62.9%) of them were associated with septic shock. Overall, 14-day mortality was observed in 172 (61.2%) patients, while 30-day mortality in 207 (73.6%) patients. On multivariate analysis, previous surgery, continuous renal replacement therapy, inadequate source control of infection, and pneumonia were independently associated with higher risk of septic shock. Instead, septic shock and Charlson Comorbidity Index >3 were associated with 14-day mortality, while adequate source control of infection and combination therapy with survival. Finally, septic shock, previous surgery, and aminoglycoside-containing regimen were associated with 30-day mortality, while colistin-containing regimen with survival. BSI caused by MDR-AB represents a difficult challenge for physicians, considering the high rates of septic shock and mortality associated with this infection.

Epidemiological features and risk factors for mortality in Pseudomonas aeruginosa bacteremia in children.

The objective was to describe the epidemiological, clinical, microbiological, and evolutionary characteristics and the risk factors for mortality. Retrospective, cohort study. A total of 100 patients were included. Of these, 42 (42 %) had septic shock upon admission and 56 (56 %) were admitted to the intensive care unit. Bacteremia was primary in 17 patients (17 %); catheter-related, in 15 (15 %); and secondary, in 68 (68 %). The most common source of infection was the skin and mucous membrane. Resistance to one or more antibiotic groups was 38 %. Thirty-one patients died (31 %). Risk factors for mortality were septic shock (p < 0.0005), admission to the intensive care unit (p < 0.0001), primary bacteremia (p < 0.009) or secondary, non-catheter-related bacteremia (p < 0.003), presence of mucocutaneous or pulmonary source of infection (p < 0.004), and multidrug resistance (p < 0.01) or resistance to carbapenems (p < 0.01).

Epidemiological, clinical, and microbiological characteristics of carbapenemase-producing Enterobacteriaceae bloodstream infection in the Republic of Korea

BackgroundCarbapenemase-producing Enterobacteriaceae (CPE) is an important pathogen in nosocomial infections; nevertheless, only a few studies regarding CPE infection and its epidemiological factors have been conducted in the Republic of Korea (ROK). We aimed to analyze the clinical, microbiological, and epidemiological characteristics of CPE bloodstream infections (BSIs) in the ROK.MethodsThis retrospective cohort study included data collected from the National Surveillance System from January 2015 to December 2016 based on the epidemiologic survey performed by an epidemiologist from the Korea Centers for Disease Control and Prevention. We selected patients with CPE BSI from the Korea National Institute of Health based on carbapenemase genotyping.ResultsIn this study, 131 CPE BSIs were identified, and the proportion of CPE BSI among total CPE isolates was 7%. Klebsiella pneumoniae accounted for 69% of all CPE BSIs, and 66% of these produced K. pneumoniae carbapenemase. Among nine provinces in ROK, one province had NDM as the most common carbapenemase. CPE was susceptible to amikacin, tigecycline, and gentamicin (76, 41, and 39%, respectively). Of 29 patients tested for colistin sensitivity, one patient showed colistin resistance. The most common CPE BSI sources were pneumonia, primary bacteremia, and biliary tract infection. Multivariable analysis showed that adequate antibiotic use at CPE detection was significantly associated with decreased 30-day mortality.ConclusionsCPE BSIs are prevalent in the ROK. Moreover, most CPE BSIs originated from hospital-acquired infection, demonstrating the need to improve hospital infection control strategies.

A Case-Control Study of Real-Life Experience with Ceftolozane-Tazobactam in Patients with Hematologic Malignancy and Pseudomonas aeruginosa Infection.

We present our experience in patients with hematologic malignancy and Pseudomonas aeruginosa infection treated with ceftolozane-tazobactam. We performed a single-center case-control study comparing patients with hematologic malignancy and P. aeruginosa infection treated with ceftolozane-tazobactam (study group) with similar patients not treated with ceftolozane-tazobactam (control group) to assess safety and efficacy. Nineteen cases and 38 controls were analyzed. Cases were younger (45.6 years versus 57.6 years; P = 0.012) and less frequently had bacteremia (52.6% versus 86.8%; P = 0.008). They also had worse Multinational Association for Supportive Care in Cancer (MASCC) scores (10.2 versus 16.1; P = 0.0001), more hospital-acquired infections (78.9% versus 47.4%; P = 0.013), and more extremely drug-resistant (XDR) P. aeruginosa infections (47.4% versus 21.1%; P = 0.015). Cases received a median of 14 days (7 to 18 days) of ceftolozane-tazobactam (monotherapy in 11 cases [57.9.6%]). Ceftolozane-tazobactam was mostly used as targeted therapy (16 cases; 84.2%) because of resistance (9 cases; 47.4%), failure (4 cases; 21.1%), and toxicity (3 cases; 15.8%). Ten cases had bacteremia (52.6%). The sources were pneumonia (26.3%), catheter-related bacteremia (21.1%), primary bacteremia (21.1%), and perianal/genital (15.7%), urinary (10.5%), and skin/soft tissue (5.3%) infection. No toxicity was attributed to ceftolozane-tazobactam. More than 60% had neutropenia, and 15.8% fulfilled the criteria for sepsis. There were no significant differences in clinical cure at day 14 (89.5% versus 71.1%; P = 0.183) or recurrence (15.8% versus 10.5%; P = 0.675). Thirty-day mortality was lower among cases (5.3% versus 28.9%; P = 0.045). Ceftolozane-tazobactam was well tolerated and at least as effective as other alternatives for P. aeruginosa infection in patients with hematologic malignancy, including neutropenic patients with sepsis caused by XDR strains.