Risk Factors For Bacteremia Research Articles

Clinical and laboratory predictors for bacteremia in critically ill calves.

Sepsis is a main contributor to calf mortality, but diagnosis is difficult. Develop and validate a predictive model for bacteremia in critically ill calves (CIC). A total of 334 CIC, sampled for blood culture. Cross-sectional study. Multivariable logistic regression and classification tree analysis on clinical, ultrasonographic, and laboratory variables were performed on a dataset including all animals. Model validation was done on 30% of the dataset. Similar statistics (except validation) were performed on a subset of the database (n = 143), in which presumed contaminants were excluded. The best performing model to predict bacteremia, taking all detected bacteria into account, included tachypnea, tachycardia, acidemia, hypoglycemia, venous hypoxemia, and hypoproteinemia. Sensitivity and specificity of this model were 70.6% and 98.0%, respectively, but decreased to 61.5% and 91.7% during model validation. The best-performing model, excluding presumed contaminants, included abnormal temperature, heart rate, absence of enteritis, hypocalcemia, and hyperlactatemia as risk factors for bacteremia. Sensitivity and specificity of this model were 71.4% and 93.9%, respectively. Both classification trees performed less well in comparison to logistic regression. The classification tree excluding presumed contaminants, featured hypoglycemia, absence of diarrhea, and hyperlactatemia as risk factors for bacteremia. Sensitivity and specificity were 39.4% and 92.7%, respectively. Hypoglycemia, hyperlactatemia, and hypoproteinemia seem relevant in assessing bacteremia in CIC. The performance of these models based on basic clinical and blood variables remains insufficient to predict bacteremia.

Risk factors for bacteremia in infants with urinary tract infection

BackgroundSome infants with urinary tract infection (UTI) may exhibit concurrent bacteremia, potentially leading to septic shock or bacterial meningitis. Identifying risk factors for bacteremia in infants with UTI is crucial for prompt intervention to prevent subsequent adverse outcomes. MethodsBetween 2015 and 2021, a total of 632 infants with UTI aged ≤12 months were enrolled at Kaohsiung Veterans General Hospital (KSVGH), among whom 20 had concurrent bacteremia. We analyzed their differences in outcomes and demographic, clinical, and laboratory characteristics. Independent risk factors for bacteremic UTI were identified using binary logistic regression analysis. ResultsA positive underlying disease (including congenital anomalies of kidney and urinary tract [CAKUT] and prematurity), C-reactive protein (CRP) > 8mg/dL, lower body weight, and positive urinary nitrite were independent risk factors for infants with UTI and bacteremia. ConclusionsPhysicians should be mindful of the potential for bacteremia to develop in infants with UTI, particularly those with concurrent positive underlying diseases or CRP > 8 mg/dL.

Pre‐engraftment bacteremia after allogeneic hematopoietic cell transplantation without primary fluoroquinolone antibacterial prophylaxis

AbstractBackgroundBacteremia is a common complication in allogeneic hematopoietic cell transplant recipients (alloHCTr), especially during the pre‐engraftment period. International guidelines recommend antibacterial prophylaxis (ABP), despite potential selection for multidrug‐resistant organisms (MDRO). Limited contemporary data exist on the epidemiology of pre‐engraftment bacteremia in alloHCTr, who do not receive ABP.MethodsWe performed a retrospective observational single‐center cohort study including all consecutive adult alloHCTr (2015–2021), investigating the incidence, risk factors, and outcomes of bacteremia during the engraftment period. Primary fluoroquinolone (FQ) ABP is not routinely administered in our center.ResultsAmong 421 patients identified, 124 bacteremia episodes were observed in 121/421 (29%) alloHCTr. The median time to the 1st bacteremia episode was 9 days (IQR 6–11). Most (105/124, 85%) episodes were monomicrobial, while >1 pathogens were identified in 19/124 (15%) episodes. Overall, 152 pathogens were isolated, with a predominance of Gram‐positive (118/152, 78%), including coagulase‐negative staphylococci (n:47), streptococci (n:46), and enterococci (n:15), followed by Gram‐negative bacteria (GNB, 30/152, 20%), and anaerobes (4/152, 3%). There were 2/152 (1%) MDRO (extended‐spectrum beta‐lactamase producing) GNB. Multivariable analyses identified age >40‐year‐old (OR 2.4, P = 0.02), male gender (OR 1.8, P = 0.02), and a haploidentical/mismatched unrelated donor (OR 2.5, P < 0.001) as independent risk factors for bacteremia. All cause 30‐day mortality among alloHCTr with bacteremia was 0.8% (1/121): one patient died due to an HCT‐related complication.ConclusionDespite lack of primary FQ ABP, low rates of bacteremia were observed during the pre‐engraftment period, with low MDRO prevalence and mortality. Our findings may allow to revisit the need for primary universal FQ ABP in high‐risk neutropenic hematology patients. image

Interpretable Machine Learning Models for Predicting Critical Outcomes in Patients with Suspected Urinary Tract Infection with Positive Urine Culture.

(1) Background: Urinary tract infection (UTI) is a leading cause of emergency department visits and hospital admissions. Despite many studies identifying UTI-related risk factors for bacteremia or sepsis, a significant gap remains in developing predictive models for in-hospital mortality or the necessity for emergent intensive care unit admission in the emergency department. This study aimed to construct interpretable machine learning models capable of identifying patients at high risk for critical outcomes. (2) Methods: This was a retrospective study of adult patients with urinary tract infection (UTI), extracted from the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database. The critical outcome is defined as either in-hospital mortality or transfer to an intensive care unit within 12 h. ED visits were randomly partitioned into a 70%/30% split for training and validation. The extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM) algorithms were constructed using variables selected from the stepwise logistic regression model. The XGBoost model was then compared to the traditional model and clinical decision rules (CDRs) on the validation data using the area under the curve (AUC). (3) Results: There were 3622 visits among 3235 unique patients diagnosed with UTI. Of the 2535 patients in the training group, 836 (33%) experienced critical outcomes, and of the 1087 patients in the validation group, 358 (32.9%) did. The AUCs for different machine learning models were as follows: XGBoost, 0.833; RF, 0.814; and SVM, 0.799. The XGBoost model performed better than others. (4) Conclusions: Machine learning models outperformed existing traditional CDRs for predicting critical outcomes of ED patients with UTI. Future research should prospectively evaluate the effectiveness of this approach and integrate it into clinical practice.

Early bacteremia following allogeneic hematopoietic stem cell transplantation without antibiotic prophylaxis: epidemiology and antimicrobial resistance

ObjectiveBacteremia is a serious complication in patients undergoing allogeneic hematopoietic stem cell transplantation. The aim of this study was to determine the frequency, epidemiological profile, and risk factors of bacteremia early after allogeneic hematopoietic stem cell transplantation. MethodsAn observational descriptive retrospective study was conducted in patients who received transplants between January 2016 and December 2021. Early bacteremia was defined as blood stream infection occurring between Day 0 and Day 100 after transplantation. ResultsForty episodes of early bacteremia occurred in 36/245 transplanted patients. Fifteen episodes (37.5%) were due to gram-positive bacteria and 25 (62.5%) to gram-negative bacteria. The most frequent species isolated were coagulase negative staphylococci (CoNS) in gram-positive bacteremia (n = 8/15), and Klebsiella species (8/25) and Pseudomonas species (8/25) in gram-negative bacteremia. Twenty-nine episodes of bacteremia (72.5%) occurred during the first 30 days after transplantation with a median time of nine days (range: 0-90 days). Coagulase negative staphylococci were methicillin-resistant in 75% of cases, the only Staphylococcus aureus isolated was methicillin-resistant. All gram-positive bacilli were penicillin-resistant. Gram-negative bacilli were multidrug resistant in 61.5% of cases. In multivariate analysis, bone marrow as source of graft (p-value = 0.02) and cytomegalovirus reactivation (p-value = 0.02) were significantly associated with an increased risk of bacteremia. Mortality attributable to bacteremia was 2.8%. The one-year overall survival was not significantly different between those with and without bacteremia. ConclusionsBacteremia was more frequent within the first 30 days after transplantation indicating the crucial role of neutropenia. An increase in multidrug resistant gram-negative bacteremia was noted.

Prudent Use of Blood Cultures for Hospitalized Patients With Cirrhosis.

Background No reliable risk stratification method is available to guide the extent of infectious work-up among hospitalized patients with cirrhosis. Therefore, we aimed to create a risk stratification method for obtaining blood cultures from hospitalized patients with cirrhosis. Methods This was a retrospective cohort study using the Healthcare Cost and Utilization Project - National Readmission Database 2019. Adult patients who were not immunocompromised comprised the final cohort. The primary outcome was the incidence of bacteremia among hospitalized patients with cirrhosis. Secondary outcomes included length of hospital stay, inpatient mortality, and 30-day readmission rate among cirrhosis patients with and without bacteremia. After propensity score matching, the χ2 test was used to assess the primary outcome and inpatient mortality. The Wilcoxon signed-rank test was used to compare the length of hospital stay. Readmission rates were compared via survival analysis. Concomitant bacterial infection, cirrhosis causes, and complications were assessed as potential risk factors for bacteremia using binomial regression. Results The risk ratio (RR) of bacteremia was 1.66 (95% confidence interval (CI): 1.55-1.78) among patients with cirrhosis compared to those without cirrhosis. A concomitant bacterial infection was found to have a strong association with bacteremia in patients with cirrhosis (RR: 3.3, 95% CI: 3.03-3.59). Among cirrhosis patients without concomitant bacterial infection, the incidence of bacteremia was 0.76% (<1%). Among the causes of cirrhosis, primary sclerosing cholangitis was found to have a strong association with bacteremia (RR: 3.88, 95% CI: 2.3-6.04, P < 0.001). Patients with cirrhosis who had bacteremia were hospitalized three days longer than those without bacteremia. There was no difference in inpatient mortality or 30-day readmission rates between cirrhotic patients with and without bacteremia. Conclusion This study suggests that, in the absence of another concomitant bacterial infection and primary sclerosing cholangitis, we can avoid unnecessary blood cultures among immunocompetent patients with cirrhosis. However, given some inherent limitations associated with the database (such as the unavailability of vitals or laboratory values), additional studies are needed to validate its findings.

An evaluation of a Stenotrophomonas maltophilia outbreak due to commercial arterial blood gas collection kit

BackgroundStenotrophomonas maltophilia is a gram-negative bacterium that can cause hospital infections and outbreaks within hospitals. This study aimed to evaluate an outbreak of Stenotrophomonas maltophilia, caused by ready-to-use commercial syringes containing liquid lithium and heparin for arterial blood gas collection in a university hospital.MethodsUpon detecting an increase in Stenotrophomonas maltophilia growth in blood cultures between 15.09.2021 and 19.11.2021, an outbreak analysis and a case-control study (52 patients for the case group, 56 patients for the control group) were performed considering risk factors for bacteremia. Samples from possible foci for bacteremia were also cultured. Growing bacteria were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The genetic linkage and clonal relationship isolates were investigated with pulsed-field gel electrophoresis (PFGE) in the reference laboratory.ResultsIn the case-control study, the odds ratio for the central venous catheter [3.38 (95% confidence interval [CI]: 1.444, 8.705 ; p = 0.006)], for surgery [3.387 (95% confidence interval [CI]: 1.370, 8.373 ; p = 0.008)] and for arterial blood gas collection history [18.584 (95% confidence interval [CI]:4.086, 84.197; p < 0.001)] were identified as significant risk factors. Stenotrophomonas maltophilia growth was found in ready-to-use commercial syringes used for arterial blood gas collection. Molecular analysis showed that the growths in the samples taken from commercial syringes and the growths from blood cultures were the same. It was decided that the epidemic occurred because the method for sterilization of heparinized liquid preparations were not suitable. After discontinuing the use of the kits with this lot number, the outbreak was brought under control.ConclusionsAccording to our results, disposable or sterile medical equipment should be included as a risk factor in outbreak analyses. The method by which injectors containing liquids, such as heparin, are sterilized should be reviewed. Our study also revealed the importance of the cooperation of the infection control team with the microbiology laboratory.

Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study

AimsWe investigated the characteristics of infection and the utility of inflammatory markers in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS). MethodsA multicenter, retrospective observational study in 21 acute-care hospitals was conducted in Japan. This study included adult hospitalized patients with DKA and HHS. We analyzed the diagnostic accuracy of markers including C-reactive protein (CRP) and procalcitonin (PCT) for bacteremia. Multiple regression models were created for estimating bacteremia risk factors. ResultsA total of 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 (SD, 19.3) years. Of these, 70 tested positive for blood culture. The mortality rates of those with and without bacteremia were 14 % and 3.3 % (P-value < 0.001). The area under the curve (AUC) of CRP and PCT for diagnosis of bacteremia was 0.85 (95 %CI, 0.81–0.89) and 0.76 (95 %CI, 0.60–0.92), respectively. Logistic regression models identified older age, altered level of consciousness, hypotension, and higher CRP as risk factors for bacteremia. ConclusionsThe mortality rate was higher in patients with bacteremia than patients without it. CRP, rather than PCT, may be valid for diagnosing bacteremia in hyperglycemic emergencies.Trial Registration: This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered December 23, 2016)

Do all Emergency Room Patients With Influenza-like Symptoms Need Blood Cultures? A Retrospective Cohort Study of 2 Annual Influenza Seasons.

In this retrospective cohort study, we evaluated risk factors for bacteremia in emergency department patients presenting with influenza-like symptoms during influenza epidemic seasons. In patients without fever, chronic heart or chronic liver disease, blood culture collection might be omitted.

Effects of Vancomycin Subtherapeutic Concentration on Staphylococcus aureus Isolated from Hemodialysis Patients with Low Serum Trough Concentrations.

Blood bactericidal activity and antimicrobial therapy are crucial against catheter-related infection in patients undergoing hemodialysis (HD). It is well-known that catheters colonized by biofilm-producing bacteria are a risk factor for bacteremia in HD-patients. Methicillin-resistant S. aureus bacteremia in HD-patients justify the use of vancomycin as empiric therapy. The recommended vancomycin target for therapeutic efficacy is a minimum serum concentration of 10µgmL-1 to avoid resistance. However, subtherapeutic concentrations of vancomycin have frequently occurred in HD-patients. Thus, we aim to investigate the effect of subtherapeutic vancomycin concentration on S. aureus growth, susceptibility to antimicrobials, resistance to whole blood activity, and biofilm formation. Seventeen S. aureus strains isolated from bacteremia in HD-patients and two reference strains were exposed to a vancomycin-gradient (0-10µgmL-1) for five consecutive days to mimic the dosing interval of vancomycin in HD-patients. After that, we observed the following: no effect on growth curve; decreased susceptibility to vancomycin and daptomycin; increased S. aureus survival to whole blood bactericidal action; and a strain-dependent biofilm production after drug exposure. In conclusion, our findings suggest that the subtherapeutic concentration of vancomycin decrease S. aureus susceptibility to vancomycin and daptomycin and increases its survival to whole blood bactericidal action.

230. Risk factors for bacteremia in patients receiving extracorporeal membrane oxygenation (ECMO) during the COVID-19 pandemic

Abstract Background Patients receiving extracorporeal membrane oxygenation (ECMO) are at high risk for bacteremia which can cause substantial morbidity and mortality. We sought to evaluate risk factors for bacteremia in patients receiving ECMO during the COVID-19 pandemic to better characterize those most at risk and areas for prevention. Methods A retrospective case control study evaluating patients receiving ECMO support at Yale New Haven Hospital from April 2020 – September 2021 was performed. Cases of patients who developed bacteremia were matched 1:2 to control patients on ECMO who had blood cultures drawn but who did not develop bacteremia. There were no set criteria for drawing the blood cultures; when to draw blood cultures were per provider’s discretion. Only the first set of blood cultures drawn were analyzed. Results 60 patients received ECMO support and had blood cultures drawn, 20 (33.3%) with bacteremia matched to 40 (66.7%) without bacteremia. Independent risk factors for bacteremia included being diagnosed with COVID-19 (70.0% vs 40.0%, p = 0.028), days on ECMO until culture (13.4 vs 6.2 days, p = 0.005), days on mechanical ventilation until culture (17.5 vs 7.7 days, p = 0.002), corticosteroid use (75.0% vs 40.0%, p = 0.011), ECMO type (80.0% veno-venous [VV] and 20.0% veno-arterial vs 37.5% veno-venous and 62.5% veno-arterial, p = 0.002), proning (60.0% vs 22.5%, p = 0.004), and preceding antibiotic days during the admission (16.1 days vs 9.3 days, p = 0.025). There was no difference in any evaluated infectious metric (white blood cell count, daily maximum temperature, procalcitonin, CRP, d-dimer, ferritin, fibrinogen, LDH) on the day of blood culture in those with compared to those without bacteremia. Conclusion Patients receiving ECMO support who developed bacteremia were more likely to be on VV-ECMO, proned, receive corticosteroids, and be on mechanical ventilation for longer periods of time, all factors associated with severe COVID-19. Additional risk factors included more days on ECMO and prior antibiotic use. No laboratory metric was predictive of bacteremia, highlighting the challenges in accurately predicting bacteremia in the ECMO patient population. Disclosures All Authors: No reported disclosures

Evaluation of Risk Factors Causing Nosocomial Acinetobacter Bacteremia and Mortality in the Intensive Care Unit

Objective: We aimed to evaluate risk factors for bacteremia and mortality in patients with nosocomial Acinetobacter bacteremia in a university hospital’s Anesthesia and Reanimation Intensive Care Unit (ICU) between 2013-2016. Methods: This study was designed as a retrospective case-control study; the case group consisted of patients older than 18 years, with Acinetobacter species growth in blood cultures taken 48 hours after hospitalization, with clinical bacteremia findings, followed until death or at least 30 days after culture. Patients in the control group consisted of cases without Acinetobacter bacteremia and showed similar characteristics to the case group. Patients were evaluated regarding demographic characteristics, underlying diseases, carbapenem use before blood culture was taken, appropriate empirical treatment, 30-day mortality, nutritional status, Pittsburgh Bacteremia Score (PBS), and interventional procedures. Results: Among case and control groups each consisting of 51 patients, carbapenem use (63.2% and 34.8%, respectively, odds ratio (OR)=3.67; 95% confidence interval (CI)=1.49-9.04, p=0.005) and chest tube placement (23.5% and 7.8%, respectively, OR=7.31; 95% CI=1.43-37.22, p=0.005) were independent risk factors for Acinetobacter bacteremia. Among cases with or without mortality in the case group, there was a significant difference in terms of endotracheal intubation (100%, 76.9%, respectively, p=0.023), PBS (6.6±1.08, 5.0±2.29, respectively, p=0.003), nutritional status (total parenteral nutrition [TPN] or enteral nutrition +TPN) (%28, %0 and %72, %100, respectively, p=0.004) and hypertension (HT) (%52, %19.2, respectively, p=0.03) and also HT [52% and 19.2%, respectively, OR=4.61; 95% CI=1.08-19.57, p=0.038], inappropriate empirical therapy [69.6% and 30.8%, respectively, OR=6.46; 95% CI=1.55-26.94, p=0.01] and albumin level [2.32±0.50 and 2.57±0.44 g/dL, respectively, OR=0.196; 95% CI=0.045-0.847, p=0.029] were independent mortality risk factors. Conclusion: Previous carbapenem use and chest tube insertion are important risk factors for Acinetobacter bacteremia in ICU. Inappropriate empirical treatment, HT, and low albumin levels are important mortality risk factors in Acinetobacter bacteremia in ICU. High PBS scores should be carefully evaluated for mortal Acinetobacter bacteremia.

Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection.

Bacteremia has been associated with severity in some infections; however, its impact on the prognosis of urinary tract infections (UTIs) is still disputed. Our goal is to determine the risk factors for bacteremia and its clinical impact on hospitalized patients with complicated community-acquired urinary tract infections. We conducted a prospective observational study of patients admitted to the hospital with complicated community-acquired UTIs. Clinical variables and outcomes of patients with and without bacteremia were compared, and multivariate analysis was performed to identify risk factors for bacteremia and mortality. Of 279 patients with complicated community-acquired UTIs, 37.6% had positive blood cultures. Risk factors for bacteremia by multivariate analysis were temperature ≥ 38 °C (p = 0.006, OR 1.3 (95% CI 1.1-1.7)) and procalcitonin ≥ 0.5 ng/mL (p = 0.005, OR 8.5 (95% CI 2.2-39.4)). In-hospital and 30-day mortality were 9% and 13.6%, respectively. Quick SOFA (p = 0.030, OR 5.4 (95% CI 1.2-24.9)) and Barthel Index <40% (p = 0.020, OR 4.8 (95% CI 1.3-18.2)) were associated with 30-day mortality by multivariate analysis. However, bacteremia was not associated with 30-day mortality (p = 0.154, OR 2.7 (95% CI 0.7-10.3)). Our study found that febrile community-acquired UTIs and elevated procalcitonin were risk factors for bacteremia. The outcomes in patients with bacteremia were slightly worse, but without significant differences in mortality.

COVID-19-associated MRSA infective endocarditis and mitral valve perforation: a case report

BackgroundCoronavirus disease 2019 (COVID-19) has emerged as a global pandemic, leading to significant morbidity and mortality. The interplay between COVID-19 and other medical conditions can complicate diagnosis and management, necessitating further exploration.Case presentationThis case report presents a patient with COVID-19 who developed infective endocarditis (IE) and mitral valve perforation caused by methicillin-resistant Staphylococcus aureus on a native mitral valve. Notably, the patient did not exhibit typical IE risk factors, such as intravenous drug use. However, he did possess risk factors for bacteremia, including a history of diabetes mellitus and recent steroid use due to the COVID-19 infection. The diagnosis of IE was crucially facilitated by transesophageal echocardiography.ConclusionsThis case highlights the potential association between COVID-19 and the development of infective endocarditis. Prompt evaluation using transesophageal echocardiography is vital when there is a high suspicion of IE in COVID-19 patients. Further research is required to elucidate the precise relationship between COVID-19 and IE.

Pharmacist involvement in blood culture follow up for patients discharged from the emergency department

Study objectiveThis study evaluates the time to attempted patient contact for positive blood cultures in patients discharged from the Emergency Department (ED) resulting when an Emergency Medicine (EM) pharmacist is on-duty compared to off-duty. MethodsThis single center, retrospective study included patients who were discharged from the ED and had subsequent positive blood cultures. Blood cultures were reviewed utilizing an algorithm previously approved and implemented by an interdisciplinary team in 2016. Standard practice was for the microbiology lab to notify the ED charge nurse of the positive blood culture, however, the algorithm placed the pharmacist as the responsible reviewer when on duty, leaving charge nurses and physicians as the responsible reviewers when a pharmacist was off duty and not on site. The primary outcome was time from ED notification of the positive gram stain of the blood culture to first attempted patient contact; we compared this outcome for cultures resulting when an EM pharmacist was on duty to those resulting when an EM pharmacist was off duty. Despite being off duty, a pharmacist may have reviewed these cultures if they remained unaddressed when the pharmacist returned on-site. In this case, the blood culture review was included in the off-duty cohort. Secondary outcomes included evaluation for appropriateness of the recommendation made to the patient during contact, 30-day infection-related readmission rates, patient's adherence to the recommendations, and barriers to patient contact. An infectious disease attending physician independently reviewed cases where the algorithm was not followed. ResultsA total of 127 patients identified by a query of our institution's database were screened against inclusion/exclusion criteria and 56 were excluded, leaving 71 patients for final analysis (54 and 17 in the on- and off-duty cohorts, respectively). Baseline demographics with respect to sex, age and risk factors for bacteremia were not different between groups, except there were more immunocompromised patients in the on-duty cohort (35.2%) compared to off-duty cohort (5.9%) [p = 0.01]. Median [IQR] time to first attempted patient contact was significantly shorter in the on-duty cohort at 0.8 h [0.4–2.8] vs 5.6 h [1.4–11.7] (p = 0.025). A pharmacist acted upon 93% of all cultures, including several resulting during off-duty hours. Secondary outcomes did not differ. Fourteen (25.9%) of on-duty cultures and six (35.3%) of off-duty cultures were deemed contaminants. Two recommendations in the off-duty group were inappropriate based on the infectious disease attending physician review. The lack of active voicemail was the main barrier to contacting a patient. ConclusionsIn patients discharged from the ED with subsequent positive blood cultures, time to attempted patient contact was significantly shorter when a pharmacist was on-duty. Our data emphasizes the importance of having a standardized practice in place to optimize ED patient care and outcomes and the benefit of a pharmacist's involvement in the process.

Bacteremia During the First Year After Solid Organ Transplantation: An Epidemiological Update.

There are limited contemporary data on the epidemiology and outcomes of bacteremia in solid organ transplant recipients (SOTr). Using the Swiss Transplant Cohort Study registry from 2008 to 2019, we performed a retrospective nested multicenter cohort study to describe the epidemiology of bacteremia in SOTr during the first year post-transplant. Of 4383 patients, 415 (9.5%) with 557 cases of bacteremia due to 627 pathogens were identified. One-year incidence was 9.5%, 12.8%, 11.4%, 9.8%, 8.3%, and 5.9% for all, heart, liver, lung, kidney, and kidney-pancreas SOTr, respectively (P = .003). Incidence decreased during the study period (hazard ratio, 0.66; P < .001). One-year incidence due to gram-negative bacilli (GNB), gram-positive cocci (GPC), and gram-positive bacilli (GPB) was 5.62%, 2.81%, and 0.23%, respectively. Seven (of 28, 25%) Staphylococcus aureus isolates were methicillin-resistant, 2/67 (3%) enterococci were vancomycin-resistant, and 32/250 (12.8%) GNB produced extended-spectrum beta-lactamases. Risk factors for bacteremia within 1 year post-transplant included age, diabetes, cardiopulmonary diseases, surgical/medical post-transplant complications, rejection, and fungal infections. Predictors for bacteremia during the first 30 days post-transplant included surgical post-transplant complications, rejection, deceased donor, and liver and lung transplantation. Transplantation in 2014-2019, CMV donor-negative/recipient-negative serology, and cotrimoxazole Pneumocystis prophylaxis were protective against bacteremia. Thirty-day mortality in SOTr with bacteremia was 3% and did not differ by SOT type. Almost 1/10 SOTr may develop bacteremia during the first year post-transplant associated with low mortality. Lower bacteremia rates have been observed since 2014 and in patients receiving cotrimoxazole prophylaxis. Variabilities in incidence, timing, and pathogen of bacteremia across different SOT types may be used to tailor prophylactic and clinical approaches.

Predictive value of perioperative peripheral blood cells counts for bacteremia and 90-day mortality in severe burn patients

ObjectiveBurn bacteremia is related to immune barrier damage, but whether the level of circulating immune cells predicts outcomes in severe burns is still not clear. This study aimed to explore the predictive value of perioperative blood cells of the first surgery after burn for bacteremia and 90-day death. MethodsData from severe burn patients treated at the First Affiliated Hospital of Sun Yat-sen University from 2011 to 2020 were retrospectively analyzed. Data on monocytes (M), lymphocytes (L), white blood cell-to-platelet ratio (WPR), neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and changes in temperature (T-37) were collected at one day before(X0), the first day after (X1) and the third day after (X3) the primary surgery.Univariate and multivariate logistic regression were used to identify the independent risk factors of bacteremia and death within 90 days, which were used to establish the risk prediction models (xbac and x90d-m) in severely burned patients. Severe burn cases from two other burn centers were selected to verify the prediction models. ResultsWe analyzed 169 severe burn cases in the training dataset, with a 90-day mortality of 21.3% (36/169); 56 (33.1%) patients experienced burn bacteremia. Higher M0, WPR0, NLR0, NLR3, T3–37, ∆M (M0-M3) and lower M3, L3 were associated with higher risk of bacteremia (P < 0.05). Multivariate regression analysis showed that SOFA0, WPR0, M3, and T3–37 were independently associated with bacteremia. The prediction model for bacteremia Xbac = 0.1809 × SOFA0 + 6.532 × WPR0–1.171 × M3 + 0.6987 × T3–37- 2.297. TBSAB, SOFA0, and ∆M (M0-M3) were independently correlated with 90-day mortality. The risk prediction model X90d-m= 0.055 × TBSAB + 0.301 ×SOFA0 + 1.508 × ∆M - 7.196. External validation suggested that the specificity, sensitivity and AUC of the prediction model Xbac was 90.7%, 62.5% and 0.797, respectively; of the prediction model X90d-m was 69.2%, 90.0% and 0.873, respectively. ConclusionPeripheral M3, WPR0 and ∆M (M0-M3) during the primary surgery has reasonable predictive ability for bacteremia and 90-day mortality in severe burn patients, which could inform clinical antimicrobial judgment and prognostication.

Bacteraemia Is Associated with Increased ICU Mortality in the Postoperative Course of Lung Transplantation.

We aimed to describe the prevalence, risk factors, morbidity and mortality associated with the occurrence of bacteraemia during the postoperative ICU stay after lung transplantation (LT). We conducted a retrospective single-centre study that included all consecutive patients who underwent LT between January 2015 and October 2021. We analysed all the blood cultures drawn during the postoperative ICU stay, as well as samples from suspected infectious sources in case of bacteraemia. Forty-six bacteria were isolated from 45 bacteraemic patients in 33/303 (10.9%) patients during the postoperative ICU stay. Staphylococcus aureus (17.8%) was the most frequent bacteria, followed by Pseudomonas aeruginosa (15.6%) and Enterococcus faecium (15.6%). Multidrug-resistant bacteria accounted for 8/46 (17.8%) of the isolates. The most common source of bacteraemia was pneumonia (38.3%). No pre- or intraoperative risk factor for bacteraemia was identified. Recipients who experienced bacteraemia required more renal replacement therapy, invasive mechanical ventilation, norepinephrine support, tracheotomy and more days of hospitalization during the ICU stay. After adjustment for age, sex, type of LT procedure and the need for intraoperative ECMO, the occurrence of bacteraemia was associated with a higher mortality rate in the ICU (aOR = 3.55, 95% CI [1.56–8.08], p = 0.003). Bacteraemia is a major source of concern for lung transplant recipients.

Clinical and microbiological characteristics of and risk factors for bloodstream infections among patients with extracorporeal membrane oxygenation: a single-center retrospective cohort study

Extracorporeal membrane oxygenation (ECMO) provides hemodynamic and oxygenation support to critically ill patients. Due to multiple catheter cannulations, patients on ECMO are vulnerable to bloodstream infections (BSIs). We aimed to investigate the incidence, clinical characteristics, risk factors, and microorganisms associated with BSIs during ECMO. This single-center retrospective cohort study was conducted between January 2015 and May 2021. Patients aged 18 years or older with an ECMO duration of > 48 h for cardiogenic or respiratory support were included in the study. Patients who developed bacteremia or candidemia from 12 h after ECMO cannulation to 7 days after de-cannulation were included. The clinical factors between non-BSI and BSI were compared, along with an analysis of the risk factors associated with BSI during ECMO. A total of 480 patients underwent ECMO for cardiogenic shock (n = 267, 55.6%) or respiratory failure (n = 213, 44.4%) during the study period. The incidence was 20.0 episodes per 1000 ECMO-days. Approximately 20.2% (97/480) and 5.4% (26/480) of the patients developed bacteremia and candidemia, respectively. The median numbers of days of BSI development were 8.00 days for bacteremia and 11.0 days for candidemia. The most common pathogens were methicillin-resistant coagulase-negative staphylococci (n = 24), followed by vancomycin-resistant Enterococcus (n = 21). Multivariable logistic analysis demonstrated that hemodialysis (odds ratio [OR] 2.647, p < 0.001), veno-arterial-venous mode (OR 1.911, p = 0.030), and total ECMO duration (OR 1.030, p = 0.007) were significant risk factors for bacteremia. The total ECMO duration was the only risk factor associated with candidemia (OR 1.035, p = 0.010). The mortality rate was significantly higher in the bacteremia (57.7%) and candidemia (69.2%) groups than that in the non-BSI group (43.6%). BSI is a common complication of patients receiving ECMO support and is associated with poor clinical outcomes. Determining the type of frequently isolated organisms and the median onset time of BSI would help in the selection of appropriate prophylactic antibiotics or antifungal agents.

Multicenter Study of the Risk Factors and Outcomes of Bloodstream Infections Caused by Carbapenem-Non-Susceptible Acinetobacter baumannii in Indonesia.

The prevalence of bacteremia caused by carbapenem-non-susceptible Acinetobacter baumannii (CNSAB) continues to increase, and it is associated with a high mortality rate. Early recognition of infection and mortality determinants risk factors is necessary for adequate antibiotic administration. We aimed to determine the risk factors and outcomes of CNSAB bacteremia in Indonesia. A multicenter case-control study was conducted in three referral hospitals in Indonesia. Data were collected retrospectively from January 2019 to December 2021. Cases were defined as patients with bacteremia where CNSAB was isolated from the blood, while the controls were patients with bacteremia caused by carbapenem-susceptible A. baumannii (CSAB). Risk factors for bacteremia and mortality associated with CNSAB bacteremia were determined using univariates analysis (chi-squared and Student’s t-test or Mann–Whitney test) and multivariate logistic regression analysis. A total of 144 bacteremia patients were included, of whom 72 patients were for each case and control group. The final model of multivariate regression analysis revealed that bacteremia source from the lower respiratory tract (adjusted odds ratio (aOR): 3.24; 95% CI: 1.58–6.63, p = 0.001) and the use of central venous catheter (aOR: 2.56; 95% CI: 1.27–5.18; p = 0.009) were independent risk factors for CNSAB bacteremia. Charlson Comorbidity Index ≥ 4 (aOR: 28.56; 95% CI: 3.06–265.90, p = 0.003) and Pitt Bacteremia Score ≥ 4 (aOR: 6.44; 95% CI: 1.17–35.38; p = 0.032) were independent risk factors for mortality due to CNSAB bacteremia. Only high Pitt Bacteremia Score was an independent risk factor for mortality of CSAB bacteremia. In conclusion, we identified the risk factors for CNSAB-associated bacteremia and the risk factors for death, which are relevant for empiric therapy and infection control prevention, as well as prognosis evaluation of patients with bloodstream infections.