Clinical characteristics associated with mortality of patients with anaerobic bacteremia

Umemura, Takumi; Hamada, Yukihiro; Yamagishi, Yuka; Suematsu, Hiroyuki; Mikamo, Hiroshige

doi:10.1016/j.anaerobe.2016.02.007

Cited by 28 publications

(18 citation statements)

References 31 publications

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“…In our study, only 6% of organisms could not be identified by BioFire BCID since they were not found on the panel. The spectrum of causative pathogens and the sources of infection for the NB-PC group in our study corresponded to that reported in the literature (18)(19)(20). In our study, the organisms from the NB-PC cohort that were determined to be true pathogens were mostly Bacteroides spp., followed by Clostridium and Fusobacterium spp.…”

Section: Discussionsupporting

confidence: 86%

Antimicrobial Stewardship Opportunities in Patients with Bacteremia Not Identified by BioFire FilmArray

Ozaki

Pallarés

et al. 2019

J Clin Microbiol

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A subset of bacteremia cases are caused by organisms not detected by a rapid-diagnostics platform, BioFire blood culture identification (BCID), with unknown clinical characteristics and outcomes. Patients with Ն1 positive blood culture over a 15-month period were grouped by negative (NB-PC) versus positive (PB-PC) BioFire BCID results and compared with respect to demographics, infection characteristics, antibiotic therapy, and outcomes (length of hospital stay [LOS] and inhospital mortality). Six percent of 1,044 positive blood cultures were NB-PC. The overall mean age was 65 Ϯ 22 years, 54% of the patients were male, and most were admitted from home; fewer NB-PC had diabetes (19% versus 31%, P ϭ 0.0469), although the intensive care unit admission data were similar. Anaerobes were identified in 57% of the bacteremia cases from the NB-PC group by conventional methods: Bacteroides spp. (30%), Clostridium (11%), and Fusobacterium spp. (8%). Final identification of the NB-PC pathogen was delayed by 2 days (P Ͻ 0.01) versus the PB-PC group. The sources of bacteremia were more frequently unknown for the NB-PC group (32% versus 11%, P Ͻ 0.01) and of pelvic origin (5% versus 0.1%, P Ͻ 0.01) compared to urine (31% versus 9%, P Ͻ 0.01) for the PB-PC patients. Fewer NB-PC patients received effective treatment before (68% versus 84%, P ϭ 0.017) and after BCID results (82% versus 96%, P ϭ 0.0048). The median LOS was similar (7 days), but more NB-PC patients died from infection (26% versus 8%, P Ͻ 0.01). Our findings affirm the need for the inclusion of anaerobes in BioFire BCID or other rapid diagnostic platforms to facilitate the prompt initiation of effective therapy for bacteremia.

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Section: Discussionsupporting

confidence: 86%

Antimicrobial Stewardship Opportunities in Patients with Bacteremia Not Identified by BioFire FilmArray

Ozaki

Pallarés

et al. 2019

J Clin Microbiol

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“…Recent studies on anaerobic bacteremia reported that clindamycin resistance is an important risk factor for mortality and that inappropriate therapy reduces the survival rate as compared to appropriate therapy [25,26]. The present study showed that only 47% of Bacteroides species are susceptible to clindamycin.…”

Section: Discussionsupporting

confidence: 41%

Multicenter surveillance of the epidemiology of gram-negative bacteremia in Japan

Kosai

Yamagishi

Hashinaga

et al. 2020

Journal of Infection and Chemotherapy

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a b s t r a c tThis study investigated the epidemiology of adult patients with bacteremia caused by seven major gramnegative bacteria during a year at four university hospitals in Japan. Of the 438 cases included, Escherichia coli (247 patients) was the most frequently isolated pathogen, followed by Klebsiella species (89 patients), Enterobacter species (31 patients), Pseudomonas aeruginosa (29 patients), Bacteroides species (19 patients), Acinetobacter species (12 patients) and Stenotrophomonas maltophilia (11 patients). The overall, crude in-hospital mortality was 16.4%, ranging from 9.7% with Enterobacter species to 54.5% with S. maltophilia. Community-and hospital-acquired bacteremia accounted for 52.5% and 47.5%, respectively. Enterobacteriaceae were isolated from 93.0% of patients with community-acquired bacteremia, whereas non-fermenting bacteria were isolated from 21.6% of patients with hospital-acquired bacteremia. Of the 423 patients analyzed, 86.8% and 13.2% were monomicrobial and polymicrobial infections, respectively, and their in-hospital mortalities were 13.9% and 30.4%, respectively. Although carbapenemresistant Enterobacteriaceae were not detected, extended-spectrum b-lactamase (ESBL) production was seen in 24.3% of E. coli and 6.7% of Klebsiella species, respectively. E. coli producing ESBL showed high resistance rates to fluoroquinolones (approximately 90%), in contrast to non-producing-E. coli (approximately 21%). The susceptibilities to carbapenems and fluoroquinolones were approximately 80% for P. aeruginosa, whereas all Acinetobacter species were susceptible to these antibiotics. Bacteroides species showed 100% susceptibility to piperacillin/tazobactam and carbapenems, but only 47.4% were susceptible to clindamycin. Further studies, as well as continued surveillance, are required to determine the appropriate therapeutic strategy for gram-negative bacteremia.

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“…The definition of clinically relevant bacteremia varies amongst studies but typically includes growth in multiple blood cultures. For some authors, bacteremia is considered clinically relevant when at least one of the following criteria is met: white blood cell count lower or higher than normal, hyperthermia (temperature >38°C), or any clinical evidence consistent with infection [17][18][19][20]. In our study, we used rather broad criteria for clinical relevance of Clostridium bacteremia that were proposed by Benjamin et al: either more than one positive blood culture with Clostridium, presence of a source of infection potentially associated with Clostridium infection, or sepsis without another evident source of infection [10].…”

Section: Discussionmentioning

confidence: 99%

Clinical relevance of Clostridium bacteremia: An 8-year retrospective study

et al. 2020

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Clostridium spp. are recovered from 25% of the blood culture positive with anaerobes. However, the clinical relevance of Clostridium bacteremia has been controverted in the literature, particularly for C. perfringens. We aimed to evaluate the clinical relevance of Clostridium bacteremia, either due to C. perfringens or other Clostridium species, and to identify the risk factors of mortality in these patients. A retrospective cohort study was conducted from January 2010 to April 2018. All the patients with at least one blood culture positive with any Clostridium species were included. Eighty-one patients with a least one blood culture positive with any Clostridium species were included. Seventy patients (86.4%) fulfilled the criteria for clinically relevant bacteremia. Bacteremia due to C. perfringens tended to be less clinically relevant than other Clostridium species but this was not statistically significant (76% vs 91.2%, P=0.09). In case of clinically relevant bacteremia, the 30-day mortality rate was 31.4%. In multivariate analysis, adequate empiric antimicrobial therapy was significantly associated with survival (P=0.03). In conclusion, bacteremia due to C. perfringens or other Clostridium species is usually clinically relevant. This finding was also supported by an improved survival at 30 days when adequate empiric antimicrobial therapy was administered.

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Clinical characteristics associated with mortality of patients with anaerobic bacteremia

Cited by 28 publications

References 31 publications

Antimicrobial Stewardship Opportunities in Patients with Bacteremia Not Identified by BioFire FilmArray

Antimicrobial Stewardship Opportunities in Patients with Bacteremia Not Identified by BioFire FilmArray

Multicenter surveillance of the epidemiology of gram-negative bacteremia in Japan

Clinical relevance of Clostridium bacteremia: An 8-year retrospective study

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