Clinical impact of Gram-negative nonfermenters on adults with community-onset bacteremia in the emergency department

Chiu, Chun Wei; Li, Ming Chi; Ko, Wen Chien; Li, Chia Wen; Chen, Po‐Lin; Chang, Chia Ming; Lee, Nan Yao; Lee, Ching Chi

doi:10.1016/j.jmii.2013.08.004

Cited by 37 publications

(29 citation statements)

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“…[1] Enterobacteriaceae, particularly Klebsiella pneumoniae and Escherichia coli , are the leading causes of community-onset bacteremia. [2,3] The presence of extended-spectrum β-lactamases (ESBLs) in the Enterobacteriaceae family is of great microbiological and clinical importance. [4] In the past years, ESBL producers have spread from hospital environments to community environments, and the associated infections are a serious public health concern.…”

Section: Introductionmentioning

confidence: 99%

A simple scoring algorithm predicting extended-spectrum β-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia

Lee¹,

Chu

Hsieh³

et al. 2017

Medicine

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The incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBL-producer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB).In a retrospective cohort, multicenter study, adults with CoMEB in the emergency department (ED) were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype. Clinical information was obtained from chart records.Of the total 1141 adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs)—recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98)—were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6%) and an acceptable specificity (92.5%); the area under the receiver operating characteristic curve was 0.92.In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

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Section: Introductionmentioning

confidence: 99%

A simple scoring algorithm predicting extended-spectrum β-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia

Lee¹,

Chu

Hsieh³

et al. 2017

Medicine

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“…The mortality rate attributed to NFGNB bacteremia could be as high as 25%. 2,3 Among NFGNB, Pseudomonas aeruginosa, Acinetobacter baumannii complex, and Stenotrophomonas maltophilia were the most common pathogens causing healthcare-associated bloodstream infections. 3 NFGNB are easily resistant to most of the beta-lactam antibiotics through beta-lactamase production, impermeability, and multidrug efflux pumps.…”

Section: Introductionmentioning

confidence: 99%

“…4 The emerging resistance of NFGNB to all commonly used antibiotics may lead to inappropriate administration of empirical antibiotics, which contributes to the high fatality rate of NFGNB bacteremia. 2,5,6 The limitation of the susceptible antibiotic spectrum also makes the clinical treatment more difficult. Therefore, periodic active surveillance for the epidemiology of NFGNB resistance is crucial for infection control and antibiotic stewardship.…”

Section: Introductionmentioning

confidence: 99%

In vitro activity of aminoglycosides against clinical isolates of Acinetobacter baumannii complex and other nonfermentative Gram-negative bacilli causing healthcare-associated bloodstream infections in Taiwan

Liu

Wang

et al. 2016

Journal of Microbiology, Immunology and Infection

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Background/Purpose: Aminoglycosides possess in vitro activity against aerobic and facultative Gram-negative bacilli. However, nationwide surveillance on susceptibility data of Acinetobacter baumannii complex and Pseudomonas aeruginosa to aminoglycosides was limited, and aminoglycoside resistance has emerged in the past decade. We study the in vitro susceptibility of A. baumannii complex and other nonfermentative Gram-negative bacilli (NFGNB) to aminoglycosides. Methods: A total of 378 NFGNB blood isolates causing healthcare-associated bloodstream infections during 2008 and 2013 at four medical centers in Taiwan were tested for their susceptibilities to four aminoglycosides using the agar dilution method (gentamicin, amikacin, tobramycin, and isepamicin) and disc diffusion method (isepamicin). Please cite this article in press as: Liu J-Y, et al., In vitro activity of aminoglycosides against clinical isolates of Acinetobacter baumannii complex and other nonfermentative Gram-negative bacilli causing healthcare-associated bloodstream infections in Taiwan, Journal of Microbiology, Immunology and Infection (2015), http://dx.Journal of Microbiology, Immunology and Infection (2015) xx, 1e6 nonfermentativeGram-negative bacilli Results: A. baumannii was highly resistant to all four aminoglycosides (range of susceptibility, 0e4%), whereas >80% of Acinetobacter nosocomialis and Acinetobacter pittii blood isolates were susceptible to amikacin (susceptibility: 96% and 91%, respectively), tobramycin (susceptibility: 92% and 80%, respectively), and isepamicin (susceptibility: 96% and 80%, respectively). All aminoglycosides except gentamicin possessed good in vitro activity (>94%) against P. aeruginosa. Amikacin has the best in vitro activity against P. aeruginosa (susceptibility, 98%), followed by A. nosocomialis (96%), and A. pittii (91%), whereas tobramycin and isepamicin were less potent against A. pittii (both 80%). Aminoglycoside resistances were prevalent in Stenotrophomonas maltophilia and Burkholderia cepacia complex blood isolates in Taiwan. Conclusion: Genospecies among the A. baumannii complex had heterogeneous susceptibility profiles to aminoglycosides. Aminoglycosides, except gentamicin, remained good in vitro antimicrobial activity against P. aeruginosa. Further in vivo clinical data and continuous resistance monitoring are warranted for clinical practice guidance.

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“…Non-fermenting, gram-negative bacteria (NFGNB) are described as a strictly aerobic and non-sporulating group of microorganisms that rely on oxidative pathways because they are unable to get energy from carbohydrates by fermentation 1 . They are opportunistic bacteria with a low level of virulence that seldom cause disease in healthy individuals.…”

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confidence: 99%

Prevalence and antimicrobial susceptibility of non-fermenting Gram-negative bacilli isolated from clinical samples at a tertiary care hospital

Argenta

Fuentefria

Sobottka

2017

Rev. Soc. Bras. Med. Trop.

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Introduction:We compared the prevalence and antimicrobial susceptibility of non-fermenting gram-negative bacilli (NFGNB) isolated from clinical samples at a Brazilian tertiary care hospital in 2008 and 2013. Methods: Collected data included patient's name, age, sex, inpatient unit, laboratory record number, type of biological material, culture test result, and antimicrobial susceptibility of isolated strains. Results: Out of 19,112 culture tests analyzed, 926 (4.8%) were positive for NFGNB. Among these, 45.2% were metallo-beta-lactamase (MBL) producing strains. Conclusion: Between 2008 and 2013, the number of MBL-producing NFGNB isolates increased by 21.5%, which was accompanied by a consequent reduction in susceptibility to antimicrobials.

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Clinical impact of Gram-negative nonfermenters on adults with community-onset bacteremia in the emergency department

Abstract: For adults with bacteremia visiting the ED, GNNF is associated with a higher mortality rate and more inappropriate empirical antibiotic therapy in the ED. To allow early administration of empirical antibiotics, several clinical predictors of GNNF infections were identified.

Cited by 37 publications

References 28 publications

A simple scoring algorithm predicting extended-spectrum β-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia

A simple scoring algorithm predicting extended-spectrum β-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia

In vitro activity of aminoglycosides against clinical isolates of Acinetobacter baumannii complex and other nonfermentative Gram-negative bacilli causing healthcare-associated bloodstream infections in Taiwan

Prevalence and antimicrobial susceptibility of non-fermenting Gram-negative bacilli isolated from clinical samples at a tertiary care hospital

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