Clinical predictors and outcome impact of community-onset polymicrobial bloodstream infection

Yo, Chia‐Hung; Hsein, Yenh-Chen; Wu, Yi-Luen; Hsu, Wan‐Ting; Huei‐Ming, Matthew; Tsai, Cheng‐Hsien; Chen, Shyr‐Chyr; Lee, Chien‐Chang

doi:10.1016/j.ijantimicag.2019.09.015

Cited by 33 publications

(27 citation statements)

References 38 publications

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“…Our current study found that the proportion of polymicrobial KP-BSI was 13.9% among total KP-BSI, which was consistent with previous reports that ranged from 11.7% to 21.0% [ 15 , 16 , 30 ]. In Zheng et al's study, the proportion of polymicrobial enterococcal BSI was even higher [ 31 ].…”

Section: Discussionsupporting

confidence: 93%

“…Polymicrobial BSI occurs in 10.9% to 20.6% of patients with BSI and is associated with adverse outcomes [ 13 – 15 ]. Maria et al have found that patients with polymicrobial BSI are characterized by higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, more proportions of severe sepsis or septic shock, and higher mortality compared to patients with monomicrobial BSI.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics, Risk Factors, and Outcomes of Patients with Polymicrobial Klebsiella pneumoniae Bloodstream Infections

Song

Zhang

Huang

et al. 2021

BioMed Research International

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Background. Polymicrobial Klebsiella pneumoniae bloodstream infection (KP-BSI) has been reported to account for more than 10% of all KP-BSI, but few studies have characterized polymicrobial KP-BSI. Our study investigated the clinical characteristics, risk factors, and outcomes of polymicrobial KP-BSI by comparing with monomicrobial KP-BSI. Methods. We conducted a single-center retrospective cohort study of patients with KP-BSI from 1 January 2013 to 31 December 2018 and collected the clinical data by reviewing electronic medical records. Results. Of the 818 patients with KP-BSI recruited, 13.9% (114/818) were polymicrobial KP-BSI. The severity of illness in polymicrobial and monomicrobial KP-BSI was similar, while the rate of resistance to carbapenems was obviously higher in polymicrobial KP-BSI (78.1% vs. 65.6%, p = 0.009 ). On multivariate analysis, hospitalization in burn ward (odds ratio (OR) 6.13, 95% confidence interval (CI) 2.00-18.76, p = 0.001 ) and intensive care unit (OR 2.39, 95% CI 1.05-5.43, p = 0.038 ) was independently associated with polymicrobial KP-BSI. Gram-negative bacteria accounted for the highest proportion (68.9%) among copathogens of polymicrobial KP-BSI, whereas gram-positive bacteria (22.9%) and Candida (8.2%) ranked the second and the third, respectively, with Acinetobacter baumannii being the most common (23.0%). Patients with polymicrobial KP-BSI had longer hospital days after BSI onset and total hospital days than patients with monomicrobial KP-BSI (median (interquartile range (IQR)), 19 (5, 39) vs. 12 (6, 25), 37 (21, 67) vs. 29 (16, 53), respectively, p < 0.05 ). The mortality did not differ between polymicrobial KP-BSI and monomicrobial KP-BSI (all p > 0.05 ). Conclusions. It was observed that polymicrobial KP-BSI accounted for a significant proportion among all KP-BSI in the current study. Hospitalization in burn ward and intensive care unit was an independent risk factor for the development of polymicrobial KP-BSI. The patients with polymicrobial KP-BSI had a higher rate of carbapenem-resistant K. pneumoniae and might have poor outcomes compared to monomicrobial KP-BSI.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics, Risk Factors, and Outcomes of Patients with Polymicrobial Klebsiella pneumoniae Bloodstream Infections

Song

Zhang

Huang

et al. 2021

BioMed Research International

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“…Although patients with mixed-CA/B-BSIs had worse outcomes (e.g., prolonged lengths of ICU stay and prolonged mechanical ventilation time) than those with mono-CA-BSI, 28-day mortality (41.7% vs. 33.3%, P=0.446), 60-day mortality (50.0% vs. 36.6%, P=0.229) and in-hospital mortality (54.2% vs. 39.8%, P=0.204) were similar between the two groups (Table 5, Figure 3), similar to previous studies [4,5,7]. In contrast, previous studies showed polymicrobial BSI was associated with a 2.2 fold risk for increased 90day mortality in patients with community-onset BSI [32], and also promoted an increase in 28-day mortality [33]. In our study, we found no correlation between mixed-CA/B-BSIs and mortality, which might be due to similar chronic comorbidities, a similar severity of illness at the onset of candidemia, a similar rate of fungal collection from drainage uid, a similar delay in the initiation of empiric antifungal treatment (75% vs. 88.2% P=0.697) and a similar rate of appropriate antifungal therapy administration (33.3% vs. 37.6%, P=0.697) ( Table 2).…”

Section: Discussionsupporting

confidence: 86%

Clinical characteristics, risk factors and outcomes of mixed Candida albicans/bacterial bloodstream infections

Zhang

Tang

et al. 2020

Preprint

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Purpose: The purpose of this study was to explore the clinical features, risk factors, and outcomes of the mixed Candida albicans/bacterial bloodstream infections (mixed-CA/B-BSIs) compared with monomicrobial Candida albicans bloodstream infection (mono-CA-BSI) in adult patients in China.Methods: All adult hospitalized cases ofadults with Candida albicans bloodstream infection (CA-BSI) were recruited in thefor this retrospective observational study from January 1, 2013, to December 31, 2018.Results: Of the 117 patients with CA-BSI, 24 patients (20.5%) werehad mixed-CA/B-BSIs. The most common co-pathogenscopathogens were Coagulasecoagulase-negative Staphylococcus (CNS) (24.0%), followed by Klebsiella pneumoniae (20.0%) and Staphylococcus aureus (16.0%). In the multivariable analysis, a prior ICU stay>2days >2 days (adjusted odds ratio [OR], 7.808445; 95% confidence interval [CI], 1.264152-48.233132) was an independent risk factor offor mixed-CA/B-BSIs. In comparisonCompared with patients with mono-CA-BSI, patients with mixed-CA/B-BSIs developed withhad a prolonged length of mechanical ventilation [17.5 (4.5, 34.8) vs. 3.0 (0.0, 24.5), Pp=0.019],] and prolonged length of ICU stay [22.0 (14.3, 42.2) vs. 8.0 (0.0, 31.5), Pp=0.010], whereas the ]; however, mortality was not significantly different. Conclusions: AThere was a high rate of mixed-CA/B-BSIs iscases among CA-BSI cases, and Coagulase-negative Staphylococcus isCNS was the predominant co-existedcoexisting species. PriorA prior ICU stay >2 days iswas an independent risk factor for mixed -CA/B-BSIs. Although there iswas no difference in mortality, the outcomes of patients with mixed -CA/B-BSIs, including prolonged length of mechanical ventilation and prolonged length of ICU stay, were worse than those with mono-CA-BSI, which; this deserves further attention offrom clinicians.

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“…However, it seems to be generally accepted that the predominant type of pathogen in CASS is Gram-positive bacteria [29]. However, there are still reports of community-acquired infections with Gram-negative bacteria, such as P. aeruginosa; however, these patients often had underlying diseases [30]. At the same time, our study found that the 28-day mortality rate of children in the HASS group was 3.661 times higher than that of children in the CASS group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hospital- and Community-Acquired Septic Shock in Children: A Single-Center, Cohort, Retrospective Study

Fan

Fang

et al. 2021

Preprint

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Background To explore differences between hospital- (HASS) and community-acquired septic shock (CASS) in patient characteristics, pathogens, complications, outcomes, and risk factors in pediatric intensive care unit (PICU) children. Methods This retrospective study enrolled septic shock children from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into HASS and CASS groups. After comparison, logistic regression analyses were used to identify risk factors for mortality. Results A total of 298 children were enrolled. 65.9% of HASS patients (N = 91) had hematological/tumor diseases and were mainly bloodstream infections of Gram-negative bacteria (47.3%). 67.7% of CASS (N = 207) had no obvious underlying disease and were mostly infected with Gram-positive bacteria (30.9%) of the respiratory or central nervous system. 28-day mortality was 62.6% and 32.7% in HASS and CASS groups, respectively (p < 0.001). The factor associated with 28-day mortality of HASS and CASS was MODS (OR:11.524; 95% CI: 2.140-62.051) and needed invasive mechanical ventilation therapy (OR:6.884; 95% CI: 1.499–31.624), respectively. Conclusions The underlying diseases, pathogens, complications, prognosis and mortality varied widely. 28-day mortality is associated with MODS and need for invasive mechanical ventilation therapy in HASS and CASS patients.

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Clinical predictors and outcome impact of community-onset polymicrobial bloodstream infection

Cited by 33 publications

References 38 publications

Clinical Characteristics, Risk Factors, and Outcomes of Patients with Polymicrobial Klebsiella pneumoniae Bloodstream Infections

Clinical Characteristics, Risk Factors, and Outcomes of Patients with Polymicrobial Klebsiella pneumoniae Bloodstream Infections

Clinical characteristics, risk factors and outcomes of mixed Candida albicans/bacterial bloodstream infections

Comparison of Hospital- and Community-Acquired Septic Shock in Children: A Single-Center, Cohort, Retrospective Study

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