Does the presence of a urinary catheter predict severe sepsis in a bacteraemic cohort?

Melzer, Mark; Welch, Catherine

doi:10.1016/j.jhin.2017.01.003

Cited by 24 publications

(13 citation statements)

References 12 publications

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“…As a proxy for severity of underlying illness and underlying risk of readmission, we included the CCI in our final multivariate model. While other methods to control for comorbidity burden have been used (for example, Elixhauser, Steiner, Harris, & Coffey, 1998), and although CCI was originally designed to predict the risk of mortality in longitudinal studies (Charlson et al, 1987), CCI has been found to be predictive of 30-day hospital readmission in a large cohort of Medicare beneficiaries (Dattalo et al, 2017) and has been used to control for severity of illness in a wide range of studies of other outcomes (Baris, Onyilmaz, Basyigit, Boyaci, & Yildiz, 2017;Bischoff-Ferrari et al, 2017;Hung et al, 2017;Josephson et al, 2017;Melzer & Welch, 2017). Since our data include only claims from a single commercial health plan, we likely have patients shared with other insurers for whom claims were not available.…”

Section: Discussionmentioning

confidence: 99%

Provider Connectedness to Other Providers Reduces Risk of Readmission After Hospitalization for Heart Failure

Geva

Olson

Liu³

et al. 2017

Med Care Res Rev

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Provider interactions other than explicit care coordination, which is challenging to measure, may influence practice and outcomes. We performed a network analysis using claims data from a commercial payor. Networks were identified based on provider pairs billing outpatient care for the same patient. We compared network variables among patients who had and did not have a 30-day readmission after hospitalization for heart failure. After adjusting for comorbidities, high median provider connectedness-normalized degree, which for each provider is the number of connections to other providers normalized to the number of providers in the region-was the network variable associated with reduced odds of readmission after heart failure hospitalization (odds ratio = 0.55; 95% confidence interval [0.35, 0.86]). We conclude that heart failure patients with high provider connectedness are less likely to require readmission. The structure and importance of provider relationships using claims data merits further study.

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Section: Discussionmentioning

confidence: 99%

Provider Connectedness to Other Providers Reduces Risk of Readmission After Hospitalization for Heart Failure

Geva

Olson

Liu³

et al. 2017

Med Care Res Rev

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“…According to Melzer et al, urinary catheters increase the risk of severe bacteremia and should be used only when there is a clinical indication [ 14 ]. Research results by Lillie et al confirm that one of the main reasons for the increase in BSI is the use of urinary catheters, often unnecessary [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Resistance in Enterobacterales Bacilli Isolated from Bloodstream Infection in Surgical Patients of Polish Hospitals

Kłos

Pomorska-Wesołowska²,

Romaniszyn

et al. 2021

International Journal of Microbiology

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Background and Aims. Bloodstream infections (BSIs) are one of the most frequently observed hospital-acquired infections (HAIs). We sought to describe the epidemiology and drug resistance secondary Enterobacterales BSIs in surgical patients and check for any correlation with the type of hospital ward. Materials and Methods. This multicenter (13 hospitals in southern Poland) laboratory-based retrospective study evaluated adults diagnosed with BSI secondary to surgical site infection (SSI) hospitalized in 2015–2018; 121 Enterobacterales strains were collected. The drug resistance was tested according to the EUCAST recommendations. Tests confirming the presence of extended-spectrum β-lactamases (ESBLs) and bla resistance genes were carried out. The occurrence of possible clonal epidemics among K. pneumoniae strains was examined. Results. The prevalence of Enterobacterales in secondary BSI was 12.1%; the most common strains were E. coli (n = 74, 61.2%) and Klebsiella spp. (n = 33, 27.2%). High resistance involved ampicillin and ampicillin/sulbactam (92, 8–100%), fluoroquinolones (48–73%), and most cephalosporins (29–50%). Carbapenems were the antimicrobials with the susceptibility at 98%. The prevalence of ESBL strains was 37.2% (n = 45). All the ESBL strains had blaCTX-M gene, 26.7% had the blaSHV gene, and 24.4% had blaTEM gene. The diversity of Klebsiella strains was relatively high. Only 4 strains belonged to one clone. Conclusions. What is particularly worrying is the high prevalence of Enterobacterales in BSI, as well as the high resistance to antimicrobial agents often used in the empirical therapy. To improve the effectiveness of empirical treatment in surgical departments, we need to know the epidemiology of both surgical site infection and BSI, secondary to SSI. We were surprised to note high heterogeneity among K. pneumoniae strains, which was different from our previous experience.

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“…A 2017 study by Melzer and Welch [21] used multivariate logistic regression to demonstrate that bacteremia secondary to CAUTI is signiicantly more likely than bacteremia from other hospital-acquired sources to result in severe sepsis, as deined by a Pit bacteremia score ≥ 2 (OR 3.94). Conversely, bacteremia secondary to a urinary source without an associated IUC was much less likely to result in severe sepsis, with an odds ratio of 1.27 [21].…”

Section: Catheter-associated Bacteremiamentioning

confidence: 99%

“…The current IDSA guidelines published in 2010 recommend against routine screening for asymptomatic bacteriuria. This suggestion is based on the grounds that treatment of asymptomatic bacteriuria with a short course of antimicrobials and catheter replacement did not prevent the subsequent incidence of urosepsis or repeat bacteriuria [21]. Recent research developments suggested that these recommendations warrant further study.…”

Section: Catheter-associated Bacteremiamentioning

confidence: 99%

Unnecessary Complications: The Forgotten Indwelling Urinary Catheter

Hromatka¹,

Guo²

2017

Vignettes in Patient Safety - Volume 1

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Complications of indwelling urinary catheters (IUCs) are common, with the infectious one accounting for 40% of all reported healthcare-associated infections. Myths and rituals exist among healthcare professionals in the application of the urinary catheter, and the catheter is often forgoten after the placement, resulting in a potentially signiicant impact on patient outcomes and healthcare cost. The implementation of institutional protocols through a bundled approach can signiicantly reduce forgoten IUCs and dramatically improve patient safety.

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Does the presence of a urinary catheter predict severe sepsis in a bacteraemic cohort?

Abstract: Background: Sepsis is a major cause of mortality with an estimated 37 000 UK deaths

Cited by 24 publications

References 12 publications

Provider Connectedness to Other Providers Reduces Risk of Readmission After Hospitalization for Heart Failure

Provider Connectedness to Other Providers Reduces Risk of Readmission After Hospitalization for Heart Failure

Antimicrobial Resistance in Enterobacterales Bacilli Isolated from Bloodstream Infection in Surgical Patients of Polish Hospitals

Unnecessary Complications: The Forgotten Indwelling Urinary Catheter

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