Isolated pathogens and clinical outcomes of adult bacteremia in the emergency department: A retrospective study in a tertiary Referral Center

Kao, Chih Hsiang; Kuo, Yau Chang; Chen, Chih Chung; Chang, Yun Ting; Chen, Yao Shen; Wann, Shue Ren; Liu, Yung Ching

doi:10.1016/j.jmii.2011.01.023

Cited by 28 publications

(34 citation statements)

References 27 publications

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“…The receipt of intravenous therapy [7,14,30,31,35-39,41,45-47], wound care or specialized nursing care [34-37,41,42,45], and hemodialysis [7,11-14,31-42,44-46], as well as attendance at a hospital or clinic [32,42,44,45] are important factors as this group of patients has documented higher rates of colonization and infection with MDR microorganisms [48-50]. Three additional studies have included the criteria of other previous invasive procedures [7,30,45], like urological procedures [45]. There is no reason to believe that this last group of patients is different from the previous ones in regards to the risks of infection by MDR organisms, so we propose that the first criterion be generalized to include all patients that received invasive procedures in the 30 days before the infection.…”

Section: Discussionmentioning

confidence: 99%

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Classification of healthcare-associated infection: a systematic review 10 years after the first proposal

Cardoso

Almeida

Friedman

et al. 2014

BMC Med

121

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BackgroundTen years after the first proposal, a consensus definition of healthcare-associated infection (HCAI) has not been reached, preventing the development of specific treatment recommendations. A systematic review of all definitions of HCAI used in clinical studies is made.MethodsThe search strategy focused on an HCAI definition. MEDLINE, SCOPUS and ISI Web of Knowledge were searched for articles published from earliest achievable data until November 2012. Abstracts from scientific meetings were searched for relevant abstracts along with a manual search of references from reports, earlier reviews and retrieved studies.ResultsThe search retrieved 49,405 references: 15,311 were duplicates and 33,828 were excluded based on title and abstract. Of the remaining 266, 43 met the inclusion criteria. The definition more frequently used was the initial proposed in 2002 - an infection present at hospital admission or within 48 hours of admission in patients that fulfilled any of the following criteria: received intravenous therapy at home, wound care or specialized nursing care in the previous 30 days; attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the previous 30 days; were hospitalized in an acute care hospital for ≥2 days in the previous 90 days, resided in a nursing home or long-term care facility. Additional criteria founded in other studies were: immunosuppression, active or metastatic cancer, previous radiation therapy, transfer from another care facility, elderly or physically disabled persons who need healthcare, previous submission to invasive procedures, surgery performed in the last 180 days, family member with a multi-drug resistant microorganism and recent treatment with antibiotics.ConclusionsBased on the evidence gathered we conclude that the definition initially proposed is widely accepted. In a future revision, recent invasive procedures, hospitalization in the last year or previous antibiotic treatment should be considered for inclusion in the definition. The role of immunosuppression in the definition of HCAI still requires ongoing discussion.

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Section: Discussionmentioning

confidence: 99%

“…This is a criterion frequently used among alternative definitions [7,14,30,31,35,38-40,42,44],[45] along with having active or metastatic cancer [11,32] that suggest receipt of some kind of anti-cancer therapy. These are a special group of patients due to underlying immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Classification of healthcare-associated infection: a systematic review 10 years after the first proposal

Cardoso

Almeida

Friedman

et al. 2014

BMC Med

121

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“…All hospitals are requested to reduce cost; therefore, newer antimicrobial agents those may cost more are restricted from being used as the initial antibiotics in some hospitals. Even though most antimicrobial resistance surveillance studies show that the major pathogens in Taiwan are resistant to the first or secondary generations of beta-lactams and aminoglycosides [20,23,24], cefazolin, gentamicin and amoxicillin/clavulanate are still common choices of empiric antibiotics in community hospitals. Our result alerts clinicians to notice impact on patient outcomes due to inappropriate antibiotic administration.…”

Section: Discussionmentioning

confidence: 99%

The impact of inappropriate antibiotics on bacteremia patients in a community hospital in Taiwan: an emphasis on the impact of referral information for cases from a hospital affiliated nursing home

et al. 2013

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BackgroundEvidence for the impact of inappropriate antimicrobial therapy on bacteremia is mainly from studies in medical centers. We investigated the impact of inappropriate antimicrobial therapy on bacteremia in a community hospital. In particular, patients from the hospital’s affiliated nursing home were sent to the hospital with adequate referral information.MethodsWe performed a retrospective study to collect data of patients with bacteremia in a community hospital in Taiwan from 2005 to 2007.ResultsA total of 222 patients with blood stream infection were diagnosed, of whom 104 patients (46.8%) died. The rate of initial inappropriate antibiotic prescriptions was high (59%). Multivariate analysis revealed that patients with initial inappropriate antibiotics, patients with ventilator support and patients requiring ICU care were the independent predictors for inhospital mortality. Patients referred from the hospital-affiliated nursing home and patients with normal WBC counts had better survival outcome. More than 80% cases infected with methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis received initial inappropriate antimicrobial therapy. With the longer delay to administer appropriate antibiotic, a trend of higher mortality rates was observed.ConclusionsBacteremia patients from a hospital-affiliated nursing home had a better prognosis, which may have been due to the adequate referral information. Clinicians should be aware of the commonly ignored drug resistant pathogens, and efforts should be made to avoid delaying the administration of appropriate antibiotic therapy.

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“…The infectious diseases society of American previously stated that an antibiotic may reasonably remain an appropriate empirical agent if less than 20% of the likely pathogens show in vitro resistance. 11, 13 In our study, cefazolin had more than 80% effectiveness against E. coli, K. pneumoniae , and P. mirabilis , and these three organisms comprised 80% of detected uropathogens.. A separate study conducted in southern Taiwan also showed low rate of resistance to cefazolin and still supported cefazolin as appropriate empirical antibiotic for UTI [10]. Importantly, we were able to determine when cefazolin would likely fail; cefazolin should be avoided in male patients with a urinary catheter or nephrolithiasis and in female patients with diabetes and malignancy.…”

Section: Discussionmentioning

confidence: 51%

“…This observation suggests that UTIs are the commonest etiology of community-acquired bacteremia [10]. Appropriate treatment of bacteremia during sepsis could further reduce case-mortality.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and antimicrobial susceptibility pattern of hospitalised patients with community-acquired urinary tract infections at a regional hospital in Taiwan

Chen

Chiu

et al. 2014

Healthcare infection

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Background Community-acquired urinary tract infection (UTI) is the most common bacterial infection encountered at hospitals. Effective empirical antibiotic therapy relies on updated epidemiological data. Aim We described the epidemiology of patients with urosepsis presenting to a community hospital in Taiwan in order to assess the appropriateness of empirical therapy. Methods Retrospective cohort study of hospitalized adult patients with UTI from January 1 to December 31 in 2010. The clinical and microbiological characteristics were analyzed using descriptive statistics. Logistic regression analysis was performed to determine predictors of antibiotic resistance. Findings A total of 420 consecutive patients with 599 isolates were identified. Most patients were >=65 years old and women (75.4%), and 114 patients (27.1%) had bacteremia. Escherichia coli (69%) was the most common organism. Cefazolin was effective against E. coli, K. pneumoniae, and P. mirabilis in greater than 80% of the cases. In male patients, urinary catheter and renal stone were independent predictors for cefazolin resistance; while diabetes mellitus and malignancy were predictors among female patients. Conclusion Patients admitted with UTI should be screened to identify risk factors for bacteremia and antimicrobial resistance. The treatment guideline in Taiwan needs to be revised in the current era of increasing antimicrobial resistance.

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Isolated pathogens and clinical outcomes of adult bacteremia in the emergency department: A retrospective study in a tertiary Referral Center

Cited by 28 publications

References 27 publications

Classification of healthcare-associated infection: a systematic review 10 years after the first proposal

Classification of healthcare-associated infection: a systematic review 10 years after the first proposal

The impact of inappropriate antibiotics on bacteremia patients in a community hospital in Taiwan: an emphasis on the impact of referral information for cases from a hospital affiliated nursing home

Clinical characteristics and antimicrobial susceptibility pattern of hospitalised patients with community-acquired urinary tract infections at a regional hospital in Taiwan

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