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

Abstract

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.

The two faces of cyanide: an environmental toxin and a potential novel mammalian gasotransmitter

“…Population‐based incidence studies indicate that only approximately 2–8% of all septic shock cases include systemic Pseudomonas bacteremia, but these cases tend to be associated with severe clinical picture and high mortality [ 163 , 164 , 165 , 166 , 167 ]. To our knowledge, circulating cyanide levels have not been assessed in these patients.…”

Current situation of carbapenem‐resistant Enterobacteriaceae and Acinetobacter in Japan and Southeast Asia

“…48 Today, the isolation rate of MDR (especially carbapenem-resistant) Acinetobacter is very high in countries around the world, with 50% in the United States, 57 50%-80% in Europe, 58 and 50%-90% in South and Southeast Asia. 35 Contrarily, the resistance rate in Japan is less than 5%, 59,60 which is a rare situation worldwide. Once the MDR Acinetobacter enters and colonizes in Japan, it is highly possible that it will fall into a state similar to that in other countries, and it is necessary to pay attention to the trend of detecting resistant bacteria.…”

Treatment outcomes and its associated factors among pneumonia patients admitted to public hospitals in Harar, eastern Ethiopia: a retrospective follow-up study

“… 18 The presence of comorbidity may also increase in-hospital mortality among patients with pneumonia as an independent risk factor. 38 In addition, by prolonging hospital stays, comorbidity may increase the risk of acquiring multidrug-resistant pathogens, 39–41 further contributing to undesirable treatment outcomes.…”