Polymicrobial Bloodstream Infection in Pediatric Patients

Sutter, Deena E.; Stagliano, David; Braun, LoRanée; Williams, Francis M.; Arnold, John; Ottolini, Martin G.; Epstein, J S

doi:10.1097/inf.0b013e31816591be

Cited by 43 publications

(37 citation statements)

References 32 publications

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“…We defined ‘bloodstream infection episodes’ as time-periods associated with positive blood cultures [1] and the infection episode was considered resolved when at least two subsequent blood cultures performed every 24 hrs were negative. Usually when an organism is isolated from a blood culture specimen, blood cultures are repeated every 24 hr till two blood culture specimens are negative for organisms.…”

Section: Methodsmentioning

confidence: 99%

“…Polymicrobial infections increase mortality more than 2-fold in adults and children, increase length of hospital stay and healthcare costs [1,2]. Risk factors for polymicrobial infections in children and adults include the presence of a central venous catheter, administration of parenteral nutrition, gastrointestinal pathology, especially short gut syndrome, use of broad-spectrum antibiotics and immunosuppression [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Risk factors for polymicrobial infections in children and adults include the presence of a central venous catheter, administration of parenteral nutrition, gastrointestinal pathology, especially short gut syndrome, use of broad-spectrum antibiotics and immunosuppression [1,3,4]. …”

Section: Introductionmentioning

confidence: 99%

“…Organisms that are commonly implicated in neonatal polymicrobial bloodstream infections are coagulase-negative staphylococcus (CONS), Candida spp., Staphylococcus aureus and Enterococcus spp. [1,9,13-16]. A common risk factor appears to be multi-species biofilm infections originating from indwelling medical devices, notably indwelling vascular catheters or endotracheal tubes [1,17].…”

Section: Introductionmentioning

confidence: 99%

“…Polymicrobial bloodstream infections may be defined as multiple organisms isolated during an infectious episode including those from a single blood specimen [1] or more restrictively as isolation of more than one organism from a single blood specimen only [11,12,17]. Different definitions may partly explain the varying incidence of polymicrobial bloodstream infections reported.…”

Section: Introductionmentioning

confidence: 99%

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Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: a case-control study

et al. 2014

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BackgroundPolymicrobial infections in adults and children are associated with increase in mortality, duration of intensive care and healthcare costs. Very few studies have characterized polymicrobial bloodstream infections in the neonatal unit. Considerable variation has been reported in incidence of polymicrobial infections and associated clinical outcomes. We characterized the risk factors and outcomes of polymicrobial bloodstream infections in our neonatal units in a tertiary hospital in North America.MethodsIn a retrospective case control study design, we identified infants in the neonatal intensive care unit with positive blood cultures at Texas Children’s Hospital, over a 16-year period from January 1, 1997 to December 31, 2012. Clinical data from online databases were available from January 2009 to December 2012. For each polymicrobial bloodstream infection (case), we matched three infants with monomicrobial bloodstream infection (control) by gestational age and birth weight.ResultsWe identified 2007 episodes of bloodstream infections during the 16 year study period and 280 (14%) of these were polymicrobial. Coagulase-negative Staphylococcus, Enterococcus, Klebsiella and Candida were the most common microbial genera isolated from polymicrobial infections. Polymicrobial bloodstream infections were associated with more than 3-fold increase in mortality and an increase in duration of infection. Surgical intervention was a significant risk factor for polymicrobial infection.ConclusionThe frequency and increased mortality emphasizes the clinical significance of polymicrobial bloodstream infections in the neonatal intensive care unit. Clinical awareness and focused research on neonatal polymicrobial infections is urgently needed.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: a case-control study

et al. 2014

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Biofilm-Based Central Line-Associated Bloodstream Infections

Yousif

Mohamed

Raad

2014

Advances in Experimental Medicine and Biology

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Different types of central venous catheters (CVCs) have been used in clinical practice to improve the quality of life of chronically and critically ill patients. Unfortunately, indwelling devices are usually associated with microbial biofilms and eventually lead to catheter-related bloodstream infections (CLABSIs).An estimated 250,000-400,000 CLABSIs occur every year in the United States, at a rate of 1.5 per 1,000 CVC days and a mortality rate of 12-25 %. The annual cost of caring for patients with CLABSIs ranges from 296 million to 2.3 billion dollars.Biofilm formation occurs on biotic and abiotic surfaces in the clinical setting. Extensive studies have been conducted to understand biofilm formation, including different biofilm developmental stages, biofilm matrix compositions, quorum-sensing regulated biofilm formation, biofilm dispersal (and its clinical implications), and multi-species biofilms that are relevant to polymicrobial infections.When microbes form a matured biofilm within human hosts through medical devices such as CVCs, the infection becomes resistant to antibiotic treatment and can develop into a chronic condition. For that reason, many techniques have been used to prevent the formation of biofilm by targeting different stages of biofilm maturation. Other methods have been used to diagnose and treat established cases of CLABSI.Catheter removal is the conventional management of catheter associated bacteremia; however, the procedure itself carries a relatively high risk of mechanical complications. Salvaging the catheter can help to minimize these complications.In this article, we provide an overview of microbial biofilm formation; describe the involvement of various genetic determinants, adhesion proteins, organelles, mechanism(s) of biofilm formation, polymicrobial infections, and biofilm-associated infections on indwelling intravascular catheters; and describe the diagnosis, management, and prevention of catheter-related bloodstream infections.

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Evaluation of the Bruker® MBT Sepsityper IVD module for the identification of polymicrobial blood cultures with MALDI-TOF MS

Scohy

Noël

Boeras

et al. 2018

Eur J Clin Microbiol Infect Dis

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Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) considerably reduces timeframe required from initial blood culture positivity towards complete bacterial identification. However, rapid identification of polymicrobial blood cultures remains challenging. We evaluated the performances of the Bruker® MBT Sepsityper IVD module on MALDI-TOF MS for the direct identification of polymicrobial blood culture bottles. This module has the ability to give a strong indication that a sample contains a mixture of organisms and to identify two of them. Blood culture bottles considered as polymicrobial using routine subculture were collected and processed using the Sepsityper kit. MALDI-TOF MS identification was performed using the MBT Compass IVD software including the Sepsityper module. From 143 polymicrobial blood culture bottles tested, 34.3% (49/143) were completely identified by the module. Both microorganisms were more easily detected by the module in samples containing two pathogens than in samples containing two contaminants (36.8% vs 29.4%). Additionally, in more than half of the samples, the module detected 1 of the different microorganisms contained in the same vial. In these cases, with a pathogen and contaminant in the same sample, the module detected the pathogen in more than 80%. The Sepsityper module identified 14 microorganisms which were not recovered by conventional culture methods. The Bruker® MBT Sepsityper IVD module contributed to a valuable identification of polymicrobial blood cultures in more than a third of all cases. Conventional culture methods are still required to complete the results and to carry on susceptibility testing.

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Polymicrobial Bloodstream Infection in Pediatric Patients

Abstract: Chronic medical conditions, particularly gastrointestinal disease, are risk factors for PBSIs. Because clinical illness may be more severe, alteration of the empiric antimicrobial regimen should be considered in some of these patients.

Cited by 43 publications

References 32 publications

Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: a case-control study

Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: a case-control study

Biofilm-Based Central Line-Associated Bloodstream Infections

Evaluation of the Bruker® MBT Sepsityper IVD module for the identification of polymicrobial blood cultures with MALDI-TOF MS

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