The Burden of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection among Hematology, Oncology, and Stem Cell Transplant Patients

Metzger, Kristen; Rucker, Yvonne; Callaghan, Mary; Churchill, Michelle; Jovanovic, Borko; Zembower, Teresa; Bolon, Maureen K.

doi:10.1017/ice.2014.38

Cited by 67 publications

(38 citation statements)

References 21 publications

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“…A previous study in adult hematology/oncology and stem cell transplant settings has also reported MBI-LCBI events to be associated mainly with neutropenia but without a significant difference in the frequency of neutropenia in MBI-LCBI vs. non-MBI–LCBI cases. 15 However, we found a statistically significant difference in the frequency of neutropenia between MBI and non-MBI LCBI events in pediatric cancer patients. Additional studies in pediatric cancer centers in LMIC that offer allogeneic hematopoietic stem cell transplantation would help to determine whether the absence of transplantation at our center may explain this difference.…”

Section: Discussioncontrasting

confidence: 51%

“…13 The MBI-LCBI surveillance definition was revised and improved after testing at 94 cancer centers in the U.S. 14 Recently, an oncology center reported using the MBI-LCBI surveillance protocol to separately track MBI and non-MBI events to measure the impact of a CLABSI quality improvement initiative. 15 Because MBI-LCBI cases define a specific at-risk population, the CDC will continue requiring their tracking and reporting. However, MBI-LCBI data may be removed from the main bloodstream infection events tracking metrics by 2016, in which case they will not be included in CLABSI data publicly reported to the U.S. Centers for Medicare and Medicaid Services.…”

Section: Introductionmentioning

confidence: 99%

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The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country

Torres

González

Loera

et al. 2016

American Journal of Infection Control

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Background The U.S. National Healthcare Safety Network (NHSN) has provided a definition of mucosal barrier injury–associated, laboratory-confirmed bloodstream infection (MBI-LCBI) to improve infection surveillance. To date there is little information about its impact in pediatric oncology centers in low- to middle-income countries. Objectives To determine the impact of the definition on the rate of central line-associated bloodstream infection (CLABSI) and compare the clinical characteristics of MBI vs. non-MBI LCBI cases. Methods We retrospectively applied the NHSN definition to all CLABSIs recorded at a pediatric oncology center in Tijuana, Mexico, from January 2011 through December 2014. CLABSI events were re-classified according to the MBI-LCBI definition. Clinical characteristics and outcomes of MBI and non-MBI CLABSIs were compared. Results Of 55 CLABSI events, 44% (24/55) qualified as MBI-LCBIs; all were MBI-LCBI subcategory 1 (intestinal flora pathogens). After the number of MBI-LCBI cases was removed from the numerator, the CLABSI rate during the study period decreased from 5.72 to 3.22 infections per 1,000 central line days. Patients with MBI-LCBI were significantly younger than non-MBI-LCBI patients (P=0.029) and had a significantly greater frequency of neutropenia (100% vs. 39%, P=0.001) and chemotherapy exposure (87% vs. 58%, P=0.020) and significantly longer median hospitalization (34 vs. 23 days, P=0.008). Conclusion A substantial proportion of CLABSI events at our pediatric cancer center met the MBI-LCBI criteria. Our results support separate monitoring and reporting of MBI and non-MBI– -LCBIs in low- to middle-income countries to allow accurate detection and tracking of preventable (non-MBI) bloodstream infections.

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Section: Discussioncontrasting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country

Torres

González

Loera

et al. 2016

American Journal of Infection Control

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“…E coli es el patógeno identificado en sangre con mayor frecuencia en bacteremias nosocomiales en la última década, particularmente en la población de pacientes con neoplasias hematológicas asociadas con bacteremia por daño a mucosas. 10,11 En este estudio se reportó un incremento sostenido en la resistencia de 18% en 2003 a 48.6% en 2015, tendencia que también se ha reportado en algunos otros países del mundo, en bacteremia asociada con el cuidado de la salud. [12][13][14][15] El comportamiento de otras bacterias MDR es diverso; se observa un incremento progresivo para K. pneumoniae BLEE y para P. aeruginosa tanto en pacientes con neoplasias hematológicas como en pacientes con tumores sólidos.…”

Section: Discussionunclassified

Cepas E-ESKAPE multidrogorresistentes aisladas en hemocultivos de pacientes con cáncer

2018

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Objetivo. Describir la tendencia de cepas multidrogorresistentes (MDR) aisladas en hemocultivos de pacientes con cáncer durante el periodo de 2005 a 2015. Material y métodos. Análisis retrospectivo en el que se procesaron 33 127 hemocultivos. La identificación y la sensibilidad antimicrobianas se realizaron a través de métodos automatizados WaLK away (Siemens Laboratory Diagnostics) y BD Phoenix (Becton, Dickinson and Company). Se determinaron cepas resistentes de acuerdo con la concentración mínima inhibitoria, según los parámetros del Clinical and Laboratory Standards Institute (CLSI). Resultados. 5 604 (16.9%) aislamientos fueron positivos, con 6 397 aislamientos, 3 732 (58.4%) bacilos gramnegativos, 2 355 (36.9%) cocos grampositivos, 179 (2.7%) levaduras y 126 (1.9%) bacilos grampositivos. Escherichia coli (n=1 591, 24.5%) fue la bacteria más frecuente, 652 (41%) productoras de beta-lactamasas de espectro-extendido (BLEE); Enterococcus faecium 143 (2.1%), 45 (31.5%) resistente a vancomicina; Staphylococcus aureus 571 (8.7%), 121 (21.2%) resistentes a meticilina (SARM); Klebsiella pneumoniae 367 (5.6%), 41 (11.2%) BLEE, Acinetobacter baumannii 96 (1.4%), 23 (24%) MDR; Pseudomonas aeruginosa 384 (5.6%), 43 (11.2%) MDR. Las cepas MDR se aislaron más frecuentemente en pacientes con neoplasias hematológicas en comparación con tumores sólidos; SARM (RM=4.48, IC95% 2.9-6.8); E. coli BLEE (RM=1.3, IC95% 1.10-1.65) y A. baumannii-MDR (RM=3.2, IC95% 1.2-8.3). Conclusiones. Se observó un aislamiento significativamente mayor de cepas E-ESKAPE MDR en pacientes con neoplasias hematológicas.

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“…It has been estimated that approximately 40-50% of bloodstream infections in oncologic settings are due to mucosal barrier injury. 89 Therefore, in a recent manual on Central Line-Associated Blood Stream Infections (CLABSI), the definition of Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection (MBI-LCBI) has been introduced as reported in Table 1. 7 …”

Section: Central Venous Cathetersmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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The Burden of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection among Hematology, Oncology, and Stem Cell Transplant Patients

Cited by 67 publications

References 21 publications

The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country

The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country

Cepas E-ESKAPE multidrogorresistentes aisladas en hemocultivos de pacientes con cáncer

Bloodstream infections in neutropenic cancer patients: A practical update

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