1.Bloodstream Infections and Clinical Significance of Healthcare-associated Bacteremia: A Multicenter Surveillance Study in Korean Hospitals.
Jun Seong SON ; Jae Hoon SONG ; Kwan Soo KO ; Joon Sup YEOM ; Hyun Kyun KI ; Shin Woo KIM ; Hyun Ha CHANG ; Seong Yeol RYU ; Yeon Sook KIM ; Sook In JUNG ; Sang Yop SHIN ; Hee Bok OH ; Yeong Seon LEE ; Doo Ryeon CHUNG ; Nam Yong LEE ; Kyong Ran PECK
Journal of Korean Medical Science 2010;25(7):992-998
Recent changes in healthcare systems have changed the epidemiologic paradigms in many infectious fields including bloodstream infection (BSI). We compared clinical characteristics of community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA) BSI. We performed a prospective nationwide multicenter surveillance study from 9 university hospitals in Korea. Total 1,605 blood isolates were collected from 2006 to 2007, and 1,144 isolates were considered true pathogens. HA-BSI accounted for 48.8%, CA-BSI for 33.2%, and HCA-BSI for 18.0%. HA-BSI and HCA-BSI were more likely to have severe comorbidities. Escherichia coli was the most common isolate in CA-BSI (47.1%) and HCA-BSI (27.2%). In contrast, Staphylococcus aureus (15.2%), coagulase-negative Staphylococcus (15.1%) were the common isolates in HA-BSI. The rate of appropriate empiric antimicrobial therapy was the highest in CA-BSI (89.0%) followed by HCA-BSI (76.4%), and HA-BSI (75.0%). The 30-day mortality rate was the highest in HA-BSI (23.0%) followed by HCA-BSI (18.4%), and CA-BSI (10.2%). High Pitt score and inappropriate empirical antibiotic therapy were the independent risk factors for mortality by multivariate analysis. In conclusion, the present data suggest that clinical features, outcome, and microbiologic features of causative pathogens vary by origin of BSI. Especially, HCA-BSI shows unique clinical characteristics, which should be considered a distinct category for more appropriate antibiotic treatment.
Adult
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Aged
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Anti-Bacterial Agents/therapeutic use
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Bacteremia/drug therapy/*epidemiology/microbiology/mortality
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Community-Acquired Infections/drug therapy/*epidemiology/microbiology/mortality
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Cross Infection/drug therapy/*epidemiology/microbiology/mortality
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Humans
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Korea/epidemiology
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Male
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Middle Aged
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Prospective Studies
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Risk Factors
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Treatment Outcome
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Young Adult
2.Risk Factors for Mortality in Patients with Serratia marcescens Bacteremia.
Sun Bean KIM ; Yong Duk JEON ; Jung Ho KIM ; Jae Kyoung KIM ; Hea Won ANN ; Heun CHOI ; Min Hyung KIM ; Je Eun SONG ; Jin Young AHN ; Su Jin JEONG ; Nam Su KU ; Sang Hoon HAN ; Jun Yong CHOI ; Young Goo SONG ; June Myung KIM
Yonsei Medical Journal 2015;56(2):348-354
PURPOSE: Over the last 30 years, Serratia marcescens (S. marcescens) has emerged as an important pathogen, and a common cause of nosocomial infections. The aim of this study was to identify risk factors associated with mortality in patients with S. marcescens bacteremia. MATERIALS AND METHODS: We performed a retrospective cohort study of 98 patients who had one or more blood cultures positive for S. marcescens between January 2006 and December 2012 in a tertiary care hospital in Seoul, South Korea. Multiple risk factors were compared with association with 28-day all-cause mortality. RESULTS: The 28-day mortality was 22.4% (22/98 episodes). In a univariate analysis, the onset of bacteremia during the intensive care unit stay (p=0.020), serum albumin level (p=0.011), serum C-reactive protein level (p=0.041), presence of indwelling urinary catheter (p=0.023), and Sequential Oran Failure Assessment (SOFA) score at the onset of bacteremia (p<0.001) were significantly different between patients in the fatal and non-fatal groups. In a multivariate analysis, lower serum albumin level and an elevated SOFA score were independently associated with 28-day mortality [adjusted odds ratio (OR) 0.206, 95% confidential interval (CI) 0.044-0.960, p=0.040, and adjusted OR 1.474, 95% CI 1.200-1.810, p<0.001, respectively]. CONCLUSION: Lower serum albumin level and an elevated SOFA score were significantly associated with adverse outcomes in patients with S. marcescens bacteremia.
Adult
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Aged
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Aged, 80 and over
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Anti-Bacterial Agents/therapeutic use
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Bacteremia/drug therapy/microbiology/*mortality
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Cross Infection/mortality
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Female
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Humans
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Intensive Care Units
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Male
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Middle Aged
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Multiple Organ Failure
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Republic of Korea/epidemiology
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Retrospective Studies
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Risk Factors
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Serratia Infections/diagnosis/drug therapy/*mortality
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Serratia marcescens/drug effects/*isolation & purification
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Severity of Illness Index
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Survival Rate
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Time Factors
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Treatment Outcome
3.Independent predictors for mortality in patients with positive Stenotrophomonas maltophilia cultures.
Andrea L H KWA ; Jenny G H LOW ; Tze Peng LIM ; Pay Chin LEOW ; Asok KURUP ; Vincent H TAM
Annals of the Academy of Medicine, Singapore 2008;37(10):826-830
INTRODUCTIONStenotrophomonas maltophilia is an emerging pathogen in nosocomial infections that may result in high mortality. S. maltophilia often present as part of a polymicrobial culture and it is not well established when treatment is indicated. We aimed to identify predictors of mortality in patients with positive cultures of S. maltophilia.
MATERIALS AND METHODSA retrospective cohort study in a tertiary care medical centre was performed in 150 adult patients with positive cultures of S. maltophilia. Patients' demographics, underlying diseases, severity of illness, length of hospitalisation, prior antibiotic exposure, number/types of indwelling catheters, culture sites, and appropriateness of empiric therapy were collected. Logistic regression was used to determine the independent risk factor(s) for infection-attributed mortality.
RESULTSNinety-nine males and 51 females were studied. The mean (SD) age and APACHE II score of the patients were 61.9 (16.0) and 14.0 (6.1), respectively. The respiratory tract was the most frequent site (55.3%) where S. maltophilia was isolated. Infection-attributed mortality was observed in 22 of the 150 patients (14.7 %). Admission to ICU [Odds ratio (OR), 3.767; 95% confidence interval (CI), 1.277-11.116, P = 0.016], and delayed effective treatment (OR, 18.684; 95% CI, 4.050-86.188; P <0.001) were identified as independent risk factors for mortality.
CONCLUSIONSPredictors of mortality in patients with positive cultures of S. maltophilia were identified, which may guide clinicians in patient assessment and devising therapeutic decisions. Further studies are needed to validate our results.
APACHE ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents ; therapeutic use ; Cohort Studies ; Confidence Intervals ; Cross Infection ; drug therapy ; mortality ; Female ; Gram-Negative Bacterial Infections ; drug therapy ; mortality ; Humans ; Intensive Care Units ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Respiratory System ; microbiology ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Stenotrophomonas maltophilia ; drug effects ; isolation & purification ; Treatment Outcome ; Trimethoprim, Sulfamethoxazole Drug Combination ; therapeutic use