RESUMEN

OBJECTIVES: To assess the clinical features, risk factors, molecular epidemiology and outcome of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) bacteraemia in hospitalized cancer patients. METHODS: Episodes of ESBL-EC bacteraemia were compared with a susceptible control group in a 3 year prospective study. ESBL-EC strains were studied by PCR and isoelectric focusing, and molecular typing was performed by PFGE. RESULTS: Out of 531 episodes of bacteraemia, 135 were caused by E. coli. Seventeen of these cases involved ESBL-EC-producing strains (12.6%). In the multivariate analysis, female gender [odds ratio (OR) 3.43; 95% confidence interval (CI) 1.03-11.4] and previous antibiotic therapy (OR 3.22; 95% CI 1.00-10.3) were found to be independent risk factors for ESBL acquisition. An analysis of ESBL-EC isolates revealed a polyclonal distribution with CTX-M predominance (59%). Patients with ESBL-EC bacteraemia were more likely to have received an inadequate empirical antibiotic therapy (65% versus 6%; P = 0.000), and the time to adequate therapy was longer in this group (0 versus 1.50 days; P = 0.000). The overall mortality rate was 22%, ranging from 20% to 35% (P = 0.20). Risk factors for mortality were solid tumour (OR 19.41; 95% CI 4.66-80.83), corticosteroid therapy (OR 3.04 95% CI 1.05-8.81) and intensive care unit admission (OR 248.24, 95% CI 18.49-3332.14). In neutropenic patients, ESBL-EC bacteraemia was associated with poorer outcome and a higher overall mortality rate (37.5% versus 6.5%; P = 0.01). CONCLUSIONS: In our centre, ESBL-EC bacteraemia is frequent among cancer patients, especially in those exposed to antibiotic pressure. All ESBL-EC strains were unrelated and most of them carried a CTX-M group enzyme. Patients with ESBL-EC bacteraemia received inadequate empirical antibiotic therapy more frequently than patients carrying a susceptible strain, but significant differences in mortality could not be demonstrated.

Asunto(s)

Antibacterianos/uso terapéutico , Bacteriemia/epidemiología , Infecciones por Escherichia coli/epidemiología , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Neoplasias/complicaciones , beta-Lactamasas/biosíntesis , Adulto , Anciano , Bacteriemia/microbiología , Técnicas de Tipificación Bacteriana , Análisis por Conglomerados , Dermatoglifia del ADN , Electroforesis en Gel de Campo Pulsado , Escherichia coli/clasificación , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Factores de Riesgo , Resultado del Tratamiento

RESUMEN

La bacteriemia relacionada con catéteres (BRC) vasculares aumenta la morbimortalidad de los pacientes ingresados en la unidad de cuidados intensivos (UCI). La estrategia óptima para la prevención de la BRC no está bien definida. La comparación de las tasas de BRC con las facilitadas por programas como el National Nosocomial Infection Surveillance System de los EE. UU. o el Estudio Nacional de Vigilancia de Infección Nosocomial (ENVIN) permiten determinar la necesidad de aplicar medidas de control. En el año 2000 se detectaron tasas de BRC en las UCI del Hospital Universitario de Bellvitge muy por encima de las publicadas por el ENVIN. Objetivo Evaluar el impacto que tiene sobre las tasas de BRC la aplicación de un protocolo para el uso adecuado de catéteres intravasculares en una UCI. Metodología Estudio prospectivo de pacientes ingresados en las UCI de un hospital terciario en el período de mayo a junio durante los años 2000 a 2004. En el año 2001 se aplicó un programa de prevención de la BRC que incluía aspectos relacionados con la inserción y el mantenimiento del catéter en los pacientes de la UCI. Se calcularon las tasas de infección por 1.000 días de catéter en los diferentes períodos bimensuales y se compararon los resultados del año 2000 con los del año 2004 mediante el análisis de la odds ratio (OR) y de su intervalo de confianza (IC) (..) (AU)

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Introduction Catheter-related bloodstream infection (CR-BSI) is a cause of morbidity and mortality in intensive care units, and the optimal approach for preventing these infections is not well defined. Comparison of CR-BSI rates with those provided by programs such as the National Nosocomial Infection Surveillance System (NNISS) from the USA and the Spanish National Nosocomial Infection Surveillance Study (ENVIN), enable determination of the need to implement control measures. In 2000, we found that the CR-BSI rates in UCIs of our hospital were much higher than the data reported by ENVIN. Objective To assess the impact of implementing a protocol for proper use of intravascular catheters on CR-BSI rates in the intensive care unit (ICU) of a tertiary hospital. Methods Prospective study of patients admitted to the ICUs of a tertiary hospital in the months of May and June, from 2000 to 2004. In 2001, a CR-BSI prevention program including aspects related to catheter insertion and maintenance in ICU patients was implemented. We calculated infection rates per 1000 days of catheter use in all the 2-month periods studied, and compared the 2000 and 2004 results by analysis of the odds ratios and confidence intervals. Results A total of 923 patients were included. Mean age was 58.7 years (SD: 15.4), mean ICU stay was 11.6 days (SD: 11.4), mean SAPSII was 28.2 (SD: 15.9), and mortality was 20.5%. There was a significant reduction in CR-BSI rates from 13.3 episodes per 1000 days of catheter use in the first period to 3.21 in the last period (OR=3.53, 95% CI: 2.36–5.31).Conclusions Application of a prevention program for CR-BSI and a system for monitoring BSI rates led to a significant, sustained reduction in these infections (AU)

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Bacteriemia/prevención & control , Infección Hospitalaria/prevención & control , Unidades de Cuidados Intensivos/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Antibacterianos/administración & dosificación , Infección Hospitalaria/epidemiología , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , España/epidemiología

RESUMEN

INTRODUCTION: Catheter-related bloodstream infection (CR-BSI) is a cause of morbidity and mortality in intensive care units, and the optimal approach for preventing these infections is not well defined. Comparison of CR-BSI rates with those provided by programs such as the National Nosocomial Infection Surveillance System (NNISS) from the USA and the Spanish National Nosocomial Infection Surveillance Study (ENVIN), enable determination of the need to implement control measures. In 2000, we found that the CR-BSI rates in UCIs of our hospital were much higher than the data reported by ENVIN. OBJECTIVE: To assess the impact of implementing a protocol for proper use of intravascular catheters on CR-BSI rates in the intensive care unit (ICU) of a tertiary hospital. METHODS: Prospective study of patients admitted to the ICUs of a tertiary hospital in the months of May and June, from 2000 to 2004. In 2001, a CR-BSI prevention program including aspects related to catheter insertion and maintenance in ICU patients was implemented. We calculated infection rates per 1000 days of catheter use in all the 2-month periods studied, and compared the 2000 and 2004 results by analysis of the odds ratios and confidence intervals. RESULTS: A total of 923 patients were included. Mean age was 58.7 years (SD: 15.4), mean ICU stay was 11.6 days (SD: 11.4), mean SAPSII was 28.2 (SD: 15.9), and mortality was 20.5%. There was a significant reduction in CR-BSI rates from 13.3 episodes per 1000 days of catheter use in the first period to 3.21 in the last period (OR=3.53, 95% CI: 2.36-5.31). CONCLUSIONS: Application of a prevention program for CR-BSI and a system for monitoring BSI rates led to a significant, sustained reduction in these infections.

Asunto(s)

Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/prevención & control , Hospitales Universitarios/estadística & datos numéricos , Control de Infecciones/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Adulto , Anciano , Antibacterianos/administración & dosificación , Bacteriemia/epidemiología , Bacteriemia/etiología , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/etiología , Cateterismo/estadística & datos numéricos , Intervalos de Confianza , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Femenino , Humanos , Control de Infecciones/estadística & datos numéricos , Comunicación Interdisciplinaria , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Gestión de Riesgos , España/epidemiología

RESUMEN

Clinical characteristics, etiologies, evolution, and prognostic factors of community-acquired bacterial meningitis in elderly patients are not well known. To improve this knowledge, all episodes of community-acquired bacterial meningitis were prospectively recorded and cases occurring in patients >or=65 years old were selected. During the period 1977-2006, 675 episodes in adults (aged >or=18 yr) were recorded, with 185 (27%) in patients aged >or=65 years old; 76 were male and 109 were female, with a mean age of 73 +/- 6 years (range, 65-93 yr). Causative microorganisms were Streptococcus pneumoniae 74, Neisseria meningitidis 49, Listeria monocytogenes 17, other streptococcal 9, Escherichia coli 6, Haemophilus influenzae 4, Klebsiella pneumoniae and Staphylococcus aureus 2 each, Capnocytophaga canimorsus and Enterococcus faecalis 1 each, and unknown in 20. On admission 91% had had fever, 32% were in a coma (Glasgow Coma Scale or=65 yr), who showed a higher frequency of diabetes and malignancy as underlying disease; pneumonia, otitis, and pericranial fistula as predisposing factors; and S. pneumoniae and L. monocytogenes as etiology. There were also differences in clinical presentation, complications, sequelae, and mortality. Factors independently related with mortality were age, pneumonia as a predisposing factor, coma on admission, and heart failure and seizures after therapy. Dexamethasone therapy was a protective factor. In conclusion, bacterial meningitis in elderly patients is associated with greater diagnostic difficulties and neurologic severity and more complications, as well as with increased mortality. Antiseizure prophylaxis might be useful in these patients.

Asunto(s)

Meningitis Bacterianas/epidemiología , Meningitis Bacterianas/microbiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Coma/epidemiología , Coma/microbiología , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Diabetes Mellitus/epidemiología , Femenino , Fiebre/epidemiología , Fiebre/microbiología , Fístula/epidemiología , Hemorragia Gastrointestinal/epidemiología , Escala de Coma de Glasgow , Insuficiencia Cardíaca/epidemiología , Humanos , Hipernatremia/epidemiología , Masculino , Análisis Multivariante , Neoplasias/epidemiología , Otitis/epidemiología , Neumonía/epidemiología , Pronóstico , Estudios Prospectivos , Insuficiencia Renal/epidemiología , Convulsiones/epidemiología , Convulsiones/microbiología , Choque/epidemiología , Choque/microbiología , España/epidemiología

RESUMEN

We reviewed 75 episodes of Aeromonas spp. bacteraemia observed at our institution in 1979-2002, with special reference to episodes occurring in elderly patients (> or = 65 y) and to nosocomial episodes. In addition, we compared monomicrobial bacteraemic episodes caused by Aeromonas spp. (n = 54) with those caused by Escherichia coli (n = 108) and Pseudomonas aeruginosa (n = 108), to assess differences in clinical presentation and outcome. The 75 episodes of Aeromonas spp. bacteraemia occurred mainly in males (72%), suffering from chronic liver disease (36%) or neoplasm (33%). They had an abdominal origin in 52% of cases, were recorded as primary bacteraemia in 40%, and showed a 30-d case fatality rate of 36%. 22 episodes (29%) were nosocomial, 36 (48%) occurred in elderly patients and 21 (28%) were polymicrobial infections. In comparison with Aeromonas spp., E. coli bacteraemia was more often associated with less severe underlying conditions, a community-acquired infection (74%), and a urinary tract (52%) or abdominal (27%) origin and had a 30-d case fatality rate of 24%. P. aeruginosa bacteraemia occurred mainly in patients with severe underlying conditions, was associated with nosocomial infection (69%), and had a 30-d case fatality rate of 43%. In conclusion, Aeromonas spp. bacteraemia is a serious infection that should be considered in patients with chronic liver disease or neoplasm. It may occur in the elderly and as a nosocomial infection, and differs in clinical findings from bacteraemia due to other common pathogens.

Asunto(s)

Aeromonas/clasificación , Bacteriemia/epidemiología , Infecciones por Escherichia coli/epidemiología , Escherichia coli/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/epidemiología , Pseudomonas aeruginosa/aislamiento & purificación , Adolescente , Adulto , Aeromonas/aislamiento & purificación , Distribución por Edad , Anciano , Anciano de 80 o más Años , Bacteriemia/diagnóstico , Estudios de Cohortes , Infecciones por Escherichia coli/diagnóstico , Femenino , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Probabilidad , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Distribución por Sexo , España/epidemiología , Tasa de Supervivencia