Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections

BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.

Bloodstream Infections Caused by Enterococcus spp：A 10-year Retrospective Analysis at a Tertiary Hospital in China

In order to discover the risk factors for 30-day mortality in bloodstream infections（BSI） caused by Enterococcus spp.strains,we explored the clinical and therapeutic profile of patients with Enterococcus spp.BSI and the characteristics of this condition.A total of 64 patients with BSI caused by Enterococcus spp.who were treated in our hospital between 2006 and 2015 were included in the study.The clinical features of patients,microbiology,and 30-day mortality were collected from the electronic medical records database and analyzed.The results showed that there were 38 patients infected by Enterococcus faecalis（E.faecalis）,24 by Enterococcus faecium（E.faecium）,1 by Enterococcus casseliflavus（E.casseliflavus）,and 1 by Enterococcus gallinarum（E.gallinarum）.A Charlson comorbidity score ≥5,corticosteroid treatment,placement of catheters or other prosthetic devices and history of antibiotic use were found more frequently in E.faecium BSI patients than in E.faecalis patients（P=0.017,P=0.027,P=0.008 and P=0.027,respectively）.Furthermore,the univariate and multivariate analysis showed that corticosteroid treatment（OR=17.385,P=0.008）,hospital acquisition（OR=16.328,P=0.038）,and vascular catheter infection（OR=14.788,P=0.025） were all independently associated with 30-day mortality.Our results indicate that E.faecalis and E.faecium are two different pathogens with unique microbiologic characteristics,which cause different clinical features in BSI,and the empiric antimicrobial treatments are paramount for patients with enterococcal BSI.

Investigation and Analysis of the Status Quo of Prevention and Control Practices of Catheter-Line Associated Bloodstream Infections (CLABSI) in Guangxi, China

The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella Pneumoniae Bloodstream Infections in Wuhan,China

Objective:The clinical characteristics and microbiological data of patients with K.pneumoniae bloodstream infections(BSI)from January 2018 to December 2020 were retrospectively analyzed to study the molecular epidemiology of Carbapenem-resistant Klebsiella pneumoniae(CRKP).We also aimed to identify the risk factors for the development of CRKP BSI.Methods:This retrospective study was conducted at Renmin Hospital of Wuhan University from January 2018 to December 2020.The date of non-duplicate K.pneumoniae isolates isolated from blood samples was identified using the microbiology laboratory database.The data from patients diagnosed with K.pneumoniae BSI were collected and analyzed.

Trends of central line-associated bloodstream infections in the intensive care unit in the Kingdom of Bahrain:Four years’experience

BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.

Bloodstream infections in the era of the COVID-19 pandemic: Changing epidemiology of antimicrobial resistance in the intensive care unit

The Coronavirus disease 2019(COVID-19)pandemic increased the burden of critically ill patients who required hospitalization in the intensive care unit(ICU).Bacterial and fungal co-infections,including bloodstream infections(BSIs),increased significantly in ICU patients with COVID-19;this had a significant negative impact on patient outcomes.Reported data pertaining to BSI episodes from the ICU setting during the COVID-19 pandemic were collected and analyzed for this narrative review.We searched the PubMed database for articles published between March 2020 and October 2023;the terms“COVID-19”AND“bloodstream infections”AND“ICU”were used for the search.A total of 778 articles were retrieved;however,only 27 were exclusively related to BSIs in ICU patients with COVID-19.Data pertaining to the epidemiological characteristics,risk factors,characteristics of bacterial and fungal BSIs,patterns of antimicrobial resistance,and comparisons between ICU and non-ICU patients during and before the COVID-19 pandemic were obtained.Data on antimicrobial stewardship and infection-control policies were also included.The rates of BSI were found to have increased among ICU patients with COVID-19 than in non-COVID-19 patients and those admitted during the pre-pandemic period.Male gender,60–70 years of age,increased body mass index,high Sequential Organ Failure Assessment scores at admission,prolonged hospital and ICU stay,use of central lines,invasive ventilation,and receipt of extracorporeal membrane oxygenation were all defined as risk factors for BSI.The use of immune modulators for COVID-19 appeared to increase the risk of BSI;however,the available data are conflicting.Overall,Enterococci,Acinetobacter baumannii,and Candida spp.emerged as prominent infecting organisms during the pandemic;along with Enterobacterales and Pseudomonas aeruginosa they had a significant impact on mortality.Multidrug-resistant organisms prevailed in the ICU,especially if antimicrobial resistance was established before the COVID-19 pandemic and were significantly associated with increased mortality rates.The unnecessary and widespread use of antibiotics further increased the prevalence of multidrug-resistant organisms during COVID-19.Notably,the data indicated a significant increase in contaminants in blood cultures;this highlighted the decline in compliance with infection-control measures,especially during the initial waves of the pandemic.The implementation of infection-control policies along with antibiotic stewardship succeeded in significantly reducing the rates of blood contamination and BSI pathogens.BSIs considerably worsened outcomes in patients with COVID-19 who were admitted to ICUs.Further studies are needed to evaluate adequate preventive and control measures that may increase preparedness for the future.

Urgent call for attention to diabetes-associated hospital infections

In this editorial,we discuss the recent article by Zhao et al published in the World Journal of Diabetes,which highlights the importance of recognizing the risk indicators associated with diabetes mellitus(DM).Given the severe implications of healthcare-associated infections(HAIs)in hospitalized individuals-such as heightened mortality rates,prolonged hospitalizations,and increased costs-we focus on elucidating the connection between DM and nosocomial infections.Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection,with some already harboring co-infections upon admission.Notably,DM is an important risk factor for nosocomial urinary tract infections and surgical site infections,which may indirectly affect the occurrence of nosocomial bloodstream infections,especially in patients with DM with poor glycemic control.Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive,attention to this potential association is warranted.Hospitalized patients with DM should prioritize meticulous blood glucose management,adherence to standard operating procedures,hand hygiene practices,environmental disinfection,and rational use of drugs during hospitalization.Further studies are imperative to explore the main risk factors of HAIs in patients with DM,enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.

Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock

BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock.AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit.METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited.Patient population characteristics and laboratory data were collected for analysis.RESULTS The study group consisted of 85(39%)inpatients with bloodstream infection,and the control group consisted of 133(61%)with negative results or contamination.The percentage decline in platelet counts(PPCs)in patients positive for pathogens[57.1(41.3-74.6)]was distinctly higher than that in the control group[18.2(5.1–43.1)](P<0.001),whereas the PPCs were not significantly different among those with gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.Using receiver operating characteristic curves,the area under the curve of the platelet drop rate was 0.839(95%CI:0.783-0.895).CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock.However,it cannot identify gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.

The epidemiology of bloodstream infections in Fuxing Hospital in 2012 in Beijing

Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections(BSIs)in a tertiary hospital.MethodsPositive blood cultures were obtained from the microbiological laboratory in Fuxing Hospital,Capital Medical University from January 1,2012 to December 31,2012.

Clinical Characteristics of Bloodstream Infections in Pediatric Acute Leukemia： A Single-center Experience with 231 Patients

Background：Acute leukemia is the most common pediatric hematological malignancy.Bloodstream infections （BSIs） are severe complications in these patients during chemotherapy.This study aimed to explore the clinical presentation and etiology of BSI,as well as the common sites of infection,and to provide a basis for the rational regarding antibiotic use.Methods：We performed a retrospective chart review of all pediatric patients who had acute leukemia accompanied by a BSI in our hospital from December 2011 to September 2015.All patients were selected based on clinical presentation and had to have at least one positive blood culture for inclusion.The basic clinical characteristics,blood culture results,and antimicrobial susceptibilities were analyzed.Results：All 231 patients had a fever;of them,12 patients continued to have a fever.Twenty-five patients had nonremitting （NR） leukemia,and 206 patients achieved complete remission （CR）.Differences in the duration of fever between the NR and CR groups were significant （9.6 ＆#177; 7.9 vs.5.1 ＆#177; 3.8 days,P =0.016）.One hundred and eighty patients had agranulocytosis.Differences in fever duration between the agranulocytosis and nonagranulocytosis groups were significant （6.2 ＆#177; 5.1 vs.4.1 ＆#177; 2.6 days,P =0.001）.The other sites of infection in these 231 patients were the lung,mouth,digestive tract,and rectum.Blood culture comprised 2635 samples.There were 619 samples,which were positive.Of the 619 positive blood culture samples,59.9% had Gram-negative bacteria,39.3% had Gram-positive bacteria,and 0.8% had fungus.The primary pathogens were Pseudomonas aeruginosa,Enterobactercloacae,Escherichia coli,and Klebsiella pneumoniae.Of these 231 patients,217 patients were cured.The effective treatment ratio was 94%.Conclusions：Gram-negative bacteria were the main pathogenic bacteria in patients with acute leukemia in our center.NR primary illness,agranulocytosis,and drug-resistant pathogenic bacteria were all risk factors for poor prognosis.

Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

In many traditional Chinese medicine （TCM） hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections （nBSIs） are an important cause of morbidity and mortality. A retrospective sur- veillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions Escherichia coli （25.5%） was the most common Gram-negative and coagulase-negative staphylococcus （CONS） （14.1%） was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsie/la pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glyco- peptide were the most frequently used for nBSI therapy. Only about one-third of patients （157/482） received appro- priate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score 〉4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.

Analysis of Clinical Characteristics and Risk Factors of Pseudomonas aeruginosa Bloodstream Infection in 55 Cases

Objective: Pseudomonas aeruginosa bloodstream infection presents a severe challenge to hospitalized patients. To investigate the clinical characteristics, risk factors and drug resistance of Pseudomonas aeruginosa bloodstream infection. Methods: Clinical data and laboratory results of patients with Pseudomonas aeruginosa bloodstream infection in the First Affiliated Hospital of Yangtze University from January 2019 to December 2022 were retrospectively analyzed. The factors associated with infection and death were analyzed by univariate analysis. Results: A total of 55 patients were enrolled in this study, The 28-day mortality rate was 14.5%. Univariate analysis showed that high procalcitonin, low albumin, ICU admission, central venous catheterization, indwelling catheter, and mechanical ventilation were associated with death. Multivariate Logistic regression analysis showed that hypoproteinemia and central venous catheters were independent risk factors for death in patients with Pseudomonas aeruginosa bloodstream infection. Conclusions: The drug resistance of P. aeruginosa bloodstream infection is not high, but the fatality rate is high. The combination of hypoalbuminemia after the onset of the disease and the use of central vein catheters can lead to increased mortality, suggesting that clinical identification of high-risk patients as early as possible, reducing the use of catheters, preventing the occurrence of P. aeruginosa bloodstream infection and improving the prognosis.

Clinical and microbiological features of community-acquired and nosocomial bloodstream infections in the surgical department of a tertiary-care hospital in Beijing

Background Bloodstream infections （BSls） remain a major cause of morbidity and mortality in patients undergoing surgery. This study aimed at elucidating the clinical characteristics of community-acquired BSIs （CABs） and nosocomial BSIs （nBSIs） in patients admitted to the surgical wards of a teaching hospital in Beijing, China. Methods This cross-sectional study compared 191 episodes of BSIs in 4074 patients admitted to the surgical wards between January 2008 and December 2011. Cases of BSIs were classified as CABs or nBSIs, and the characteristics, relevant treatments, and outcomes of CABs and nBSIs were compared. Results Of the 191 BSIs, 52 （27.2%） and 139 （72.8%）were CABs and nBSIs, respectively. Escherichia coli, coagulasenegative staphylococci, and Klebsiella spp, were the most frequently isolated microorganisms. There were significant differences between CABs and nBSIs with respect to the use of hormonal drugs, ventilation, acute physiology and chronic health evaluation （APACHE） Ⅱand American Society of Anesthesiologists scores, and prevalence of cancer （P 〈0.05）. Empirical antibacterial therapy did not decrease the crude mortality, but multivariate analysis showed that high APACHE Ⅱwas independently associated with a risk of mortality （odds ratio =0.97, 95% confidence interval： 0.93-1.02 for APACHE Ⅱ）. Conclusions We found significant differences in the clinical characteristics of surgical patients with CABs and nBSIs. The outcome of patients seems to be related to hiah APACHE Ⅱ scores.

Study on the Risk Factors of Central Venous-Related Bloodstream Infection in Outpatients

Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted central catheter(PICC)from January 2020 to December 2021 were selected for retrospective analysis,and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis.Results:The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%.It was found that age,duration of catheterization,catheter site,number of punctures,and diabetes were all risk factors for catheter-associated bloodstream infection,and the differences were statistically significant.Conclusion:Age,duration of catheterization,catheterization site,and diabetes are all risk factors for catheter-related bloodstream infection,and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection.

Cefoperazone-sulbactam and ornidazole for Gardnerella vaginalis bloodstream infection after cesarean section:A case report

BACKGROUND Gardnerella vaginalis(G.vaginalis)is a facultative anaerobic bacteria known to cause bloodstream infections.However,cases are very rare in clinics.There is very limited clinical experience in the treatment of bloodstream infections caused by G.vaginalis.Therefore,there is an urgent need for effective antibacterial drugs to treat patients with bloodstream infections caused by G.vaginalis.CASE SUMMARY A woman who underwent a cesarean section presented with a sudden onset of high fever 1-d post-surgery.The blood cultures suggested an infection due to G.vaginalis,and treatment with cefoperazone-sulbactam was started.After 5 d of treatment,there was a decrease in the hemogram;however,the temperature and C-reactive protein levels remained high.Based on clinical experience and a review of literature,the treatment was modified to include ornidazole in combination with cefoperazone-sulbactam.Following a week of treatment,the temperature,hemogram and C-reactive protein levels returned to normal,and blood cultures turned negative,suggesting a therapeutic effect of the combination treatment.CONCLUSION This case highlighted the effective use of cefoperazone-sulbactam combined with ornidazole for bloodstream infection caused by G.vaginalis following a cesarean section.

Establishment of a Multiplex Detection Method for Common Bacteria in Blood Based on Human Mannan-Binding Lectin Protein-Conjugated Magnetic Bead Enrichment Combined with Recombinase-Aided PCR Technology

Objective Recombinase-aided polymerase chain reaction(RAP)is a sensitive,single-tube,two-stage nucleic acid amplification method.This study aimed to develop an assay that can be used for the early diagnosis of three types of bacteremia caused by Staphylococcus aureus(SA),Pseudomonas aeruginosa(PA),and Acinetobacter baumannii(AB)in the bloodstream based on recombinant human mannanbinding lectin protein(M1 protein)-conjugated magnetic bead(M1 bead)enrichment of pathogens combined with RAP.Methods Recombinant plasmids were used to evaluate the assay sensitivity.Common blood influenza bacteria were used for the specific detection.Simulated and clinical plasma samples were enriched with M1 beads and then subjected to multiple recombinase-aided PCR(M-RAP)and quantitative PCR(qPCR)assays.Kappa analysis was used to evaluate the consistency between the two assays.Results The M-RAP method had sensitivity rates of 1,10,and 1 copies/μL for the detection of SA,PA,and AB plasmids,respectively,without cross-reaction to other bacterial species.The M-RAP assay obtained results for<10 CFU/mL pathogens in the blood within 4 h,with higher sensitivity than qPCR.M-RAP and qPCR for SA,PA,and AB yielded Kappa values of 0.839,0.815,and 0.856,respectively(P<0.05).Conclusion An M-RAP assay for SA,PA,and AB in blood samples utilizing M1 bead enrichment has been developed and can be potentially used for the early detection of bacteremia.

Adding vortexing to the Maki technique provides no benefit for the diagnosis of catheter colonization or catheter-related bacteremia

BACKGROUND A previous study compared vortexing and Maki techniques for the diagnosis of catheter-related bloodstream infection(CRBSI),and concluded that vortexing was not superior to Maki method.AIM To determine whether the combined use of vortexing and Maki techniques provides profitability versus the Maki technique for the diagnosis of catheter tip colonization(CTC)and CRBSI.METHODS Observational and prospective study carried out in an Intensive Care Unit.Patients with suspected catheter-related infection(CRI)and with one central venous catheter for at least 7 days were included.The area under the curve(AUC)of the Maki technique,the vortexing technique and the combination of both techniques for the diagnosis of CTC and CRBSI were compared.RESULTS We included 136 episodes of suspected CRI.We found 21 cases of CTC of which 10 were also CRBSI cases.Of the 21 CTC episodes,18(85.7%)were diagnosed by Maki technique and vortexing technique,3(14.3%)only by the technique of Maki,and none only by technique of vortexing.Of the 10 CRBSI episodes,9(90.0%)were diagnosed by the techniques of Maki and vortexing,1(10.0%)was diagnosed only by the technique of Maki,and none only by the technique of vortexing.We no found differences in the comparison of AUC between the technique of Maki and the combination of Maki and vortexing techniques for the diagnosis of CTC(P=0.99)and CRBSI(P=0.99).CONCLUSION The novel finding of our study was that the combined use of vortexing and Maki techniques did not provide profitability to the technique of Maki alone to CRBSI diagnosis of.

High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient.Few studies are available on the management of immunosuppression(IS)treatment in the liver transplant(LT)recipients complicated with infection.The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection(BSI)in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery,Renji Hospital from January 1,2016 through December 31,2017.All recipients diagnosed with BSI after LT were included.Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial(GNB)infection.RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients,including 45 episodes of Gram-positive bacterial(GPB)infections in 42 patients and 29 episodes of GNB infections in 28 patients.Overall,IS reduction(at least 50%dose reduction or cessation of one or more immunosuppressive agent)was made in 28(41.2%)cases,specifically,in 5(11.9%)cases with GPB infections and 23(82.1%)cases with GNB infections.The 180 d all-cause mortality rate was 18.5%(13/70).The mortality rate in GNB group(39.3%,11/28)was significantly higher than that in GPB group(4.8%,2/42)(P=0.001).All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal,but the deaths in GPB group were all due to graft-versus-host disease.GNB group was associated with significantly higher incidence of intra-abdominal infection,IS reduction,and complete IS withdrawal than GPB group(P<0.05).Cox regression showed that rejection(adjusted hazard ratio 7.021,P=0.001)and complete IS withdrawal(adjusted hazard ratio 12.65,P=0.019)were independent risk factors for 30 d mortality in patients with GNB infections after LT.CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients.Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.

Bloodstream Infection with Carbapenem-resistant Klebsiella Pneumoniae and Multidrug-resistant Acinetobacter Baumannii:a Case Report

IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic shock. As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients, the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous antibacterial use are factors that promote the spread of multi-drug resistant pathogens, and the possibility of co-existing multi-drug resistant pathogens should be suspected when treating patients with these risk factors who developed refractory shock. Here we present a case with neutropenic fever and refractory shock whose blood culture yielded multi-drug resistant Acinetobacter baumannii and carbapenem- resistant Klebsiella pneumoniae.

Assessment of pathogens and risk factors associated with bloodstream infection in the year after pediatric liver transplantation

BACKGROUND Bloodstream infection(BSI)is one of the most significantly adverse events that can occur after liver transplantation(LT)in children.AIM To analyze the profile of BSI according to the postoperative periods and assess the risk factors after pediatric LT.METHODS Clinical data,collected from medical charts of children(n=378)who underwent primary LT,were retrospectively reviewed.The primary outcome considered was BSI in the first year after LT.Univariate and multivariate analyses were performed to identify risk factors for BSI and respective odds ratios(ORs).RESULTS Of the examined patients,106(28%)experienced 162 episodes of pathogen-confirmed BSI during the first year after LT.There were 1.53±0.95 episodes per children(mean±SD)among BSIcomplicated patients with a median onset of 0.4 mo post-LT.The most common pathogenic organisms identified were Coagulase-negative staphylococci,followed by Enterococcus spp.and Streptococcus spp.About half(53%)of the BSIs were of unknown origin.Multivariate analysis demonstrated that young age(≤1.3 year;OR=2.1,P=0.011),growth failure(OR=2.1,P=0.045),liver support system(OR=4.2,P=0.008),and hospital stay of>44 d(OR=2.3,P=0.002)were independently associated with BSI in the year after LT.CONCLUSION BSI was frequently observed in patients after pediatric LT,affecting survival outcomes.The profile of BSI may inform clinical treatment and management in high-risk children after LT.