Complicaciones en pacientes con catéter de hemodiálisis según sitio de inserción en hospital de referencia

Introducción: Más de dos millones de personas en el mundo reciben tratamiento sustitutivo renal; la infección sanguínea representa una amenaza significativa, siendo la segunda causa de muerte en estos pacientes. La tasa de supervivencia depende en gran medida del tipo de acceso vascular utilizado. Objetivo: Determinar las complicaciones en pacientes con catéter de hemodiálisis en relación al sitio de inserción. Materiales y Métodos: Estudio de cohorte prospectivo, analítico, con medición de la frecuencia de complicaciones de pacientes con catéter de hemodiálisis a nivel yugular y femoral. Las variables se obtuvieron de los expedientes clínicos de pacientes internados ≥18 años. Resultados: Se incluyeron 203 pacientes, 66,01% masculinos; una edad media de 52 ± 15 años. 123 pacientes portaban catéter yugular y 80 pacientes, femoral. La curación se realizó cada 3 ± 5 días. La duración media de catéteres antes de signos de infección fue 4 ± 4 semanas en femorales y 9 ± 12 semanas en yugulares. Las bacterias gram positivas predominaron en los hemocultivos; aquellos con acceso femoral presentaron bacteriemia en mayor porcentaje. El cultivo de punta de catéter presentó una baja sensibilidad. Pacientes con catéter femoral presentaron mayor frecuencia de complicaciones. De las complicaciones infecciosas, la más frecuente fue el choque séptico en los portadores de catéteres femorales 57,50% vs los yugulares 4,88%. Otros: endocarditis, 7,32% en yugulares vs 2,50% en femorales; y finalmente la espondilodiscitis, con un 7,50% en femorales. La mortalidad fue mayor en aquellos con catéter femoral, 35% vs 8,94% en yugulares. Conclusión: Se ha evidenciado que el catéter femoral presenta mayor incidencia de complicaciones como choque séptico y bacteriemia, directamente relacionado con mayor tasa de mortalidad.

Introduction: More than two million people in the world receive renal replacement treatment; Blood infection represents a significant threat, being the second cause of death in these patients. The survival rate depends largely on the type of vascular access used. Objective: Determine complications in patients with hemodialysis catheter in relation to the insertion site. Materials and Methods: Prospective, analytical cohort study, measuring the frequency of complications in patients with hemodialysis catheters at the jugular and femoral levels. The variables were obtained from the clinical records of hospitalized patients ≥18 years of age. Results: 203 patients were included, 66.01% male; an average age of 52 ± 15 years. 123 patients had a jugular catheter and 80 patients had a femoral catheter. Healing was carried out every 3 ± 5 days. The mean duration of catheters before signs of infection was 4 ± 4 weeks in femoral and 9 ± 12 weeks in jugular. Gram-positive bacteria predominated in blood cultures; those with femoral access had bacteremia in a higher percentage. Catheter tip culture had low sensitivity. Patients with a femoral catheter had a higher frequency of complications. Of the infectious complications, the most frequent was septic shock in those with femoral catheters 57.50% vs jugular catheters 4.88%. Others: endocarditis, 7.32% in jugular vs 2.50% in femoral; and finally spondylodiscitis, with 7.50% in femoral bones. Mortality was higher in those with a femoral catheter, 35% vs. 8.94% in jugular catheters. Conclusion: It has been shown that the femoral catheter has a higher incidence of complications such as septic shock and bacteremia, directly related to a higher mortality rate.

Ceftazidima/avibactam frente a otros antimicrobianos para el tratamiento de bacteriemias por Enterobacterales productores de carbapenemasa KPC: datos de la vida real en un hospital universitario de Argentina

Introducción: Las bacteriemias por Enterobacterales productores de carbapenemasa KPC (EPC-KPC) presentan una mortalidad elevada y opciones terapéuticas limitadas. Objetivos: Describir y comparar la evolución de los pacientes con bacteriemia por EPC-KPC tratados con ceftazidima/avibactam (CA) frente a otros antimicrobianos (OA). Pacientes y Métodos: Estudio prospectivo y retrospectivo de casos y controles. Se incluyeron pacientes adultos con bacteriemia por EPC-KPC, con una proporción entre casos tratados con CA y controles tratados con OA. de 1:2. Se analizaron variables clínicas, epidemiológicas y de evolución. Resultados: Se incluyeron 48 pacientes (16 CA y 32 OA). Los casos se encontraban más frecuentemente neutropénicos (50 vs.16%, p = 0,012); asimismo, presentaron medianas de score de APACHE II más altas y de score de Pitt más bajas. El 65% de la cohorte total presentó un foco clínico y Klebsiellapneumoniae fue el microorganismo más frecuentemente aislado. Los casos recibieron una mayor proporción de tratamiento antimicrobiano empírico adecuado (81 vs. 53%, p = 0,05). La antibioterapia dirigida en casos y controles fue combinada en 38 y 91%, p = 0,009. Los casos presentaron menor mortalidad al día 7 y al día 30 relacionada a infección (0 vs. 22%, p = 0,04 y 0 vs. 34%, p = 0,008). Solo los controles desarrollaron shock, ingresaron a la unidad de cuidados intensivos y presentaron bacteriemia de brecha. Conclusión: CA mostró beneficio clínico frente a OA para el tratamiento de pacientes con bacteriemia por EPC-KPC.

Background: KPC-producing Enterobacterales bacteremia (KPCCPE) is associated with a high mortality rate and limited therapeutic options. Aim: To describe and compare the outcome of patients with KPC-CPE bacteremia treated with ceftazidime/avibactam (CA) versus other antibiotics (OA). Methods: Prospective and retrospective cases and control study performed in adult patients with KPC-CPE bacteremia, with a 1:2 ratio between cases treated with CA. and controls treated with OA. Clinical, epidemiological, and outcome variables were analyzed. Results: Forty-eight patients (16 CA and 32 OA) were included. Cases were more frequently neutropenic (50 vs. 16%, p = 0.012), presented higher median APACHE II score and lower Pitt score. Of the total cohort, 65% had a clinical source, and Klebsiella pneumoniae was the most frequently isolated microorganism. Cases received more adequate empirical antibiotic treatment (81 vs. 53%, p = 0.05). Targeted antibiotic therapy in cases and controls was combined in 38 and 91%, p = 0.009. Cases had a lower 7-day mortality and 30-day infection-related mortality (0 vs. 22%, p = 0.04 and 0 vs. 34%, p = 0.008). Only controls developed shock, were admitted to the intensive care unit, and had breakthrough bacteremia. Conclusion: CA. showed clinical benefit over OA in the treatment of patients with EPC-KPC bacteremia.

Celulitis facial por Staphylococcus aureus con metástasis infecciosas y evolución tórpida. Caso pediátrico / Facial cellulitis due to Staphylococcus aureus with metastatic infection and torpid course. A pediatric case report

La bacteriemia por Staphylococcus aureus se define como el aislamiento de dicho germen en al menos un cultivo de sangre. Las metástasis infecciosas se originan por diseminación hematógena y su posterior localización en un sitio distinto al órgano en donde se originó el proceso infeccioso. La prevalencia en la presentación de estos focos infecciosos secundarios es baja en la edad pediátrica, por lo que representa un desafío diagnóstico. Se presenta el caso de un paciente pediátrico con una celulitis facial por Staphylococcus aureus, con metástasis infecciosas y evolución tórpida.

Bacteremia due to Staphylococcus aureus is defined as the isolation of this microorganism in at least one blood culture. A metastatic infection is caused by the hematogenous dissemination and subsequent location of the microorganism in a site other than the one where the infection started. The prevalence of these secondary sources of infection is low in the pediatric population, which is a diagnostic challenge. Here we describe the case of a pediatric patient with facial cellulitis due to Staphylococcus aureus, with metastatic infection and torpid course.

Bacteremia by non-O1/non-O139 Vibrio cholerae: Case description and literature review / Bacteriemia por Vibrio cholerae no-O1/no-O139: descripción de un caso y revisión de la literatura

Bacteremia by non-O1/non-O139 Vibrio cholerae is a rare entity associated with high mortality rates. We report a case of non-O1/non-O139 V. cholerae bacteremia confirmed by polymerase chain reaction and agglutination tests. The clinicoepidemiological characteristics and therapeutic options for this infection are also described.

La bacteriemia por Vibrio cholerae no-O1/no-O139 es una entidad poco frecuente que se asocia con altas tasas de mortalidad. Se reporta un caso de bacteriemia por V. cholerae no-O1/no-O139 confirmado por reacción en cadena de la polimerasa y test de aglutinación. Se describen las características clinicoepidemiológicas y las opciones terapéuticas para esta infección.

Bacteriemia por Clostridium tertium en un paciente con cirrosis hepática / Clostridium tertium bacteremia in patient with liver cirrhosis

Resumen Clostridium tertium es una bacteria de la familia Clos tridiaceae que se puede encontrar colonizando el tracto gastrointestinal. A diferencia de otros miembros de su familia, no produce exotoxinas. Fue descripto por prime ra vez en 1917 y en el año 1963 se pudo establecer como patógeno en humanos. Desde entonces, se han reportado casos principalmente en huéspedes inmunosuprimi dos, prevalentemente con foco primario abdominal. Se describe el caso de un hombre de 48 años de edad con antecedentes de cirrosis e infección por virus de la hepatitis C, presentó una hernia umbilical atascada que requirió resección y anastomosis intestinal, con cultivos de líquido abdominal y hemocultivos positivos para Clostridium tertium. Este caso es de importancia clínica por la baja prevalencia de este germen, la posibilidad de resistencia a los esquemas antibióticos usuales y de subdiagnóstico del microorganismo dada su similitud morfológica y de crecimiento con Bacillus o Lactobacillus.

Abstract Clostridium tertium is a bacterium of the Clostridiaceae family which can be found colonizing the gastrointes tinal tract. Unlike other members of its family, it does not produce exotoxins. It was described for the first time in 1917 and in 1963 it was established as a pathogen in humans. Since then, cases have been reported mainly in immunosuppressed hosts, predominantly with primary focus at the abdominal level. The case of a 48-year-old man with a history of cirrhosis and hepatitis C virus infection is described. He presented an obstructed um bilical hernia that required intestinal resection and anastomosis, with positive blood and abdominal fluid cultures for Clostridium tertium. This case is of clinical importance due to the low prevalence of this germ, the possibility of resistance to usual antibiotic regimens and its sub diagnostic given the morphological and growth similarities with Bacillus or Lactobacillus.

Shock séptico en niños con bacteriemia por Staphylococcus aureus de la comunidad en un hospital pediátrico de alta complejidad

Introducción: La información disponible sobre los factores de riesgo para el desarrollo de shock séptico es escasa, especialmente en población pediátrica. Objetivo: Describir las características epidemiológicas y clínicas de los niños con bacteriemia adquirida en la comunidad por Staphylococcus aureus y comparar las características de los pacientes con y sin shock séptico. Pacientes y Métodos: Estudio de cohorte retrospectivo. Criterios de inclusión: niños entre 30 días y 16 años de edad, internados en el Hospital de Pediatría Juan P. Garrahan entre enero de 2017 y diciembre de 2019 por infecciones adquiridas en la comunidad con desarrollo de S. aureus en hemocultivos. Criterios de exclusión: antecedente de internación dentro de los 3 meses previos al ingreso, vivir en una comunidad cerrada, presencia de catéter de larga permanencia, dispositivos intraventriculares o intraperitoneales. Análisis estadístico: STATA 16. Resultados: Se incluyeron 142 niños. 21 niños (15%) presentaron shock séptico. En el análisis multivariado, se asociaron con shock séptico, la bacteriemia persistente (OR 7,15; IC95% 4,39-23,81; p: 0,001) y el foco secundario de infección (OR 6,72; IC 95% 2,02-22,2; p 0,002). La mortalidad relacionada con la infección fue 3,5% (5 pacientes). Conclusiones: El shock séptico se asoció con la bacteriemia persistente y la presencia de focos secundarios de infección.

Background: Available information about risk factors for the development of septic shock is scarce, especially in the pediatric population. Aim: To describe the epidemiological and clinical characteristics of children with community-acquired Staphylococcus aureus bacteremia and to compare the characteristics of children with and without septic shock. Methods: Retrospective cohort study. Inclusion criteria: Children between 30 days and 16 years old, hospitalized in the Juan P. Garrahan Pediatric Hospital between January 2017 and December 2019 for community-acquired infections with S. aureus isolation in blood cultures. Exclusion criteria: History of hospitalization within 3 months prior to admission, living in a closed community, presence of long-term catheter, intraventricular or intraperitoneal devices. Statistical analysis: STATA 16. Results: 142 children were included. 21 children (15%) experienced septic shock. On multivariate analysis, persistent bacteremia (OR 7.15, 95% CI 4.39-23.81, p: 0.001) and secondary focus of infection (OR 6.72, 95% CI 2.02-22.2, p 0.002) were associated with septic shock. The infection-related mortality rate was 3.5% (5 patients). Conclusions: Septic shock was associated with persistent bacteremia and the presence of secondary foci of infection.

Identificación y sensibilidad antibiótica directas desde el hemocultivo positivo para bacilos gram negativos. Rendimiento comparativo de los sistemas Vitek 2C y Phoenix / Direct identification and susceptibility testing from positive blood cultures. A head-to-head performance comparison between Vitek 2C and Phoenix systems / Identificação e sensibilidade antibiótica diretas a partir da hemocultura positiva para bacilos gram negativos. Desempenho comparativo dos sistemas Vitek 2C e Phoenix

Resumen El objetivo de este estudio fue comparar los resultados de las pruebas de identificación y sensibilidad antimicrobiana obtenidos por los sistemas Vitek 2C (bioMérieux, Francia) y Phoenix (Becton Dickinson, EE.UU.) directamente a partir de hemocultivos positivos. Se realizó un estudio observacional prospectivo en el Hospital Naval Pedro Mallo de Buenos Aires, Argentina, que incluyó 70 bacteriemias monomicrobianas por gram negativos. Se obtuvo una identificación correcta por Vitek® 2C y por Phoenix del 100% y 97% respectivamente [p: no significativa (NS)]. La concordancia categórica para todos los antimicrobianos fue 97,1% y 98,1% (p: NS) con Vitek 2C y con Phoenix respectivamente. El tiempo medio para obtener un resultado fue de 10,19 h y 13,8 h (p: NS), respectivamente. Vitek 2C y Phoenix son herramientas importantes, rápidas y confiables para la identificación y las pruebas de sensibilidad realizadas directamente a partir de hemocultivos positivos.

Abstract The aim of this study was to compare the results of identification and antimicrobial susceptibility tests obtained by the Vitek 2C (bioMérieux, France) and Phoenix (Becton Dickinson, USA) systems directly from positive blood cultures. A prospective observational study was performed at the Pedro Mallo Navy Hospital in Buenos Aires, Argentina, which included 70 monomicrobial bacteremias by gram negative rods. Correct identification by Vitek® 2C and Phoenix was 100% and 97%, respectively [p: not significant (NS)]. Categorical agreement for all antimicrobials was 97.1% and 98.1% (p: NS) with Vitek 2C and Phoenix, respectively. The mean time to result was 10.19 h and 13.8 h (p: NS), respectively. Vitek 2C and Phoenix are important, rapid and reliable tools for identification and susceptibility testing when performed directly from positive blood cultures.

Resumo O objetivo deste estudo foi comparar os resultados dos testes de identificação e de suscetibilidade antimicrobiana obtidos pelos sistemas Vitek 2C (bioMérieux, França) e Phoenix (Becton Dickinson, EUA) diretamente a partir de culturas de sangue positivas. Foi realizado um estudo observacional prospectivo no Hospital Naval Pedro Mallo em Buenos Aires, Argentina, incluindo 70 bacteriemias monomicrobianas devido a gram negativos. A identificação correcta por Vitek® 2C e Phoenix obtida foi de 100% e 97% respectivamente [p: não significativo (NS)]. O acordo categórico para todos os antimicrobianos foi de 97,1% e 98,1% (p: NS) com Vitek 2C e Phoenix respectivamente. O tempo médio para obter o resultado foi de 10,19 h e 13,8 h (p: NS), respectivamente. Vitek 2C e Phoenix são ferramentas importantes, rápidas e fiáveis para a identificação e testes de sensibilidade realizados diretamente a partir de hemoculturas positivas.

Microorganismos aislados de hemocultivos en niños con leucemia y linforma: Seis años de seguimiento / Microorganisms isolated from blood cultures in children with leukemia and lymphoma: six years of follow-up

Las Leucemias y linfomas constituyen las enfermedades oncológicas más frecuentes en pediatría y las bacteriemias representan infecciones graves en estos pacientes. Objetivos: describir los microorganismos aislados de sangre en pacientes con leucemia aguda o linfoma pediátrico; comparar la incidencia de aislamientos según enfermedad de base; detallar las variaciones en la incidencia de dichos aislamientos y la evolución de su resistencia antimicrobiana. Estudio retrospectivo, observacional. Se incluyeron 823 episodios de bacteriemia en 467 pacientes pediátricos, entre julio-2016 y junio-2022, dividido en tres períodos (período-1: años 2016- 2018, período-2: años 2018-2020, período-3: años 2020-2022). Se aislaron 880 microorganismos: 55,3% gram negativos (GN), 40% gram positivos (GP) y 4,7% levaduras. En GN predominaron: enterobacterias (72%) y en GP: estreptococos del grupo viridans (SGV) (34,1%). Se encontró asociación entre LLA-enterobacterias (p=0,009) y LMA-SGV (p<0,001). Hubo aumento de GN entre los períodos 1 y 3 (p=0,02) y 2 y 3 (p=0,002) y disminución de GP entre 2 y 3 (p=0,01). Se registraron los siguientes mecanismos de resistencia: BLEE (16,4%), carbapenemasas: KPC (2,5%); MBL (2,7%) y OXA (0,2%); meticilinorresistencia en Staphylococcus aureus (20%) y estafilococos coagulasa negativos (95%), vancomicina resistencia en Enterococcus spp. (39%), SGV no sensibles a penicilina (44%) y a cefotaxima (13%). Hubo aumento de MBL entre los períodos 1 y 2 (p=0,02) y una tendencia en disminución de sensibilidad a penicilina en SGV entre el 1 y 3 (p=0,058). El conocimiento dinámico y análisis de estos datos es esencial para generar estadísticas a nivel local, fundamentales para el diseño de guías de tratamientos empíricos (AU)

Leukemias and lymphomas are the most common cancers in children and bacteremia is a severe infection in these patients. Objectives: to describe the microorganisms isolated from blood in pediatric patients with acute leukemia or lymphoma; to compare the incidence of isolates according to the underlying disease; and to detail the variations in the incidence of these isolates and the evolution of their antimicrobial resistance. Retrospective, observational study. We included 823 episodes of bacteremia in 467 pediatric patients seen between July-2016 and June-2022, divided into three periods (period-1: 2016- 2018, period-2: 2018-2020, period-3: 2020-2022). A total of 880 microorganisms were isolated: 55.3% were gram-negative (GN), 40% gram-positive (GP) and 4.7% yeasts. In GN there was a predominance of: enterobacteria (72%) and in GP viridans group streptococci (VGS) (34.1%). An association was found between ALL-enterobacteria (p=0.009) and AML-VGS (p<0.001). There was an increase in GN between periods 1 and 3 (p=0.02) and 2 and 3 (p=0.002) and a decrease in GP between 2 and 3 (p=0.01). The following resistance mechanisms were recorded: BLEE (16.4%), carbapenemases: KPC (2.5%), MBL (2.7%), and OXA (0.2%); methicillin resistance in Staphylococcus aureus (20%) and coagulase negative staphylococci (95%), vancomycin resistance in Enterococcus spp. (39%), VGS resistant to penicillin (44%) and to cefotaxime (13%). There was an increase in MBL between periods 1 and 2 (p=0.02) and a decreasing trend in penicillin sensitivity in VGS between periods 1 and 3 (p=0.058). Dynamic knowledge and analysis of these data is essential to generate statistics at the local level, which is fundamental for the design of empirical treatment guidelines (AU)

Bloodstream infection by Rhodococcus corynebacterioides in a pediatric patient diagnosed with high-risk retinoblastoma / Infección del torrente sanguíneo por Rhodococcus corynebacterioides en un paciente pediátrico con diagnóstico de retinoblastoma de alto riesgo

Abstract Rhodococcus is a pathogen that is known to cause infections in animals and humans, mainly in cases of immunocompromised patients. A case of a pediatric cancer patient suffering from a bloodstream infection caused by Rhodococcus corynebacterioides was described in this work. Gram positive rods were isolated from blood cultures. The target bacterium was identified using a combination of biochemical tests, the MALDI-TOF mass spectrometry technique, and the analysis of the 16S rRNA sequence. Moreover, an antimicrobial susceptibility test was performed using the E-test. The isolated bacterium was identified as R. corynebacterioides. The 3-year-old patient was successfully treated with vancomycin and meropenem. This is the first published report of R. corynebacterioides in a pediatric patient diagnosed with retinoblastoma that developed a bloodstream infection. R. corynebacterioides should be considered among the opportunistic infectious agents affecting pediatric cancer patients.

Resumen Rhodococcus es un patógeno conocido por causar infecciones en animales y humanos, principalmente en pacientes inmunocomprometidos. En este trabajo se describe el caso de un paciente pediátrico con cáncer que presentó una infección del torrente sanguíneo causada por Rhodococcus corynebacterioides. A partir de hemocultivos, se aislaron bacilos gram positivos. La bacteria diana fue identificada usando una combinación de pruebas bioquímicas, por espectrometría de masas MALDI-TOF y por el análisis de la secuencia del gen 16S ARNr. Además, se realizó una prueba de sensibilidad a los antimicrobianos utilizando E-test. La cepa bacteriana se identificó como R. corynebacterioides. El paciente, de 3 años, fue tratado con vancomicina y meropenem, exitosamente. Este es el primer reporte de R. corynebacterioides como agente causal de una infección del torrente sanguíneo en un paciente pediátrico con retinoblastoma. R. corynebacterioides debe considerarse entre los agentes infecciosos oportunistas que afectan a los pacientes pediátricos con cáncer.

Infectious endocarditis due to Bacillus Cereus in a patient with a pacemaker: case report and literature review / Endocardite infecciosa por Bacillus Cereus em paciente portador de marcapasso: relato de caso e revisão de literatura

Introduction: Infective endocarditis (IE) is an infectious process of the cardiac endothelium, often related to the use of pacemakers and valve prostheses, which may facilitate microorganism" proliferation. Case Report: In this article, we describe the case of an 81-year-old man with infective endocarditis due to Bacillus Cereus related to the use of a pacemaker and perform a brief literature review. Discussion: Bacillus Cereus is a Gram-positive, aerobic, spore-forming, large, and generally motile bacterium that constitutes a rare cause of endocarditis, but few cases like this are described in the literature. Conclusion: Determining the etiology of IE through culture-guided methods plays a pivotal role in selecting appropriate antibiotic treatment. Maintain a high clinical suspicion for IE is paramount, especially when fever arises in patients with cardiac devices after surgical or dental procedures.

Introdução: A endocardite infecciosa é um processo infeccioso do endotélio cardíaco, muitas vezes relacionado ao uso de marca-passos e próteses valvares, que pode facilitar a proliferação de microrganismos. Relato de Caso: Neste artigo descrevemos o caso de um homem de 81 anos com endocardite infecciosa por Bacillus Cereus relacionada ao uso de marca-passo e realizamos uma breve revisão da literatura. Discussão: Bacillus Cereus é uma bactéria Gram-positiva, aeróbia, formadora de esporos, grande e geralmente móvel, que constitui uma causa rara de endocardite, com poucos casos descritos na literatura. Conclusão: A determinação da etiologia da EI através de métodos guiados por cultura desempenha um papel fundamental na seleção do tratamento antibiótico apropriado. Manter alta suspeita clínica de EI é fundamental, principalmente quando surge febre em pacientes portadores de dispositivos cardíacos após procedimentos cirúrgicos ou odontológicos.

Necrotizing fasciitis and fatal septic shock associated with Streptococcus constellatus

ABSTRACT Streptococcus constellatus is usually a benign, commensal bacteria but has increased incidence in blood cultures and abscesses. This pathogenic involvement is most prevalent in individuals with underlying medical conditions, such as solid tumors and type 2 diabetes mellitus, as well as in cases of community-acquired infections. We report a 43-year-old male with a right medial thigh ulcer and necrotic scrotal skin. The wound culture from surgical debridement grew Streptococcus constellatus, and histology was consistent with stage III necrotizing fasciitis. Regardless of etiology, the mortality rate of patients with necrotizing fasciitis is greatly decreased with early intervention and thorough surgical debridement.

Bloodstream infection in pediatric patients with febrile neutropenia induced by chemotherapy

Abstract Introduction Febrile neutropenia (FN) is a serious complication of cancer chemotherapy. The present study aimed to identify risk factors for documented infection in pediatric patients with FN and cancer. Methods This prospective cohort study included patients under 18 years from 2016 to 2018. Infection was defined according to the Centers for Disease Control and Prevention criteria. Results A total of 172 febrile neutropenic episodes were evaluated. From univariate analysis, the risk factors were: female gender; monocyte count < 100 cell/mm³, platelets < 50,000, C-reactive protein (CRP) > 90 mg/dl and hemoglobin < 7mg/dl at the onset of an episode; two or more episodes of FN, and; fever onset; positive blood culture at the fever onset. Independent risk factors according to the multivariate analysis were: CRP at the onset of a febrile episode > 90mg/dl, fever onset and first blood culture with a positive result. The lowest probability of infection was related to first episode and to platelets > 50,000 at the onset of fever. Conclusion A CRP > 90 at the onset of a febrile episode, platelets < 50,000, second episode or more, first fever episode during hospitalization and positive first blood culture were found to be associated with a higher risk of infection and they could be useful for the establishment of risk scores for infection in neutropenic children.

The incidence of intestinal colonization of carbapenem-resistant Enterobacterales and its risk factors for bloodstream infection / 中华检验医学杂志

Objective:The aim of this study was to determine the colonization rate of carbapenem-resistant Enterobacterales (CRE) and identify the proportion and risk factors for bloodstream infection.Methods:This was a retrospective study conducted at the Department of Clinical Laboratory, Peking University People′s Hospital from January 2018 to December 2021. A total of 4 993 patients underwent rectal swab CRE screening for CRE, of which 137 were found to be positive. Clinical and laboratory data of the positive patients were collected, and the following parameters were analyzed: the positive rate of CRE screening in high-risk population, the species of colonized bacteria, antimicrobial resistance and the risk factors of CRE bloodstream infection in colonized patients. Statistical analysis was performed using SPSS 26.0 software. Univariate analysis was conducted using the chi-square (χ 2) test, while multivariate analysis was performed using binary logistic regression. The results were expressed as relative risk (odds ratio, OR) and 95% confidence interval ( CI). A significance level of 0.05 was considered statistically significant. The drug resistance rate of pathogen was analyzed by WHONET 5.6 software. Results:During the study period, a total of 4 991 patients who underwent rectal swab screening were eligible for inclusion, of which 137 patients were screened positive, resulting in a positive rate of 2.7% (137/4 991). The positive rates were higher in the intensive care ward and hematology ward, with rates of 5.5% (27/493) and 3.3% (109/3 321), respectively. A total of 145 colonization strains were isolated from patients with positive CRE screening, including 63 strains of Klebsiella pneumoniae (43.4%, 63/145), 52 strains of Escherichia coli (35.9%, 52/145), 16 strains of Enterobacter cloacae (11.0%, 16/145) and 14 strains of other Enterobacterales (9.7%, 14/145). The metal β-lactamase production type was the main component of CRE positive colonizing bacteria. The antimicrobial resistance of 145 strains to 22 antibacterial agents revealed that amikacin and tigacycline were the most sensitive. Among 137 CRE screening-positive patients, 14 (10.2%, 14/137) developed bloodstream infection. The isolated pathogenic bacteria included 10 Klebsiella pneumoniae strains and 4 Escherichia coli strains, with a predominant serine carbapenemase producing. Notably, the enzyme type and antimicrobial resistance of the bloodstream infection isolates in the same patient were highly consistent with those of the previous screening strains. Comparison was made between patients with positive CRE screening and those with CRE conversion to bloodstream infection. The unifactor analysis revealed significant differences in surgical history, neutropenia, hematopoietic stem cell transplantation, history of antibiotic use before rectal swab screening, screening within 48 hours after admission, and serine carbapenemase production by strains ( P<0.05). The multivariate analysis indicated that surgical history ( OR 24.659, 95% CI 2.540-239.411, P=0.006) and neutropenia ( OR 93.796, 95% CI 6.294-1 397.804, P=0.001) remained significantly associated with the risk of CRE bloodstream infection ( P<0.05). Conclusions:The CRE colonization rate was low in our hospital, but the proportion of patients with positive screening converted to bloodstream infection was high. Surgical history and neutropenia are risk factors for bloodstream infection transmission. Thus, it is essential to enhance monitoring in high-risk areas and susceptible patients.

Clinical evaluation of direct drug sensitivity test for blood culture positive broths / 中华检验医学杂志

Objective:To evaluate the clinical performance of direct antimicrobial susceptibility test in blood culture-positive broth, and to provide a basis for optimizing the antibiotic use strategy in clinical bloodstream infection.Methods:A retrospective analysis was conducted on 780 blood culture-positive samples collected in Peking University People′s Hospital from May 2017 to December 2021. The direct antimicrobial susceptibility test was performed by disk diffusion method on blood culture-positive broth. The antimicrobial susceptibility breakpoints were in accordance with Clinical and Laboratory Standards Institute (CLSI) M100 S32 edition document.Results:In this study, a total of 331 strains of Gram-negative bacteria (139 strains of Escherichia coli, 79 strains of Klebsiella pneumoniae, 35 strains of Pseudomonas aeruginosa, 21 strains of Acinetobacter baumannii) and 396 strains of Gram-positive cocci (25 strains of Staphylococcus aureus, 316 strains of coagulase-negative staphylococci, 47 strains of Enterococcussp.) were collected, after excluding 53 cases with two or more isolates. Compared with the routine antimicrobial susceptibility test (AST), the rates of category agreement (CA), major error (ME), and very major error (VME) of Gram-negative bacteria were 86.0% (1368/1 591), 8.7% (139/1 591), and 0.5% (8/1 591), respectively. On the other hand, the CA%, ME%, and VME% of Gram-positive cocci were 89.2% (960/1 076), 7.5% (81/1 076), and 1% (11/1 076), respectively. Regarding the individual antimicrobial agents, the CA% of Escherichia coli was 16/17 for imipenem, 90.1% (109/121) for meropenem, and 70.8% (85/120) for cefepime. For Klebsiella pneumoniae, the CA% of was 10/13 for imipenem, 80.9% (55/68) for meropenem, and 80.3% (53/66) for cefepime. The CA% of meropenem in Pseudomonas aeruginosa and Acinetobacter baumannii were 96.0% (24/25) and 16/16. The CA% of linezolid and cefoxitin in Staphylococcus aureus were 100% (25/25) and 100% (24/24), respectively. The CA% of linezolid, cefoxitin and gentamicin in coagulase-negative staphylococci were 98.9% (269/272), 94.5% (277/293) and 71.6% (194/271) respectively. Finally, for Enterococcus sp., the CA% of vancomycin and ampicillin were 91.5% (43/47) and 94.7% (36/38), respectively. Conclusion:Compared with the conventional AST, the blood culture-positive broth direct AST exhibited high category agreement and low error rates for both Gram-negative bacteria and Gram-positive cocci, which can serve a rapid alternative for AST in cases of clinical bloodstream infection.

A case of severe fever with thrombocytopenia syndrome with Campylobacter jejuni bacteremia / 中国热带医学

@#Abstract: Objective　 This article aims to present a rare case of severe fever with thrombocytopenia syndrome (SFTS) complicated by with bacteraemia caused by Campylobacter jejuni, and to discuss the pathogenic characteristics, culture methods, clinical features and treatment points of Campylobacter jejuni and the patient's outcome, with a view to raising clinical awareness of blood culture and providing experience for the treatment of this disease. Methods　The clinical data of a case with SFTS complicated by bacteremia caused by Campylobacter jejuni admitted to Weihai Municipal Hospital were collected and the diagnostic process of the pathogenic bacteria as well as the treatment plan were retrospectively analysed. Results　The patient was a female who had been bitten by a tick bite half a month ago and presented to the hospital on 30th August with a fever, vague pain in the peribulbar abdomen and diarrhea for 5 days. Laboratory tests showed leukopenia and thrombocytopenia, and nucleic acid detection for SFTS was positive, resulting in a diagnosis of SFTS. After a week of antiviral treatment with ribavirin and symptomatic treatment, the patient suddenly experienced high fever at night, with a temperature reaching 39.5 °C. Blood cultures were immediately taken from both sides of the double bottle. Bilateral anaerobic bottles were tested for positive after 53.06 hours, and Gram-negative Campylobacter was cultured anaerobically in a transfer blood plate and further identified as Campylobacter jejuni using mass spectrometry MALDI-TOF MS. Vancomycin was stopped clinically on the basis of bacterial pathogenesis and meropenem was used for anti-infection and symptomatic treatment. During the treatment, blood culture and nucleic acid detection for SFTS turned negative, and the patient's symptoms improved. After normal results were achieved in the follow-up testing, the patient was discharged. Conclusions　This case serves as a reminder that Campylobacter jejuni not only causes intestinal infections, but can also lead to extra-intestinal infections in immunocompromised individuals. Clinical and laboratory personnel should increase their recognition of Campylobacter jejuni, prioritize blood culture methods, and utilize a multidisciplinary approach in diagnosis and treatment.

Research progress on the molecular mechanism of periodontal pathogens promoting the development of cardiovascular diseases / 口腔疾病防治

@#Periodontitis is a multifactorial infectious and inflammatory disease occurring in tooth-supporting tissues. In recent decades, many studies have reported a potential relationship between periodontitis and cardiovascular disease, and periodontal pathogens are an important factor linking periodontitis and cardiovascular disease. In this review, we summarize updated preclinical studies and epidemiological evidence on the association of these two diseases. Moreover, possible mechanisms accounting for such links are introduced, including bacteremia and direct invasion of pathogens, endotoxemia caused by virulence factors of periodontal pathogens leading to systemic inflammation, abnormal lipid metabolism and oxidative stress, which further affect the inflammatory states of the cardiovascular system. The molecular mimicry theory and the intrinsic correlation of apolipoprotein E between periodontitis and cardiovascular disease require further study. Combined with existing studies, it is reasonable to assume that periodontal treatment and oral hygiene can reduce the risk of cardiovascular disease in patients with periodontitis. More studies are needed to focus on the molecular mechanism linking periodontal pathogens and cardiovascular diseases. These studies will provide evidence that periodontal pathogens directly invade the cardiovascular system or indirectly invade host cells as well as isolate and culture bacteria from the tissues of lesions. Studies should also explore how the local inflammatory state, periodontal pathogens and their products directly influence cardiovascular disease-related biomarkers (C-reactive protein, vascular endothelial growth factor, heat shock protein, etc.) and the mechanism. This information may provide a reference for the effective prevention and treatment of periodontitis and cardiovascular disease in the future.

Prognostic value of Pitt bacteremia score in patients with extensively drug-resistant Klebsiella pneumoniae bloodstream infection / 中华急诊医学杂志

Objective:To investigate the predictive value of Pitt bacteremia score (PBS) on 28-day mortality of patients with extensively drug-resistant Klebsiella pneumoniae (XDR-KP) bloodstream infection.Methods:A retrospective cohort study was conducted to analyze the clinical characteristics of patients with XDR-KP bloodstream infection admitted to the Emergency Intensive Care Unit of Nanjing Drum Tower Hospital from January, 2018, to December, 2021. The patients were divided into the survival and non-survival groups according to the 28-day survival. Multivariate logistic regression analysis was performed to determine the risk factors of 28-day mortality of the patients. Receiver operating curve (ROC) curve was drawn to analyze the predictive value of PBS in 28-day mortality of patients with XDR-KP bloodstream infection. The correlations between PBS, and acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure (SOFA) assessment were performed using Pearson correlation coefficient. The optimal cut-off value of PBS score was used as the boundary point to group the differences between APACHE II and SOFA scores in different groups. Kaplan-Meier method was used to analyze the prognosis of patients with XDR-KP bloodstream infection.Results:A total of 118 patients (82 males and 36 females) with XDR-KP bloodstream infection, aged (65.98±15.16) years, were included in this study. The 28-day mortality was 61.02%. The PBS was significant higher in the non-survival group than in the survival group [(5.68±1.86) vs. (2.48±1.02), P=0.011]. Multivariate logistic regression analysis showed that PBS ( OR=4.940, 95% CI: 2.720-8.968, P=0.008), APACHE II score ( OR=1.630, 95% CI: 1.361-1.952, P=0.010) and SOFA score ( OR=1.879, 95% CI: 1.451-2.422, P=0.009) were independently risk factors of 28-day mortality of patients with XDR-KP bloodstream infection. The area under the ROC curve of the PBS predicting 28-day mortality was 0.970 (95% CI: 0.945-0.995, P<0.001), and the optimal cut-of value was 3.5. In addition, PBS was significantly associated with APACHE II score ( r=0.916, P<0.001) and SOFA score ( r=0.829, P<0.001). Moreover, Kaplan-Meier analysis showed that the 28-day survival rate of patients with PBS <3.5 was significantly higher than that of patients with PBS >3.5 ( P=0.001). Conclusions:PBS is a significant, independent predictor of 28-day mortality in patients with XDR-KP bloodstream infection.

Factores de riesgo de bacteriemia asociada a los cuidados sanitarios

Introducción: las infecciones asociadas a los cuidados sanitarios (IACS), tienen un fuerte impacto social y económico; asimismo, constituyen un indicador de la calidad de atención en hospitales. Objetivo: identificar los factores de riesgo que influyen de forma independiente para adquirir bacteriemia asociada a los cuidados sanitarios. Métodos: se realizó un estudio observacional, analítico de casos y controles, se seleccionaron 48 casos y 144 controles. Con una proporción de 1: 3. Se realizó el análisis estadístico univariado y multivariado. Resultados: en el análisis univariado, la comorbilidad, el uso de sonda nasogástrica y sonda vesical se mostraron sin influencia estadísticamente significativa, mientras que el multivariado mostró que el factor con independencia más importante fue el uso de catéter venoso central (OR 11,837 ajustado IC 95% 4,493-31,180), seguido de la presencia de shock séptico al ingreso en UCIP (OR 4,908 ajustado IC 95% 1,152-20,907) y la presencia de ostomías (OR ajustado 10.44 IC 95% 2,806−17,836) de manera similar. Conclusiones: la comorbilidad, el uso de sonda nasogástrica y uso de sonda vesical no contribuyeron al riesgo de adquirir bacteriemia asociada a los cuidados sanitarios. La presencia de catéter venoso central, presencia de shock séptico al ingreso en UCIP y la presencia de ostomías resultaron ser los factores de mayor riesgo.

Introduction: infections associated with health care (IACS) have a strong social and economic impact; likewise, they constitute an indicator of the quality of care in hospitals. Objective: to identify the risk factors that influence independently to acquire bacteremia associated with health care. Methods: an observational, analytical study of cases and controls was carried out, 48 cases and 144 controls were selected. With a ratio of 1:3. Univariate and multivariate statistical analysis was performed. Results: in the univariate analysis, comorbidity, the use of a nasogastric tube and a bladder catheter did not show a statistically significant influence, while the multivariate analysis showed that the most important independent factor was the use of a central venous catheter (OR 11,837 adjusted CI 95% 4,493-31,180), followed by the presence of septic shock on admission to the PICU (OR 4,908 adjusted 95% CI 1,152-20,907) and the presence of ostomies (adjusted OR 10.44 95% CI 2,806−17,836) in a similar way. Conclusions: comorbidity, the use of a nasogastric tube and the use of a bladder catheter did not contribute to the risk of acquiring healthcare-associated bacteremia. The presence of a central venous catheter, the presence of septic shock on admission to the PICU, and the presence of ostomies were the highest risk factors.

Introdução: as infecções associadas aos cuidados de saúde (IACS) têm um forte impacto social e económico; Eles também são um indicador da qualidade do atendimento nos hospitais. Objetivo: identificar os fatores de risco que influenciam independentemente a aquisição de bacteremia associada à assistência à saúde. Métodos: foi realizado um estudo observacional e analítico de casos e controles, selecionados 48 casos e 144 controles. Com uma proporção de 1: 3. Foram realizadas análises estatísticas univariada e multivariada. Resultados: na análise univariada, a comorbidade, o uso de sonda nasogástrica e cateter urinário foram mostrados sem influência estatisticamente significativa, enquanto o multivariado mostrou que o fator independente mais importante foi o uso de cateter venoso central (OR 11,837 ajustado IC 95% 4,493-31,180), seguido pela presença de choque séptico na admissão na UTIP (OR 4,908 ajustado IC 95% 1,152-20,907) e a presença de ostomias (OR ajustado 10,44 IC 95% 2,806−17, 836) da mesma forma. Conclusões: comorbidade, uso de sonda nasogástrica e cateter vesical não contribuíram para o risco de adquirir bacteremia associada à assistência à saúde. A presença de cateter venoso central, a presença de choque séptico na admissão na UTIP e a presença de ostomias foram os maiores fatores de risco.

Acute cellulitis with Shewanella algae bacteremia

ABSTRACT Shewanella algae are gram-negative bacteria commonly found in aquatic environments. Infections caused by this agent are rarely documented; however, they are increasingly reported, mainly in countries with warm to temperate climates. Herein, we present a case of a 46-year-old immunocompetent woman with acute cellulitis and S. algae bacteremia (the first isolation culture performed at our hospital). To better understand the epidemiology, clinical outcomes, and treatment possibilities for S. algae bacteremia, we searched literature for similar cases; however, we did not find any cases of infections caused by this microorganism reported in Portugal or the Azores.