Objective To analyze distribution and drug resistance of pathogens in bloodstream infection in Sichuan Antibiotic Resistance Monitoring Network in 2016, and to provide the basis for clinical rational use of antimicrobial drugs in Sichuan province. Methods A total of 14 543 strains of bacteria in bloodstream infection were collected from Sichuan Antibiotic Resistance Monitoring Network in 2016. Bacteria strains were identified to species, drug susceptibility test was performed by using the MIC and disc diffusion method (KB method). The results were interpreted according to the clinical laboratory standards institute CLSI 2016. Drug resistance was analyzed by using WHONET 5.6 software. Results Among the 14 543 strains of bacteria, Escherichia coli (34.5%), Klebsiella pneumoniae (10.7%), Staphylococcus epidermidis (10.2%), Staphylococcus aureus (7.2%), Staphylococcus hominis (6.0%) ranked the first five. Resistance rate to imipenem was 0.9% for Escherichia coli, resistance rate to imipenem was 2.4% for Klebsiella pneumoniae. No vancomycin-resistance and linezolid-resistance Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus hominis were found. MRSA detection rate was 25.8%. Conclusion Gram negative bacteria are the main pathogens in the blood cultures in Sichuan province, while attention should pay to the Staphylococcus.
中心靜脈置管是現代重癥醫學救治危重患者的常用方法, 目前應用十分廣泛。盡管這些導管提供了必要的血管通路, 但也將患者置于局部和全身性感染并發癥的危險之中, 增加了感染的發生率, 并使導管相關性血流感染( catheter-related bloodstream infections, CRBSI) 更為常見, 明顯延長了ICU 住院時間并增加了醫療費用。本文就近年來CRBSI 的發病機制、微生物學、診斷及治療, 尤其是如何根據病原體對CRBSI 進行治療做一概述。
Objective To analyze the species distribution and resistance of the pathogens isolated fromblood cultures of the patients in intensive care unit ( ICU) , and provide a basis for prevention and control of bloodstream infections in critically ill patients. Methods The data of blood cultures of the patients in ICUduring January 2009 to December 2011 was investigated retrospectively.Results In the last 3 years, positive rate of blood cultures of ICU patients was 15. 4% , 15. 7% , and 17. 6% respectively. Among the isolates, Gram-positive bacteria were predominant ( 52. 3% ) , followed in order by gram-negative bacteria ( 33. 1% ) and fungi ( 14. 7% ) . Aerobe and facultative anaerobe were the predominant bacterial isolates ( 99. 7% ) . Enterococcus faeciumand Staphylococcus spp. were the most common gram-positive bacteria, and 4. 5% of E. faecium isolates were resistant to vancomycin. Rate of methicillin-resistance for S. aureus and S. epidermidis was 73. 5% and 93. 7% respectively. In terms of gram-negative bacteria, Acinetobacter calcoaceticus- A. baumannii complex were the leading species, 96. 9% of the isolates had multi-drug resistance and 14. 1% of the isolates had extra-drug resistance. Klebsiella pneumonia and Escherichia coli isolates were less frequently isolated and those producing extended spectrum beta-lactamases accou ted for 70. 3% and 80. 0% of the isolates respectively. Candida spp. was the most common fungi isolates ( 96. 7% )with an annual change of species distribution and declining susceptibility to azoles.Conclusions Gram-positive bacteria should be the major target for prevention and control of bloodstream infections in critically ill patients. Whereas, more attention should be paid to the infection caused by candida spp. and multidrug resistant gram-negative bacteria.
Objective To investigate the clinical characteristics and bacterial drug resistance of bloodstream infection of gram-negative bacteria, and provide guidance for clinical rational drug use and control of hospital infection. Methods A retrospective analysis was conducted in the patients diagnosed as severe pneumonia with blood culture of gram-negative bacteria from January 2015 to December 2017 in Beijing Anzhen Hospital. Results A total of 60 severe pneumonia patients suffered from bloodstream infection of gram-negative bacteria were recruited including 34 males and 26 females aging from 42 to 89 years and 73.4 years in average. In the 60 patients, 32 cases were infected with Klebsiella pneumonias, 20 cases were infected with Acinetobacter baumanni, and 8 cases were infected with Escherichia coli. The antimicrobial susceptibility testing result of Klebsiella pneumonias showed that the drug susceptibility rate was 100% to tigecycline, and 6.3% to amikacin. Escherichia coli was sensitive to Amikacin, imipenem, ceftazidime and meropenem while resistance to other drugs. The antimicrobial resistance of Acinetobacter baumanni was 28.6% for cefoperazone/sulbactam, and 14.3% for tigecycline. C-reactive protein, procalcitonin and SOFA scores were higher in the patients infected with Acinetobacter baumanni. Neutrophils and blood lactic acid were higher in the patients infected with Klebsiella pneumonias. There were no statistical differences in white blood cell, platelet or motality rate between the patients infected with Acinetobacter baumanni and the patients infected with Klebsiella pneumonias. SOFA scores and blood lactic acid had significantly statistical relevance with prognosis. Conclusion There is a high proportion of drug resistance of Klebsiella pneumoniae and Acinetobacter baumanni in the bloodstream infection of gram-negative bacteria.
Objective To investigate the species distribution and antibiotic resistance of pathogens fromcatheter-related bloodstream infections ( CRBSI) in intensive care unit( ICU) , to provide evidence for the guidance of clinical rational administration.Methods A retrospective analysis was performed to review the microbiological and susceptibility test data of all CRBSI patients in ICU from January 2009 to December 2011. The patterns of antibiotic resistance among the top seven bacteria were compared. Results 67 cases of CRBSI were detected with 81 strains, including 40 Gram-positive ( G+ ) bacteria( 49.4% ) , 38 Gram-negative( G- ) bacteria ( 46.9% ) , and 3 fungi ( 3.7% ) . The main pathogens causing CRBSI were coagulase negative Staphylococci ( 27 strains, 33.3%) , Acinetobacter baumannii ( 12 strains, 14.8% ) , Klebsiella pneumoniae( 9 strains, 11. 1% ) , Staphylococcus aureus ( 8 strains, 9. 9% ) , Pseudomonas aeruginosa ( 7 strains, 8. 6% ) , Escherichia coli ( 6 strains, 7.4% ) , suggesting that Staphylococcus epidermidis was predominant pathogenic G+ bacteria, and Acinetobacter baumannii was predominant G- bacteria. The antibiotic resistance tests demonstrated that isolated G- bacillus was highly sensitive to carbopenem, while vancomycin-resistant G+ bacteria were not found. Conclusions Within the latest 3 years, the predominant pathogens of CRBSI in ICU are Staphylococcus epidermidis and Acinetobacter baumannii. Acinetobacter baumannii exhibited high drug resistance to all antibiotics.
ObjectiveTo explore the prognostic risk factors for patients with gram positive coccus bloodstream infections. MethodsBy retrospective analysis, 93 patients with gram positive coccus bloodstream infections were recruited from the China-Japan Friendship Hospital during January 2013 to April 2015.According to the 28-day survival situation, the patients were divided into a survival group and a death group.The clinical data including basic diseases and invasive operation were collected.Logistic regression analysis was used to evaluate the risk factors for predicting prognosis. ResultsThe albumin concentration in the death group was lower than that in the survival group (P < 0.05).The D-Dimer concentration, APACHEⅡscores, the percentage of patients with mechanical ventilation, and the percentage of patients with deep venous cannels in the death group were all higher than those in the survival group (P < 0.05).The percentages with diabetes mellitus, surgery, tumor, renal failure in the patients with enterococcus bloodstream infections were much higher than those patients with other gram positive coccus bloodstream infections (P < 0.05), but were not different with those patients with Staphylococcus aureus bloodstream infection (P > 0.05).The APACHEⅡscore and albumin concentration had statistical significance for predicting the 28-day and 90-day mortality.The area under the receiver operating characteristic (ROC) curve was 0.768 and 0.775.If using APACHEⅡscore > 22.5 as cut off value for predicting death in 28 days, the sensitivity was 70.0%, and the specificity was 81.2%.If Using albumin concentration < 32.5 g/L as a cutoff value for predicting death in 28 days, the sensitivity was 55.3%, and the specificity was 86.7%. The logistic multifactor analysis revealed only the lower albumin concentration was an independent prognostic factor for 28-day mortality of the patients with gram positive coccus bloodstream infections (P < 0.05). ConclusionsThe patients with diabetes mellitus, surgery, tumor, and renal failure need to be cautious of enterococcus bloodstream infection.The low albumin concentration suggests a poor prognosis in patients with gram positive coccus bloodstream infections.
Objective To explore the vascular access infection (VAI) incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic (epidemic period) compared with the corresponding period with no local cases of COVID-19 (control period). Methods A single-center, retrospective study was carried out. Adult patients who underwent hemodialysis at the Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7, 2022 and February 23, 2023 and the control period between December 7, 2020 and February 23, 2021 were selected. The incidence of local access site infection (LASI) and access related bloodstream infection (ARBSI) in included patients were observed and compared. ResultsA total of 1 401 patients were included. Among them, there were 737 cases during the epidemic period and 664 cases during the control period. There was no statistically significant difference in the age, gender, and duration of catheterization among patients of different periods and pathway types (P>0.05). There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period (χ2=1.800, P=1.180). There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period [χ2=4.610, relative risk (RR)=2.575, 95% confidence interval (CI) (1.053, 6.298), P=0.032]. There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters (TCC) (P＞0.05). There were statistically significant differences in the incidence of LASI [χ2=4.898, RR=3.832, 95%CI (1.058, 13.885), P=0.027] and ARBSI [χ2=7.150, RR=4.684, 95%CI (1.333, 16.460), P=0.005] among non cuffed catheters (NCC) patients at different stages. TCC patients might experience LASI (P<0.05) during the epidemic period and ARBSI (P<0.05) during the control period compared with the arteriovenous fistula patients; both central venous catheterization and NCC patients might experience LASI and ARBSI during the control period (P<0.05). Conclusion Targeting COVID-19 prevention may be associated with the reduction of vascular access infection in hemodialysis patients, in particular in NCC patients.
Bloodstream infections are featured by acute onset, rapid progression and high mortality. Early identification and accurate prognostic assessment are crucial for improving patient outcomes. This article reviews five novel biomarkers in assessing the severity and prognosis of patients with acute bloodstream infection, namely soluble triggering receptor expressed on myeloid cell-1, soluble form of the urokinase plasminogen activator receptor, presepsin, heparin-binding protein and microRNAs, all of which are positively correlated with the severity of patients’ condition, and some perform better than traditional biomarkers. However, they still have limitations such as inadequate specificity or sensitivity and lack of large-scale verification. In the future, it is necessary to integrate molecular detection and artificial intelligence to optimize application strategies and provide personalized diagnosis and treatment.