共查询到11条相似文献,搜索用时 15 毫秒
1.
Hitoshi Honda Naofumi Higuchi Kensuke Shintani Masanori Higuchi David K. Warren 《Journal of infection and chemotherapy》2018,24(10):807-811
Background
Bloodstream infections are responsible for a large proportion of deaths among geriatric patients. Japan is a rapidly aging society; however, little is known about the epidemiology of bloodstream infections in geriatric patients in Japanese institutions.Methods
We conducted a retrospective cohort study of patients aged ≥65 years old with a bloodstream infection in a Japanese tertiary care hospital in 2013. We defined inadequate empiric antimicrobial therapy as either antimicrobial treatment that was ineffective against subsequently isolated organisms or treatment initiated after notification of a positive culture. Predictors of inadequate antimicrobial therapy and 30-day mortality among geriatric patients with bloodstream infections were evaluated.Results
We identified 275 patients with a bloodstream infection, of which 42.2% of cases (116/275) were healthcare-associated, hospital-onset. The most common source of bloodstream infection was hepatobiliary (28.0%). Inadequate empiric antimicrobial therapy occurred in 29.8% of the patients. Factors associated with inadequate empiric therapy included a history of surgery prior to bloodstream infection during index hospitalization (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.18–9.12). In 275 patients, 38 (13.8%) died within 30 days after the first positive blood culture. Predictors of 30-day mortality was Pitt bacteremia score >6 (aOR 9.80; 95% CI 4.72–20.36).Conclusion
Inadequate empiric antimicrobial therapy occurred in approximately one-third of episodes of bloodstream infection in geriatric patients. Severity at the time of bloodstream infection was likely to have contributed to mortality. The initiation of adequate empiric antimicrobial therapy may have important implications for antimicrobial stewardship even in the elderly population. 相似文献2.
Martina Beckman Matthew C. Washam Barbara DeBurger David B. Haslam Joshua D. Courter Heidi Andersen Joshua K. Schaffzin Michael J. Tchou Andrea Ankrum Joel Mortensen 《Diagnostic microbiology and infectious disease》2019,93(3):191-195
Background
Targeted antimicrobial therapy can reduce morbidity in patients with sepsis. Molecular methodologies used in the clinical laboratory can provide information about infectious agents faster than traditional culture methods. Using molecular information to make clinical decisions more quickly has been shown to improve patient outcomes, and reduce length of stay and healthcare cost in adults. Its effect on pediatric care is less well described.Methods
Blood cultures growing Gram-positive cocci or Gram-positive bacilli on Gram stain were evaluated by molecular and traditional methodologies. Results from the molecular platform, Luminex Verigene® Blood Culture – Gram-positive Panel (BC-GP) were compared to results from standard culture and susceptibility testing (Vitek? MS, Vitek?, E-test®). Overall statistical agreement is evaluated.Results
1231 positive pediatric blood cultures grew single isolates detectable by the BC-GP panel. 899 were correctly identified to species, 282 to genus, 50 isolates were not detected. All organisms detected by BC-GP that grew in single isolate cultures were identified as the same organism by Vitek? MS with the exception of 7 organisms.112 cultures were found to have polymicrobial growth of Gram-positive organisms. Excellent overall agreement was noted for antimicrobial resistance markers with only 5 samples displaying discordant results.Discussion
In general, clinicians can use the identification and antimicrobial resistance marker data gained from Luminex Verigene® BC-GP with confidence to alter empiric coverage. Rare instances of disagreement with traditional culture data led to maintaining the empiric clinical approach and did not result in patient harm. 相似文献3.
BackgroundIn adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters.AimIdentify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters.MethodsA systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion.ResultsNineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the ‘On the CUSP: Stop Blood Stream Infections' national programme.ConclusionsCentral venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection. 相似文献
4.
Minimum inhibitory concentrations (MICs) of vancomycin (VCM) and teicoplanin (TEIC) were measured using a novel susceptibility test based on the chemiluminescence assay (CA) method (Rapid-Lumi Eiken; Eiken Chemicals, Tokyo, Japan) against 33 strains in total: 7, 5, and 10 strains of which are VCM-resistant enterococci (VRE) with vanA, vanB, and vanC genes, respectively, and the other 11 strains are vancomycin-susceptible enterococci (VSE). The results were in good accordance with the values determined by the standard broth dilution method approved by the National Committee for Clinical Laboratory Standards (NCCLS): i.e., 88% (29/33) of consistency for VCM and 97% (32/33) for TEIC, respectively. In addition, genotypes in VRE strains (vanA, vanB, vanC-1, and vanC-2/3 genes) were properly estimated from the results of the CA method and the NCCLS interpretive categories, even though the incubation time was very short (2–4h). In conclusion, it was found that the new method is reliable and rapid to detect VRE strains in clinical laboratories. 相似文献
5.
目的了解瑞安市胎膜早破患者生殖道的支原体、衣原体的感染状况及支原体的耐药状况。方法对626例胎膜早破晚孕患者的宫颈分泌物进行支原体培养及药敏和衣原体快速检测。结果626例胎膜早破病例中,支原体培养阳性为516例,总感染率为82.4%;其中单独解脲支原体(Uu)阳性348例(55.6%),对交沙霉素、米诺环素、强力霉素、阿奇霉素、红霉素、罗红霉素、氧氟沙星、诺氟沙星、林可霉素耐药率分别为1.1%、6.3%、6.6%、10.6%、14.7%、17.8%、27.3%、63.1%、94.6%;Uu与人型支原体(Mh)混合感染158例(25.2%),对上述药物耐药率分别为4.4%、8.6%、9.2%、90.0%、94.8%、95.6%、42.5%、69,9%、95.1%;单独Mh感染10例(1.6%),对交沙霉素、强力霉素、米诺环素高敏感,耐药率均为0,对林可霉素耐药率为10.0%;衣原体阳性34例(5.43%)。结论胎膜早破患者中支原体的高检出率提示其与胎膜早破密切相关;支原体体外药敏试验对交沙霉素、米诺环素、强力霉素敏感率较高。 相似文献
6.
《Journal of infection and chemotherapy》2022,28(4):563-568
IntroductionWe evaluated the performance of Rapid Sepsityper Kit in species identification (ID) and antimicrobial susceptibility testing (AST).MethodsPositive blood culture bottles (n = 227) containing single microorganisms were enrolled. We compared the direct method using Rapid Sepsityper Kit for ID and AST with the conventional method. The analyses of ID and AST were performed using MALDI Biotyper and BD Phoenix platform, respectively.ResultsThe direct ID method correctly identified 89.4% (203/227) of samples, and Gram-negative bacilli (95.2%) had a higher ID rate than Gram-positive cocci (84.4%). Five cases were misidentified, and non-acceptable identification was high among Streptococcus species.Direct AST results were obtained from 168 isolates. Non-acceptable ID occurred among 24 isolates; 4 Streptococcus species, and 31 isolates, which did not grow in the direct AST method, were excluded. A total of 1714 antibiotic susceptibility tests (625 from 69 Gram-positive cocci and 1089 from 99 Gram-negative bacilli) were performed. The direct AST methods showed 98.3% (1685/1714) of categorical agreement (CA), 0.7% (12/1714) of very major errors, 0.2% (4/1714) of major errors, and 0.8% (13/1714) of minor errors. Complete CA was obtained for methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing Escherichia coli.ConclusionsThe direct ID method using Rapid Sepsityper Kit and the direct AST method in combination with the BD Phoenix platform, which was associated with a reduction of turnaround time, may be a reliable approach for blood culture bottles. However, additional validation and further improvements, especially for Gram-positive cocci, would have an impact on microbiological diagnoses. 相似文献
7.
《Molecular and cellular probes》2014,28(5-6):264-270
The objective of this study was to develop a multiplex real-time PCR panel using TaqMan probes for the detection and differentiation of porcine circovirus type 2 (PCV2), porcine reproductive and respiratory syndrome virus North American type (PRRSV-NA), pseudorabies virus (PRV), classical swine fever virus (CSFV), porcine parvovirus type 1 (PPV1) and Japanese encephalitis virus (JEV). Specific primer and probe combinations for PCV2, PRRSV, PRV, CSFV, PPV1 and JEV were selected within the conserved region of each viral genome. The multiplex real-time PCR panel which was run in two separate tubes was capable of specific detection of the six selected pig viruses, without cross-reactions with other non-targeted pig viruses. The detection limit of the assays was 10 copies/μL for PCV2, PRV, CSFV and PRRSV and 100 copies/μL for PPV and JEV. The two-tube multiplex real-time PCR panel showed 99.2% concordance with conventional PCR assays on 118 field samples. Overall, the multiplex real-time PCR panel provides a fast, specific, and sensitive diagnostic tool for detection of multiple viral pathogens in pigs and will be useful not only for diagnostics, or ecological, epidemiological and pathogenesis studies, but also for investigating host/virus or virus/virus interactions, particularly during coinfections. 相似文献
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9.
BackgroundSoy has several beneficial effects on cardiovascular disease (CVD); however, results of clinical trial studies are equivocal. Thus, the present study sought to discern the efficacy of soy intake on blood pressure.MethodsThe search process was conducted in PubMed, Scopus, Web of Science, and Cochrane Library, to ascertain studies investigating the efficacy of soy intake on blood pressure in adults, published up to June 2020. A random-effects model was applied to pool mean difference and 95 % confidence interval (CI). Begg’s and Egger’s methods were conducted to assess publication bias.ResultsPooled effects from 17 effect sizes revealed a significant improvement in systolic blood pressure (SBP) (−1.70; −3.34 to −0.06 mmHg; I2 = 45.4 %) and diastolic blood pressure (DBP) (−1.27; −2.36 to −0.19 mmHg, I2 = 43.9 %) following soy consumption, in comparison with controls. Subgroup analysis demonstrated a reduction in both SBP and DBP in younger participants with lower baseline DBP and intervention durations of <16 weeks.ConclusionOur results suggest that soy intake is associated with an ameliorating effect on blood pressure in adults. 相似文献
10.
《Journal of infection and chemotherapy》2019,25(10):806-810
Microbacterium species are coryneform gram-positive rods that are widely distributed in the environment and have been recently recognized as rare pathogens in humans. However, information about the epidemiologic and clinical characteristics of Microbacterium species is scarce. We herein reported an 11-year-old girl with acute leukemia who was found to have catheter-related bloodstream infection in her neutropenic phase. Gram-positive bacilli repeatedly grew on the blood cultures and were later confirmed by 16S rRNA analysis as Microbacterium paraoxydans. A literature review found available clinical courses in 21 cases (7 pediatric cases) of Microbacterium spp. bacteremia. Our case and those in literature suggested that Microbacterium spp. bacteremia often occurs in patients with indwelling central venous catheters; the literature review further suggested that removal of central venous catheters is required in most cases and that 16S rRNA sequence was useful in identifying in detail the species of Microbacterium. 相似文献
11.
《Journal of infection and chemotherapy》2014,20(1):61-64
We report the first case of both endocarditis and bilateral septic arthritis in a patient caused by Moraxella lacunata and successful management of the infection with antimicrobial therapy. The route of entry leading to bacteremia may have been the oral cavity given the poor oral hygiene of the patient as evidenced by bleeding gums. We hypothesize that the bacteremia led to septic arthritis and mitral valve infective endocarditis. In this case report, we also review the literature on M. lacunata infections and conclude that this organism should be considered in bilateral septic arthritis in a patient with underlying heart abnormalities and/or with renal failure. 相似文献