OBJECTIVES: Gram-positive microorganisms have been the predominant pathogens in central venous catheter-related bloodstream infections (CRBSIs). Recent guidelines recommend empirical therapy according to this and restrict coverage for Gram-negatives to specific circumstances. This study aimed to analyse the epidemiological changes in CRBSIs over the 1991-2008 period and to analyse predictors of Gram-negative CRBSIs. PATIENTS AND METHODS: A prospectively collected cohort of patients with confirmed CRBSIs was analysed. Strains isolated and antimicrobial susceptibility, as well as clinical and demographic variables were recorded. Differences observed during the study period were analysed by means of a χ² trend test and factors associated with Gram-negative CRBSIs by means of multivariable analysis. RESULTS: Between 1991 and 2008, 1129 episodes of monomicrobial CRBSIs were recorded. There was an increase in the incidence of CRBSIs, from 0.10 (1991-92) to 0.31 (2007-08) episodes/1000 patient-days. A significant increase in the number of Gram-negative strains among the total isolates was also found, from 3 (4.7%) in 1991-92 to 70 (40.23%) in 2007-08, with a parallel decrease in the percentage of Gram-positives. Solid organ transplantation, prior use of penicillins and hospital stay longer than 11 days were independently associated with a significantly higher risk of Gram-negative CRBSIs, while cirrhosis, diabetes and use of quinolones were associated with a higher risk of Gram-positives. CONCLUSIONS: Gram-negative strains are an increasing cause of CRBSIs, reaching a prevalence of 40% in the 2007-08 period in our hospital. If this trend is confirmed in other centres, a broad-spectrum empirical therapy should be considered in managing these infections.
OBJECTIVES: Gram-positive microorganisms have been the predominant pathogens in central venous catheter-related bloodstream infections (CRBSIs). Recent guidelines recommend empirical therapy according to this and restrict coverage for Gram-negatives to specific circumstances. This study aimed to analyse the epidemiological changes in CRBSIs over the 1991-2008 period and to analyse predictors of Gram-negative CRBSIs. PATIENTS AND METHODS: A prospectively collected cohort of patients with confirmed CRBSIs was analysed. Strains isolated and antimicrobial susceptibility, as well as clinical and demographic variables were recorded. Differences observed during the study period were analysed by means of a χ² trend test and factors associated with Gram-negative CRBSIs by means of multivariable analysis. RESULTS: Between 1991 and 2008, 1129 episodes of monomicrobial CRBSIs were recorded. There was an increase in the incidence of CRBSIs, from 0.10 (1991-92) to 0.31 (2007-08) episodes/1000 patient-days. A significant increase in the number of Gram-negative strains among the total isolates was also found, from 3 (4.7%) in 1991-92 to 70 (40.23%) in 2007-08, with a parallel decrease in the percentage of Gram-positives. Solid organ transplantation, prior use of penicillins and hospital stay longer than 11 days were independently associated with a significantly higher risk of Gram-negative CRBSIs, while cirrhosis, diabetes and use of quinolones were associated with a higher risk of Gram-positives. CONCLUSIONS: Gram-negative strains are an increasing cause of CRBSIs, reaching a prevalence of 40% in the 2007-08 period in our hospital. If this trend is confirmed in other centres, a broad-spectrum empirical therapy should be considered in managing these infections.
Authors: Marco Ripa; Laura Morata; Olga Rodríguez-Núñez; Celia Cardozo; Pedro Puerta-Alcalde; Marta Hernández-Meneses; Juan Ambrosioni; Laura Linares; Marta Bodro; Andrea Valcárcel; Climent Casals; Maria de Los Angeles Guerrero-León; Manel Almela; Carolina Garcia-Vidal; Ana Del Río; Francesc Marco; Josep Mensa; José Antonio Martínez; Alex Soriano Journal: Antimicrob Agents Chemother Date: 2018-10-24 Impact factor: 5.191
Authors: Angela Ahlquist Cleveland; Monica M Farley; Lee H Harrison; Betsy Stein; Rosemary Hollick; Shawn R Lockhart; Shelley S Magill; Gordana Derado; Benjamin J Park; Tom M Chiller Journal: Clin Infect Dis Date: 2012-08-14 Impact factor: 9.079
Authors: F Jockenhöfer; H Gollnick; K Herberger; G Isbary; R Renner; M Stücker; E Valesky; U Wollina; M Weichenthal; S Karrer; B Ross; E Heintschel von Heinegg; J Dissemond Journal: Hautarzt Date: 2014-11 Impact factor: 0.751
Authors: Angela Ahlquist Cleveland; Lee H Harrison; Monica M Farley; Rosemary Hollick; Betsy Stein; Tom M Chiller; Shawn R Lockhart; Benjamin J Park Journal: PLoS One Date: 2015-03-30 Impact factor: 3.240