M Cristina Vazquez Guillamet1,2, Rodrigo Vazquez2, Jonas Noe3, Scott T Micek4, Victoria J Fraser5, Marin H Kollef2. 1. Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA. 2. Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA. 3. Department of Internal Medicine, John Cochran Veterans Affairs Hospital, St. Louis, Missouri, USA. 4. Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri, USA. 5. Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Abstract
BACKGROUND: Looking only at the index infection, studies have described risk factors for infections caused by resistant bacteria. We hypothesized that septic patients with bloodstream infections may transition across states characterized by different microbiology and that their trajectory is not uniform. We also hypothesized that baseline risk factors may influence subsequent blood culture results. METHODS: All adult septic patients with positive blood cultures over a 7-year period were included in the study. Baseline risk factors were recorded. We followed all survivors longitudinally and recorded subsequent blood culture results. We separated states into bacteremia caused by gram-positive cocci, susceptible gram-negative bacilli (sGNB), resistant GNB (rGNB), and Candida spp. Detrimental transitions were considered when transitioning to a culture with a higher mortality risk (rGNB and Candida spp.). A multistate Markov-like model was used to determine risk factors associated with detrimental transitions. RESULTS: A total of 990 patients survived and experienced at least 1 transition, with a total of 4282 transitions. Inappropriate antibiotics, previous antibiotic exposure, and index bloodstream infection caused by either rGNB or Candida spp. were associated with detrimental transitions. Double antibiotic therapy (beta-lactam plus either an aminoglycoside or a fluoroquinolone) protected against detrimental transitions. CONCLUSION: Baseline characteristics that include prescribed antibiotics can identify patients at risk for subsequent bloodstream infections caused by resistant bacteria. By altering the initial treatment, we could potentially influence future bacteremic states.
BACKGROUND: Looking only at the index infection, studies have described risk factors for infections caused by resistant bacteria. We hypothesized that septic patients with bloodstream infections may transition across states characterized by different microbiology and that their trajectory is not uniform. We also hypothesized that baseline risk factors may influence subsequent blood culture results. METHODS: All adult septic patients with positive blood cultures over a 7-year period were included in the study. Baseline risk factors were recorded. We followed all survivors longitudinally and recorded subsequent blood culture results. We separated states into bacteremia caused by gram-positive cocci, susceptible gram-negative bacilli (sGNB), resistant GNB (rGNB), and Candida spp. Detrimental transitions were considered when transitioning to a culture with a higher mortality risk (rGNB and Candida spp.). A multistate Markov-like model was used to determine risk factors associated with detrimental transitions. RESULTS: A total of 990 patients survived and experienced at least 1 transition, with a total of 4282 transitions. Inappropriate antibiotics, previous antibiotic exposure, and index bloodstream infection caused by either rGNB or Candida spp. were associated with detrimental transitions. Double antibiotic therapy (beta-lactam plus either an aminoglycoside or a fluoroquinolone) protected against detrimental transitions. CONCLUSION: Baseline characteristics that include prescribed antibiotics can identify patients at risk for subsequent bloodstream infections caused by resistant bacteria. By altering the initial treatment, we could potentially influence future bacteremic states.
Authors: Pilar Retamar; María M Portillo; María Dolores López-Prieto; Fernando Rodríguez-López; Marina de Cueto; María V García; María J Gómez; Alfonso Del Arco; Angel Muñoz; Antonio Sánchez-Porto; Manuel Torres-Tortosa; Andrés Martín-Aspas; Ascensión Arroyo; Carolina García-Figueras; Federico Acosta; Juan E Corzo; Laura León-Ruiz; Trinidad Escobar-Lara; Jesús Rodríguez-Baño Journal: Antimicrob Agents Chemother Date: 2011-10-17 Impact factor: 5.191
Authors: Tiffanie K Jones; Barry D Fuchs; Dylan S Small; Scott D Halpern; Asaf Hanish; Craig A Umscheid; Charles A Baillie; Meeta Prasad Kerlin; David F Gaieski; Mark E Mikkelsen Journal: Ann Am Thorac Soc Date: 2015-06
Authors: Cristina Vazquez-Guillamet; Michael Scolari; Marya D Zilberberg; Andrew F Shorr; Scott T Micek; Marin Kollef Journal: Crit Care Med Date: 2014-11 Impact factor: 7.598
Authors: Mitsuru Toda; Sabrina R Williams; Elizabeth L Berkow; Monica M Farley; Lee H Harrison; Lindsay Bonner; Kaytlynn M Marceaux; Rosemary Hollick; Alexia Y Zhang; William Schaffner; Shawn R Lockhart; Brendan R Jackson; Snigdha Vallabhaneni Journal: MMWR Surveill Summ Date: 2019-09-27