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    Increased mortality in hospital- compared to community-onset carbapenem-resistant enterobacterales infections
    (2024)
    Angelique E Boutzoukas
    ;
    Natalie Mackow
    ;
    Abhigya Giri
    ;
    Lauren Komarow
    ;
    Carol Hill
    <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P &amp;lt; 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P &amp;lt; 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P &amp;lt; 0.001].</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.</jats:p> </jats:sec>
    Scopus© Citations 1  3
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    Porcentaje de éxito de erradicación de Helicobacter pylori con tratamiento antibiótico empírico en pacientes pediátricos de un Hospital Terciario
    (2023)
    Sofía Darritchon Lama
    ;
    Diego Díaz García
    ;
    Marcela Toledo Cumplido
    ;
    LUCERO ALVAREZ, YALDA CECILIA  
    <jats:p>La infección por Helicobacter pylori es una condición frecuente, que a largo plazo se asocia con desarrollo de enfermedad ulceropéptica y eventualmente cáncer gástrico, que se podrían prevenir con un tratamiento oportuno. Lo óptimo sería lograr un éxito de erradicación mayor al 90%, pero los tratamientos empíricos recomendados no logran esas tasas en condiciones reales.Objetivo: Determinar el porcentaje de éxito del tratamiento empírico de erradicación de primera línea contra H. pylori en pacientes pediátricos atendidos en un hospital terciario.Pacientes y Método: Estudio descriptivo retrospectivo en pacientes con infección por H. pylori detectado en biopsias gástricas y que hubieran recibido tratamiento antibiótico de primera línea durante el periodo 2017-2021. Se consideró erradicación exitosa el resultado negativo de test de antígeno en deposiciones o nuevas biopsias luego de ≥ 1 mes de finalizado el tratamiento.Resultados: Se identificaron 82 pacientes con infección por H. pylori, de los cuales 53 recibieron tratamiento de erradicación. De éstos, 26 (49%) fueron controlados con test de erradicación luego del tratamiento y en ellos el porcentaje de éxito fue de solo 38% (10/26).Conclusiones: La tasa de erradicación con los esquemas empíricos utilizados fue menor a la esperada, lo que evidencia el desafío de buscar estrategias más efectivas de tratamiento incluyendo el estudio de susceptibilidad a antimicrobianos. La adherencia de los pacientes al protocolo de seguimiento también fue baja, lo que deberá reforzarse en el futuro para poder realizar un manejo clínico más adecuado. </jats:p>
    Scopus© Citations 4  2
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    Priorities and Progress in Gram-positive Bacterial Infection Research by the Antibacterial Resistance Leadership Group: A Narrative Review
    (2023)
    Sarah B Doernberg
    ;
    Cesar A Arias
    ;
    Deena R Altman
    ;
    Ahmed Babiker
    ;
    Helen W Boucher
    <jats:title>Abstract</jats:title><jats:p>The Antibacterial Resistance Leadership Group (ARLG) has prioritized infections caused by gram-positive bacteria as one of its core areas of emphasis. The ARLG Gram-positive Committee has focused on studies responding to 3 main identified research priorities: (1) investigation of strategies or therapies for infections predominantly caused by gram-positive bacteria, (2) evaluation of the efficacy of novel agents for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci, and (3) optimization of dosing and duration of antimicrobial agents for gram-positive infections. Herein, we summarize ARLG accomplishments in gram-positive bacterial infection research, including studies aiming to (1) inform optimal vancomycin dosing, (2) determine the role of dalbavancin in MRSA bloodstream infection, (3) characterize enterococcal bloodstream infections, (4) demonstrate the benefits of short-course therapy for pediatric community-acquired pneumonia, (5) develop quality of life measures for use in clinical trials, and (6) advance understanding of the microbiome. Future studies will incorporate innovative methodologies with a focus on interventional clinical trials that have the potential to change clinical practice for difficult-to-treat infections, such as MRSA bloodstream infections.</jats:p>
      8Scopus© Citations 7
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      13Scopus© Citations 21
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      10Scopus© Citations 10
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    Pseudomonas aeruginosa Bloodstream Infections in Patients with Cancer: Differences between Patients with Hematological Malignancies and Solid Tumors
    (2022)
    Cristina Royo-Cebrecos
    ;
    Julia Laporte-Amargós
    ;
    Marta Peña
    ;
    Isabel Ruiz-Camps
    ;
    Pedro Puerta-Alcalde
    <jats:p>Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006–May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 × 109 cells/mm) (67% vs. 44.6%; p &lt; 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p &lt; 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p &lt; 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p &lt; 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p &lt; 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p &lt; 0.001) and 30-day (49% vs. 37.3%; p &lt; 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.</jats:p>
    Scopus© Citations 11  1
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    International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty
    (2022)
    Thomas Parsons
    ;
    Jonathan French
    ;
    Takeshi Oshima
    ;
    FIGUEROA BERRIOS, FRANCISCO JAVIER  
    ;
    Thomas Neri
    <jats:p>(1) Background: Prophylactic systemic antibiotics are acknowledged to be an important part of mitigating prosthetic joint infections. Controversy persists regarding optimal antibiotic regimes. We sought to evaluate current international antibiotics guidelines for total joint arthroplasty (TJA) of the hip and knee. (2) Methods: 42 arthroplasty societies across 6 continents were contacted and their published literature reviewed. (3) Results: 17 societies had guidelines; of which 11 recommended an antibiotic agent or antibiotic class (10—cephalosporin; 1—cloxacillin); 15 recommended antibiotic infusion within an hour of incision and 10 advised for post-operative doses (8—up to 24 h; 1—up to 36 h; 1—up to 48 h). (4) Conclusions: Prophylactic antibiotic guidelines for TJA are often absent or heterogenous in their advice.</jats:p>
    Scopus© Citations 6  1
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    Recomendaciones para el manejo inicial del síndrome inflamatorio multisistémico relacionado temporalmente con COVID-19, en niños y adolescentes
    (2020)
    Guillermo Kohn-Loncarica
    ;
    Ana Fustiñana
    ;
    Franco Díaz-Rubio
    ;
    Juan C. Jaramillo-Bustamante
    ;
    Sebastián González-Dambrauskas
    Scopus© Citations 12  1
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    Scopus© Citations 226  7
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    Scopus© Citations 22  2