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P955 Epidemiological characteristics of nosocomial blood infections at a clinical centre, Belgrade, Serbia in 2005
Bloodstream infections Methods: The study was developed in a 250 bed community teaching hospital placed in the North of Spain with around 65,000 presentations to the emergency service annually. All patients to whom blood cultures were performed from January to June 2006 were recruited for the study. Univariate analyses and stepwise logistic regression were performed to identify factors associated with bacteraemia. Results: Blood cultures were performed in 390 patients in the period of study. Bacteraemia was detected in 60 (15.4%). Isolated microorganisms were E. coli in 35 (9%), S. aureus in 3 (0.8%), S. agalactiae in 2 (0.5%), P. aeruginosa in 2 (0.5%), Listeria spp. in 2 (0.5%), and others in 16 (4.1%). No significant differences among patients with positive and negative blood cultures in age, gender, proportion of comorbibities (renal chronic failure, cardiac failure, diabetes, dementia, immunosuppression, cirrhosis, neoplasia), Charlson index score, or clinical manifestations (presence of chills, or vomiting, and mean systolic blood pressure) were detected. However patients with positive blood cultures had shorter duration of the acute illness (29.3±32.5 h vs 59.4±85.7 h), more frequently had no previous antibiotic treatment (96.7% vs 84.2%), more frequently had temperature higher than 38ºC (60% vs 40.2%), severe sepsis (21.7% vs 7.9%) or altered consciousness (20% vs 6.7%). In a logistic regression model the predictors of bacteraemia were absence of previous antibiotic treatment (OR: 4.87, 95CI: 1.12−21.17), altered consciousness at arrival (OR: 3.85, 95CI: 1.55–9.54) and the presence of fever (OR: 2.18, 95CI: 1.16–3.97). Conclusions: Several clinical parameters can be useful for predict bacteraemia in an Emergency service. The absence of previous antibiotic administration, altered consciousness at arrival, and the presence of fever are associated with a higher risk of bacteraemia
P955 Epidemiological characteristics of nosocomial blood infections at a clinical centre, Belgrade, Serbia in 2005 B. Jovanovic, V. Mioljevic, S. Jovanovic, N. Mazic, I. Palibrk (Belgrade, RS) Introduction: Nosocomial bloodstream infections (BSI) represent actual and one of the most severe medical problems due to their frequency, prolonged hospitalisation and increase of medical costs. Their incidence varies depending on the characteristics of the observed patients and department, ranging between 1.3 and 18.4 per 1000 patient days. Major causes of BSI include coagulase-negative staphylocci(CNS), Staphylococcus aureus, Enterococcus spp. and Candida spp. Purpose: Determining of BSI incidence and distribution of BSI causes in percentages in patients hospitalised for more than 48 hours at the Institute of Digestive Diseases in 2005. Methods: BSI incidence is calculated using Atlanta CDC methodology. Cultivation, isolation, identification and susceptibility tests of the causative organisms obtained from the patient material was carried out using standard microbiological methods in the Microbiological Laboratory within the Emergency Center of the Clinical Center of Serbia. Results: BSI incidence at the Institute of Digestive Surgery was 5.76 per 1000 patient days. One third (28%) of all blood infections verified in the laboratory was caused by CNS, followed by Klebsiella spp. (14%), Staphylococcus aureus and Candida spp. (12.5%). Methicillin resistance was evidenced in 80% of CNS isolates and 90% of Staphylococcus aureus isolates. ESBL was produced by 18% of Klebsiella spp. isolates. Conclusion: The incidence of BSI recorded at the Institute of Digestive Diseases in 2005 was 5.76 per 1000 patient days. One third of all blood infections verified in the laboratory at the Institute during 2005, was caused by CNS, followed by Klebsiella spp., Staphylococcus aureus and Candida spp. All the isolates show high degree of resistance to antimicrobial drugs. Epidemiological surveillance of BSI enables insight into epidemiology of BSI, monitoring of resistance of causative organisms and application of the specific preventive measures against the infections.
S251 P956 Surveillance of nosocomial sepsis and identifcation of relevant risk factors in neutropenic haematology-oncology patients F. Tabibnia, F. Mattner, A. Ganser, P. Gastmeier, I. Chaberny (Hannover, DE) Objectives: Implementation of a prospective surveillance and identification of risk factors concerning nosocomial bloodstream infections (BSI) during neutropenia in adult patients of a haematology–oncology unit after hematopoetic stem cell transplantation or high dose chemotherapy (CT). Methods: BSIs were identified using CDC definitions (laboratory confirmed BSI) in neutropenic patients (NPs) with haematological and solid malignancies (absolute neutrophile counts <1000/mm3 ). Recorded risk factors (RFs): Age, gender, diagnosis, type of transplantation (autologous, allogeneic sibling donor, matched unrelated donor), type of central access (CVC, Port) or use of peripheral access, fever days. Uni- and multivariate analyses were used to determine RFs. Results: During the 12-month period of the study 202 patients with 2,843 neutropenic days (NDs) were investigated. 41 patients received autologous transplant (345 NDs), 161 were treated for other reasons (2,498 NDs). The median age was 49.5 years (17−77). The mean number of NDs (range: 2−72) was 14.1 (15.5 and 8.4 after CT and autologous transplantation (AT), respectively). A total of 37 BSIs were diagnosed. The incidence densities were 13.0 BSIs/1,000 NDs (10.2 and 23.2 after CT and AT, respectively) or a rate of 18.3 BSIs/100 NPs (18.0 and 19.5 after CT and AT, respectively). The main pathogens were coagulasenegative staphylococci (36.4%), Gram-negative rods (31.8%) and Grampositive cocci (20.5%). The shortest mean duration of neutropenia until development of BSI among the pathogens was found for Gram-negative rods counting 5 days. The mean length of fever was 4 days (with BSI 8 days). On univariate analysis, the duration of fever (p < 0.001) and of neutropenia (p < 0.001) was significantly associated with development of BSI. On multivariate analysis, the independent RFs for BSI were the number of fever days (Hazards ratio 1.2 increased risk/day) and use of CVC (Odds ratio [OR], 6.4; 95% confidence intervall, 1.5−27.7, Hazards ratio 5.8). Conclusions: The study shows and confirms that the use of CVC is a major RF for nosocomial BSIs in NPs. The incidence of BSI/1000 NDs was higher among AT recipients of this study than of the participating hospitals of ONKO-KISS (pooled data: 17.8). Compared to the results in former studys (Dettenkofer et al., CID 2005;40:926−31) a higher share of Gram-negative rods (31.8% vs. 15%) was found associated with BSI. P957 The influence of antimicrobial resistance on mortality in critically ill patients with bacteraemia J.Y. Choi, Y.K. Kim, M.S. Kim, Y.S. Park, Y.G. Song, D. Yong, K. Lee, J.M. Kim (Seoul, KR) Background: Among all hospitalised patients, ICU patients are at greatest risk for nosocomial infections. Predominant pathogens include Pseudomonas aeruginosa, Enterobacter cloacae, Staphylococcus aureus, Enterococci, and Candida spp. They are more likely to be resistant to antimicrobial agents than are isolates from elsewhere in the hospital. The isolation of antimicrobial resistant pathogens increase the risk of inadequate antimicrobial therapy. However, clinical importance of antimicrobial resistance, as a risk factor for hospital mortality and other adverse clinical outcomes, has not been systematically evaluated in the ICU setting. The objective of this study was to evaluate the effects of the isolation of antimicrobial resistant pathogens on clinical outcomes among ICU patients with bacteraemia. Methods: A retrospective cohort study was performed to identify risk factors for mortality in ICU patients with bacteraemia. Data from 76 patients with bacteraemia who admitted between January 2004 and December 2004 at ICU of Severance Hospital, Yonsei University College of Medicine in Seoul, Korea, a 1,300-bed tertiary-care teaching hospital, were analyzed to identify risk factors for in-hospital mortality. ICU patients with antimicrobial resistant pathogens such as MRSA, VRE,
P955 Epidemiological characteristics of nosocomial blood infections at a clinical centre, Belgrade, Serbia in 2005 B. Jovanovic, V. Mioljevic, S. Jovanovic, N. Mazic, I. Palibrk (Belgrade, RS) Introduction: Nosocomial bloodstream infections (BSI) represent actual and one of the most severe medical problems due to their frequency, prolonged hospitalisation and increase of medical costs. Their incidence varies depending on the characteristics of the observed patients and department, ranging between 1.3 and 18.4 per 1000 patient days. Major causes of BSI include coagulase-negative staphylocci(CNS), Staphylococcus aureus, Enterococcus spp. and Candida spp. Purpose: Determining of BSI incidence and distribution of BSI causes in percentages in patients hospitalised for more than 48 hours at the Institute of Digestive Diseases in 2005. Methods: BSI incidence is calculated using Atlanta CDC methodology. Cultivation, isolation, identification and susceptibility tests of the causative organisms obtained from the patient material was carried out using standard microbiological methods in the Microbiological Laboratory within the Emergency Center of the Clinical Center of Serbia. Results: BSI incidence at the Institute of Digestive Surgery was 5.76 per 1000 patient days. One third (28%) of all blood infections verified in the laboratory was caused by CNS, followed by Klebsiella spp. (14%), Staphylococcus aureus and Candida spp. (12.5%). Methicillin resistance was evidenced in 80% of CNS isolates and 90% of Staphylococcus aureus isolates. ESBL was produced by 18% of Klebsiella spp. isolates. Conclusion: The incidence of BSI recorded at the Institute of Digestive Diseases in 2005 was 5.76 per 1000 patient days. One third of all blood infections verified in the laboratory at the Institute during 2005, was caused by CNS, followed by Klebsiella spp., Staphylococcus aureus and Candida spp. All the isolates show high degree of resistance to antimicrobial drugs. Epidemiological surveillance of BSI enables insight into epidemiology of BSI, monitoring of resistance of causative organisms and application of the specific preventive measures against the infections.
S251 P956 Surveillance of nosocomial sepsis and identifcation of relevant risk factors in neutropenic haematology-oncology patients F. Tabibnia, F. Mattner, A. Ganser, P. Gastmeier, I. Chaberny (Hannover, DE) Objectives: Implementation of a prospective surveillance and identification of risk factors concerning nosocomial bloodstream infections (BSI) during neutropenia in adult patients of a haematology–oncology unit after hematopoetic stem cell transplantation or high dose chemotherapy (CT). Methods: BSIs were identified using CDC definitions (laboratory confirmed BSI) in neutropenic patients (NPs) with haematological and solid malignancies (absolute neutrophile counts <1000/mm3 ). Recorded risk factors (RFs): Age, gender, diagnosis, type of transplantation (autologous, allogeneic sibling donor, matched unrelated donor), type of central access (CVC, Port) or use of peripheral access, fever days. Uni- and multivariate analyses were used to determine RFs. Results: During the 12-month period of the study 202 patients with 2,843 neutropenic days (NDs) were investigated. 41 patients received autologous transplant (345 NDs), 161 were treated for other reasons (2,498 NDs). The median age was 49.5 years (17−77). The mean number of NDs (range: 2−72) was 14.1 (15.5 and 8.4 after CT and autologous transplantation (AT), respectively). A total of 37 BSIs were diagnosed. The incidence densities were 13.0 BSIs/1,000 NDs (10.2 and 23.2 after CT and AT, respectively) or a rate of 18.3 BSIs/100 NPs (18.0 and 19.5 after CT and AT, respectively). The main pathogens were coagulasenegative staphylococci (36.4%), Gram-negative rods (31.8%) and Grampositive cocci (20.5%). The shortest mean duration of neutropenia until development of BSI among the pathogens was found for Gram-negative rods counting 5 days. The mean length of fever was 4 days (with BSI 8 days). On univariate analysis, the duration of fever (p < 0.001) and of neutropenia (p < 0.001) was significantly associated with development of BSI. On multivariate analysis, the independent RFs for BSI were the number of fever days (Hazards ratio 1.2 increased risk/day) and use of CVC (Odds ratio [OR], 6.4; 95% confidence intervall, 1.5−27.7, Hazards ratio 5.8). Conclusions: The study shows and confirms that the use of CVC is a major RF for nosocomial BSIs in NPs. The incidence of BSI/1000 NDs was higher among AT recipients of this study than of the participating hospitals of ONKO-KISS (pooled data: 17.8). Compared to the results in former studys (Dettenkofer et al., CID 2005;40:926−31) a higher share of Gram-negative rods (31.8% vs. 15%) was found associated with BSI. P957 The influence of antimicrobial resistance on mortality in critically ill patients with bacteraemia J.Y. Choi, Y.K. Kim, M.S. Kim, Y.S. Park, Y.G. Song, D. Yong, K. Lee, J.M. Kim (Seoul, KR) Background: Among all hospitalised patients, ICU patients are at greatest risk for nosocomial infections. Predominant pathogens include Pseudomonas aeruginosa, Enterobacter cloacae, Staphylococcus aureus, Enterococci, and Candida spp. They are more likely to be resistant to antimicrobial agents than are isolates from elsewhere in the hospital. The isolation of antimicrobial resistant pathogens increase the risk of inadequate antimicrobial therapy. However, clinical importance of antimicrobial resistance, as a risk factor for hospital mortality and other adverse clinical outcomes, has not been systematically evaluated in the ICU setting. The objective of this study was to evaluate the effects of the isolation of antimicrobial resistant pathogens on clinical outcomes among ICU patients with bacteraemia. Methods: A retrospective cohort study was performed to identify risk factors for mortality in ICU patients with bacteraemia. Data from 76 patients with bacteraemia who admitted between January 2004 and December 2004 at ICU of Severance Hospital, Yonsei University College of Medicine in Seoul, Korea, a 1,300-bed tertiary-care teaching hospital, were analyzed to identify risk factors for in-hospital mortality. ICU patients with antimicrobial resistant pathogens such as MRSA, VRE,