Recent Research on Hospital-Acquired Bloodstream Infections

A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Bacterial Pathogens".

Deadline for manuscript submissions: closed (28 February 2024) | Viewed by 12143

Special Issue Editors


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Guest Editor
Faculty of Medicine, University of Crete, Heraklion, Greece
Interests: clinical microbiology; infectious diseases; endocarditis
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
Interests: clinical microbiology; infectious diseases; endocarditis; mycoses; fungal infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hospital-acquired infections frequently complicate hospitalization and may significantly increase morbidity and mortality of hospitalized patients. Bloodstream infections are among the most common hospital-acquired infections. Today, several changes are noted regarding the epidemiology and microbiology of hospital-acquired bloodstream infections, mostly due to the increasing prevalence of multi-drug resistant microorganisms, either Gram-positives, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus, or Gram-negatives, such as Acinetobacter baumannii, carbapenem-resistant Enterobacterales, and multidrug-resistant Pseudomonas.

To better understand the magnitude of the problem of hospital-acquired bloodstream infections, this Special Issue aims to bring together research studies and reviews related to epidemiology, microbiology, clinical characteristics, treatment, and outcomes of patients with these infections. Studies emphasizing on antimicrobial stewardship and infection control regarding hospital-acquired bloodstream infections are also welcome.

Dr. Diamantis Kofteridis
Dr. Petros Ioannou
Guest Editors

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Keywords

  • hospital-acquired infections
  • bacteremia
  • gram-negative infections
  • gram-positive infections
  • bloodstream infections

Published Papers (9 papers)

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Editorial

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2 pages, 173 KiB  
Editorial
Special Issue: Recent Research on Hospital-Acquired Bloodstream Infections
by Petros Ioannou and Diamantis P. Kofteridis
Pathogens 2023, 12(7), 906; https://doi.org/10.3390/pathogens12070906 - 04 Jul 2023
Viewed by 716
Abstract
Hospital-acquired infections (HAIs) are infections that occur in patients 48 h after admission to hospital [...] Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)

Research

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9 pages, 266 KiB  
Article
Factors Associated with Extended-Spectrum β-Lactamases and Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections: A Five-Year Retrospective Study
by Andreas G. Tofarides, Panagiotis Dimitriou, Georgios K. Nikolopoulos, Dimitrios Rogkas, Christina Flourou, Elina Khattab, Diamanto Kasapi, Chara Azina and Eirini Christaki
Pathogens 2023, 12(11), 1277; https://doi.org/10.3390/pathogens12111277 - 25 Oct 2023
Viewed by 963
Abstract
Klebsiella pneumoniae is one of the leading causes of nosocomial infections. It has been estimated that nosocomial infection by Klebsiella pneumoniae comprises 3–8% of all nosocomial infections. Klebsiella pneumoniae bloodstream infections (BSIs) occur worldwide with varying mortality. Resistant strains, like those producing extended-spectrum [...] Read more.
Klebsiella pneumoniae is one of the leading causes of nosocomial infections. It has been estimated that nosocomial infection by Klebsiella pneumoniae comprises 3–8% of all nosocomial infections. Klebsiella pneumoniae bloodstream infections (BSIs) occur worldwide with varying mortality. Resistant strains, like those producing extended-spectrum beta-lactamases (ESBL) and carbapenemases, are becoming increasingly common, especially in hospital settings, posing therapeutic challenges. In this article, we aimed to study the epidemiology and risk factors of BSIs due to resistant Klebsiella pneumoniae strains in the period 1 January 2014–31 December 2018 at the Nicosia General Hospital, the largest tertiary hospital in Cyprus. Data on demographics, co-morbidities, prior hospitalization, prior intensive care unit (ICU) admission, previous antimicrobial use, nosocomial acquisition of the infection, the presence of a prosthetic device or surgery, and the primary site of infection were retrospectively recorded. Associations between the detection of ESBL Klebsiella pneumoniae BSIs and factors/covariates were examined using logistic regression. This study involved 175 patients with BSI caused by Klebsiella pneumoniae. Of these, 61 BSIs were caused by ESBL strains, 101 by non-ESBL, and 13 by carbapenem-resistant (CR) strains. In univariable analyses, age, sex, heart disease, antimicrobial use during current admission, previous hospitalization (ward or ICU), and primary BSI were associated with the presence of an ESBL strain. Antibiotic use during current admission and heart disease remained statistically significantly associated with ESBL Klebsiella pneumoniae BSI in multivariable models. Antibiotic use during current admission, respiratory infection, and a recent history of surgery were more prevalent among CR Klebsiella pneumoniae BSI patients than among non-CR Klebsiella pneumoniae BSI patients. Our study showed that recent antimicrobial use and heart disease were associated with BSI due to ESBL-producing Klebsiella pneumoniae. This finding could inform clinical practice in hospital settings. Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)
20 pages, 2302 KiB  
Article
Prevalence of Multidrug-Resistant Bacteria in Healthcare-Associated Bloodstream Infections at Hospitals in Riyadh, Saudi Arabia
by Saeed S. Banawas, Ahmed S. Alobaidi, Turki M. Dawoud, Abdullah AlDehaimi, Faisal M. Alsubaie, Ahmed Abdel-Hadi and Palanisamy Manikandan
Pathogens 2023, 12(9), 1075; https://doi.org/10.3390/pathogens12091075 - 23 Aug 2023
Viewed by 1621
Abstract
Bloodstream infection (BSI) prevalence in hospitalized patients has increased owing to the spread of antibiotic-resistant pathogens; moreover, antimicrobial resistance in bacteria is a global problem. Here, BSIs are investigated in several patients at a hospital in Saudi Arabia, and the resistance of bacterial [...] Read more.
Bloodstream infection (BSI) prevalence in hospitalized patients has increased owing to the spread of antibiotic-resistant pathogens; moreover, antimicrobial resistance in bacteria is a global problem. Here, BSIs are investigated in several patients at a hospital in Saudi Arabia, and the resistance of bacterial isolates to widely used drugs is determined. Throughout 2020, bacteria isolated from patients were identified and subjected to antibiotic susceptibility testing. In total, 1125 bacterial isolates were obtained from 1039 patients; among them, gram-positive bacteria were significantly more abundant than gram-negative bacteria. The most prevalent bacteria were Staphylococcus epidermidis and Klebsiella pneumoniae. Notably, gram-negative bacteria were mainly isolated from adult patients, and 20.63% of the gram-positive isolates were from pediatric patients, which was significantly higher than the corresponding percentages in elders and adults. The gram-positive isolates were mainly resistant to cephalothin, oxacillin, amoxicillin-clavulanate, and erythromycin and susceptible to penicillin, gentamicin, ciprofloxacin, and vancomycin. Additionally, the gram-negative isolates were mainly resistant to ampicillin, cephalothin, and amoxicillin-clavulanate and susceptible to amikacin, ertapenem, aztreonam, colistin, and trimethoprim-sulfamethoxazole. Consequently, the high prevalence of infective multidrug-resistant bacteria may account as a significant health issue; it is considered a hazard in Riyadh hospitals and must be prevented at all costs. Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)
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13 pages, 383 KiB  
Article
Patterns, Cost, and Immunological Response of MDR vs. Non MDR-Bacteremia: A Prospective Cohort Study
by Georgios Schinas, Katerina Skintzi, Anne-Lise De Lastic, Maria Rodi, Charalambos Gogos, Athanasia Mouzaki and Karolina Akinosoglou
Pathogens 2023, 12(8), 1044; https://doi.org/10.3390/pathogens12081044 - 15 Aug 2023
Viewed by 834
Abstract
Background: Antimicrobial resistance (AMR) is a significant global health concern, posing a critical challenge for the effective management of infectious diseases. This study aimed to compare the immunological response, clinical outcomes, and associated costs in patients with bacteremia due to antibiotic-resistant vs. susceptible [...] Read more.
Background: Antimicrobial resistance (AMR) is a significant global health concern, posing a critical challenge for the effective management of infectious diseases. This study aimed to compare the immunological response, clinical outcomes, and associated costs in patients with bacteremia due to antibiotic-resistant vs. susceptible bacterial microorganisms. Methods: This study was a single-center, prospective cohort study conducted from May 2017 to November 2019. The study population consisted of patients admitted with a confirmed diagnosis of bacteremia. Results: A total of 116 patients were included, with 53 (45.7%) harboring non-multidrug-resistant (non-MDR) bacterial isolates and 63 (54.3%) harboring multidrug-resistant (MDR) bacterial isolates. Patients with MDR bacteremia had more severe clinical presentations, as indicated by higher SOFA and APACHE II scores. Results revealed higher all-cause mortality rates (39.7% vs. 17%) and median healthcare costs (€4791 vs. €2843.5) in the MDR bacteremia group. Moreover, MDR bacteremia was linked to higher levels of TNF-a, indicating a differential immune response. Furthermore, MDR bacteremia was found to be an independent predictor of mortality (OR = 3.216, 95% CI: 1.338–7.730, p = 0.009) and increased healthcare costs (effect size of approximately 27.4%). Conclusion: These findings underscore the significant impact of antimicrobial resistance in healthcare settings, highlighting the urgency of addressing the challenges posed by MDR microorganisms. Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)
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16 pages, 1240 KiB  
Article
The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections
by Vasilios Petrakis, Maria Panopoulou, Petros Rafailidis, Nikolaos Lemonakis, Georgios Lazaridis, Irene Terzi, Dimitrios Papazoglou and Periklis Panagopoulos
Pathogens 2023, 12(6), 780; https://doi.org/10.3390/pathogens12060780 - 30 May 2023
Cited by 8 | Viewed by 2038
Abstract
Introduction: The pressure of the COVID-19 pandemic on healthcare systems led to limited roles of infectious diseases services, increased rates of irrational use of antimicrobials, and incidence of infections by multidrug-resistant microorganisms. The aim of the present study is to evaluate the incidence [...] Read more.
Introduction: The pressure of the COVID-19 pandemic on healthcare systems led to limited roles of infectious diseases services, increased rates of irrational use of antimicrobials, and incidence of infections by multidrug-resistant microorganisms. The aim of the present study is to evaluate the incidence of antimicrobial resistance and the management of bloodstream infections before and during the COVID-19 pandemic at the University General Hospital of Alexandroupolis (Greece). Materials and Methods: This is a retrospective study conducted from January 2018 to December 2022. Data were collected from the University Microbiology Laboratory per semester regarding the isolated strains of Gram-positive and -negative bacteria in blood cultures and respiratory samples in hospitalized patients in medical and surgical wards and in the intensive care unit (ICU). Additionally, bloodstream infections with requested infectious disease consultations were reported (n = 400), determining whether these were carried out via telephone contact or at the patient’s bedside. Demographic data, comorbidities, focus of infection, antimicrobial regimen, duration of treatment, length of hospitalization, and clinical outcome were analyzed. Results: A total of 4569 strains of Gram-positive and -negative bacteria were isolated. An increasing trend was reported compared to the pre-pandemic period in the incidence of resistant Gram-negative bacteria, particularly in ICUs. Prior antimicrobial use and the rate of hospital-acquired infections were increased significantly during the pandemic. In the pre-pandemic period 2018–2019, a total of 246 infectious disease consultations were carried out, while during the period 2020–2022, the number was 154, with the percentage of telephone consultations 15% and 76%, respectively. Detection of the source of infection and timely administration of appropriate antimicrobial agents were more frequently recorded before the pandemic, and 28-day mortality was significantly reduced in cases with bedside consultations. Conclusion: The empowering of infectious disease surveillance programs and committees, rational use of antimicrobials agents, and bedside infectious disease consultations are vital in order to reduce the impact of infections caused by multidrug-resistant strains. Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)
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7 pages, 372 KiB  
Article
Impact of the COVID-19 Pandemic on the Management of Staphylococcus aureus Bloodstream Infections in a Tertiary Care Hospital
by Christian W. Böing, Neele J. Froböse, Frieder Schaumburg and Stefanie Kampmeier
Pathogens 2023, 12(4), 611; https://doi.org/10.3390/pathogens12040611 - 18 Apr 2023
Cited by 1 | Viewed by 1078
Abstract
Staphylococcus aureus bacteremia (SAB) is associated with a high mortality rate. The clinical outcome of SAB patients highly depends on early diagnosis, adequate antibiotic therapy and source control. In the context of the COVID-19 pandemic, the health care system faced additional organizational challenges [...] Read more.
Staphylococcus aureus bacteremia (SAB) is associated with a high mortality rate. The clinical outcome of SAB patients highly depends on early diagnosis, adequate antibiotic therapy and source control. In the context of the COVID-19 pandemic, the health care system faced additional organizational challenges and the question arose whether structured screening and triaging for COVID-19 and shifting resources influence the management of SAB. Patients (n = 115) with SAB were enrolled in a retrospective comparative study with historical controls (March 2019–February 2021). The quality of SAB therapy was assessed with a point score, which included correct choice of antibiotic, adequate dosage of antibiotic, sufficient duration of therapy, early start of therapy after receipt of findings, focus search and taking control blood cultures 3–4 days after starting adequate antibiotic therapy. The quality of treatment before and after the onset of the COVID-19 pandemic were compared. No significant differences in the total score points were found between the pre-COVID-19 and COVID-19 cohort. All quality indicators, except the correct duration of antibiotic therapy, showed no significant differences in both cohorts. Furthermore, there were no significant differences in the outcome between both cohorts. The treatment quality of SAB therapy was comparable before and during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)
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Review

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12 pages, 577 KiB  
Review
Fungemia by Wickerhamomyces anomalus—A Narrative Review
by Petros Ioannou, Stella Baliou and Diamantis P. Kofteridis
Pathogens 2024, 13(3), 269; https://doi.org/10.3390/pathogens13030269 - 21 Mar 2024
Viewed by 1054
Abstract
Wickerhamomyces anomalus has been previously classified as Hansenula anomala, Pichia anomala, and Candida pelliculosa and was recently reclassified in the genus Wickerhamomyces after phylogenetic analysis of its genetic sequence. An increasing number of reports of human infections by W. anomalus have emerged, [...] Read more.
Wickerhamomyces anomalus has been previously classified as Hansenula anomala, Pichia anomala, and Candida pelliculosa and was recently reclassified in the genus Wickerhamomyces after phylogenetic analysis of its genetic sequence. An increasing number of reports of human infections by W. anomalus have emerged, suggesting that this microorganism is an emerging pathogen. The present review aimed to provide data on the epidemiology, antifungal resistance, clinical characteristics, treatment, and outcomes of fungemia by W. anomalus by extracting all the available information from published original reports in the literature. PubMed/Medline, Cochrane Library, and Scopus databases were searched for eligible articles reporting data on patients with this disease. In total, 36 studies involving 170 patients were included. The age of patients with fungemia by W. anomalus ranged from 0 to 89 years; the mean age was 22.8 years, the median age was 2.2 years, with more than 37 patients being less than one month old, and 54% (88 out of 163 patients) were male. Regarding patients’ history, 70.4% had a central venous catheter use (CVC), 28.7% were on total parenteral nutrition (TPN), 97% of neonates were hospitalized in the neonatal ICU (NICU), and 39.4% of the rest of the patients were hospitalized in the intensive care unit (ICU). Previous antimicrobial use was noted in 65.9% of patients. The most common identification method was the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in 34.1%, VITEK and VITEK 2 in 20.6%, and ID32 C in 15.3%. W. anomalus had minimal antifungal resistance to fluconazole, echinocandins, and amphotericin B, the most commonly used antifungals for treatment. Fever and sepsis were the most common clinical presentation noted in 95.8% and 86%, respectively. Overall mortality was 20% and was slightly higher in patients older than one year. Due to the rarity of this disease, future multicenter studies should be performed to adequately characterize patients’ characteristics, treatment, and outcomes, which will increase our understanding and allow drawing safer conclusions regarding optimal management. Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)
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14 pages, 531 KiB  
Review
The Gordian Knot of C. auris: If You Cannot Cut It, Prevent It
by Vasiliki Rapti, Katerina Iliopoulou and Garyfallia Poulakou
Pathogens 2023, 12(12), 1444; https://doi.org/10.3390/pathogens12121444 - 13 Dec 2023
Cited by 2 | Viewed by 1381
Abstract
Since its first description in 2009, Candida auris has, so far, resulted in large hospital outbreaks worldwide and is considered an emerging global public health threat. Exceptionally for yeast, it is gifted with a profoundly worrying invasive potential and high inter-patient transmissibility. At [...] Read more.
Since its first description in 2009, Candida auris has, so far, resulted in large hospital outbreaks worldwide and is considered an emerging global public health threat. Exceptionally for yeast, it is gifted with a profoundly worrying invasive potential and high inter-patient transmissibility. At the same time, it is capable of colonizing and persisting in both patients and hospital settings for prolonged periods of time, thus creating a vicious cycle of acquisition, spreading, and infection. It exhibits various virulence qualities and thermotolerance, osmotolerance, filamentation, biofilm formation and hydrolytic enzyme production, which are mainly implicated in its pathogenesis. Owing to its unfavorable profile of resistance to diverse antifungal agents and the lack of effective treatment options, the implementation of robust infection prevention and control (IPC) practices is crucial for controlling and minimizing intra-hospital transmission of C. auris. Rapid and accurate microbiological identification, adherence to hand hygiene, use of adequate personal protective equipment (PPE), proper handling of catheters and implantable devices, contact isolation, periodical environmental decontamination, targeted screening, implementation of antimicrobial stewardship (AMS) programs and communication between healthcare facilities about residents’ C. auris colonization status are recognized as coherent strategies for preventing its spread. Current knowledge on C. auris epidemiology, clinical characteristics, and its mechanisms of pathogenicity are summarized in the present review and a comprehensive overview of IPC practices ensuring yeast prevention is also provided. Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)
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Other

7 pages, 477 KiB  
Brief Report
Efficacy of Fosfomycin-Containing Regimens for Treatment of Bacteremia Due to Pan-Drug Resistant Acinetobacter baumannii in Critically Ill Patients: A Case Series Study
by Stelios F. Assimakopoulos, Vassilis Karamouzos, Gerasimos Eleftheriotis, Maria Lagadinou, Christina Bartzavali, Fevronia Kolonitsiou, Fotini Paliogianni, Fotini Fligou and Markos Marangos
Pathogens 2023, 12(2), 286; https://doi.org/10.3390/pathogens12020286 - 09 Feb 2023
Cited by 10 | Viewed by 1814
Abstract
Acinetobacter baumannii (AB) has evolved over the last decades as a major problem in carbapenem-resistant gram-negative nosocomial infections, associated with high mortality rates especially in the intensive care unit (ICU). Recent reports highlight the increasing prevalence of resistance to colistin, a last resort [...] Read more.
Acinetobacter baumannii (AB) has evolved over the last decades as a major problem in carbapenem-resistant gram-negative nosocomial infections, associated with high mortality rates especially in the intensive care unit (ICU). Recent reports highlight the increasing prevalence of resistance to colistin, a last resort therapeutic option for carbapenem-resistant AB. We retrospectively evaluated the characteristics, treatment regimens and outcomes of twenty patients with pan-drug resistant (PDR) AB primary bacteremia hospitalized in the ICU of the University General Hospital of Patras, during a two-year period (October 2020–September 2022). The 28-day mortality reached 50%. Between survivors and non-survivors, no differences were found regarding age, gender, and Charlson comorbidity index (CCI). However, non-survivors had higher APACHE II scores and higher prevalence of septic shock and COVID-19 infection. A significantly higher percentage in the survivor group received Fosfomycin as part of the combination regimen. Inclusion of fosfomycin in the combination therapeutic regimen was associated with significantly better survival as compared to non-fosfomycin-containing regimens. In view of the increasing prevalence of PDR-AB infections in ICUs, its associated high rates of mortality and the lack of effective treatment options, the observed survival benefit with fosfomycin inclusion in the therapeutic regimen merits further validation in larger prospective studies. Full article
(This article belongs to the Special Issue Recent Research on Hospital-Acquired Bloodstream Infections)
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