Indian journal of medical microbiology · 2025
A risk-based assessment of Enterococcal Bloodstream infection: Suggesting considerations in empirical therapy strategies in a tertiary care hospital.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kumar Pooja, Thakuria Bhaskar, Pati Binod Kumar, Prathyusha K, Sarfraz Asim, Archana
Аннотация
PURPOSE: Enterococcal bloodstream infections (E-BSIs) pose a significant challenge due to their unique intrinsic and increasing resistance. Empirical treatment guidelines are often ineffective in E-BSI, as Antibiotic policies mainly address Gram-negative bacilli and MRSA for Hospital-acquired infection (HAI) in India.
METHODS: The study was designed to investigate the risk factors, infection source, species profile, antimicrobial susceptibility and clinical outcomes in diagnosed E-BSI patients at a tertiary care centre in India. From the blood culture samples from August 2022 to July 2023, 52 non-duplicate blood culture isolates of Enterococcus species were identified with categorisation of vancomycin resistance genes, and the patients were followed up for risk factors, probable sources, and ongoing therapies, with a switch to definitive therapy for the outcome.
RESULTS: Of 52 confirmed E-BSI cases, the species distribution was as follows: E. faecium (61.5 %), E. faecalis (26.92 %), E. gallinarum (9.61 %), and E. durans (1.92 %). Antimicrobial resistance was significantly higher in E. faecium. Nine isolates (17.3 %) were vancomycin-resistant enterococci (VRE), with diverse outcomes. HAI comprised 44.23 % of cases. The overall mortality rate was 26.9 % and ICU patients had significantly higher mortality, with significant risk factors being invasive medical devices (59.6 %), followed by bedridden status (23 %) and immunosuppression (9.61 %). Significant risk factors included the presence of invasive medical devices (59.6 %), followed by a bedridden status (23.0 %) and immunosuppression (9.6 %). Patients with early empirical therapy that has enterococcal coverage showed a protective effect on survival. However, switching over to definitive therapy alone could not significantly reduce mortality.
CONCLUSION: This study underscores the importance of early empirical therapy with enterococcal coverage in high-risk patients. Timely initiation of empirical coverage appears more crucial than later definitive therapy adjustments in improving survival. Invasive device use remains a significant risk factor, reinforcing the need for stringent infection control to prevent HAI, including E-BSI.
METHODS: The study was designed to investigate the risk factors, infection source, species profile, antimicrobial susceptibility and clinical outcomes in diagnosed E-BSI patients at a tertiary care centre in India. From the blood culture samples from August 2022 to July 2023, 52 non-duplicate blood culture isolates of Enterococcus species were identified with categorisation of vancomycin resistance genes, and the patients were followed up for risk factors, probable sources, and ongoing therapies, with a switch to definitive therapy for the outcome.
RESULTS: Of 52 confirmed E-BSI cases, the species distribution was as follows: E. faecium (61.5 %), E. faecalis (26.92 %), E. gallinarum (9.61 %), and E. durans (1.92 %). Antimicrobial resistance was significantly higher in E. faecium. Nine isolates (17.3 %) were vancomycin-resistant enterococci (VRE), with diverse outcomes. HAI comprised 44.23 % of cases. The overall mortality rate was 26.9 % and ICU patients had significantly higher mortality, with significant risk factors being invasive medical devices (59.6 %), followed by bedridden status (23 %) and immunosuppression (9.61 %). Significant risk factors included the presence of invasive medical devices (59.6 %), followed by a bedridden status (23.0 %) and immunosuppression (9.6 %). Patients with early empirical therapy that has enterococcal coverage showed a protective effect on survival. However, switching over to definitive therapy alone could not significantly reduce mortality.
CONCLUSION: This study underscores the importance of early empirical therapy with enterococcal coverage in high-risk patients. Timely initiation of empirical coverage appears more crucial than later definitive therapy adjustments in improving survival. Invasive device use remains a significant risk factor, reinforcing the need for stringent infection control to prevent HAI, including E-BSI.