Antimicrobial Resistance Rates and Treatment Options in Bloodstream Infections: A Prospective Observational Study
Background: Emerging antibacterial resistance is a constant threat. Broad-spectrum antibiotics are preferred in empirical treatment for bloodstream infections (BSI) due to increasing resistance rates. METHODS: A prospective observational study was conducted in three tertiary hospitals in Türkiye. Mi...
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Elsevier
2024-12-01
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| Series: | Journal of Global Antimicrobial Resistance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716524002650 |
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| author | Lal Sude Gücer Fatihan Pınarlık Refath Farzana Nazlı Ataç ZELİHA GENÇ Bahar Madran IREM SENA BULBUL Feyza Şahin Buket ERTURK SENGEL Elif Tukenmez Tigen Arzu Ilki NURAN SARI Özlem Kurt Azap Fusun can Timothy R. Walsh Önder Ergönül |
| author_facet | Lal Sude Gücer Fatihan Pınarlık Refath Farzana Nazlı Ataç ZELİHA GENÇ Bahar Madran IREM SENA BULBUL Feyza Şahin Buket ERTURK SENGEL Elif Tukenmez Tigen Arzu Ilki NURAN SARI Özlem Kurt Azap Fusun can Timothy R. Walsh Önder Ergönül |
| author_sort | Lal Sude Gücer |
| collection | DOAJ |
| description | Background: Emerging antibacterial resistance is a constant threat. Broad-spectrum antibiotics are preferred in empirical treatment for bloodstream infections (BSI) due to increasing resistance rates. METHODS: A prospective observational study was conducted in three tertiary hospitals in Türkiye. Microbiologically documented BSIs were collected between 1 November 2023 and 1 June 2024. Demographics, clinical information, and antimicrobial susceptibility tests for each BSI case were collected. RESULTS: A total of 618 BSI patients were included in the study and 55 (8.9%) of these BSIs were polymicrobial. Among 563 monomicrobial BSIs, the causative agent was gram-negative in 278 (49.4%), gram-positive in 247 (43.9%), and Candida spp. in 38 (6.7%) patients. Gram-positive and gram-negative species distribution is depicted in Figure 1 and 2, respectively. Methicillin-resistant S. aureus (MRSA) rate was 37%. Carbapenem resistance rate for K. pneumoniae was 62%. 30-day mortality was 48% in gram-negative BSI, and it was 66% if the causative agent is carbapenem resistant. BSI caused by MRSA had a 30-day mortality of 36%. The two most common empirical treatment choices were meropenem and piperacillin-tazobactam. Of patients receiving ineffective empirical treatment, 35% failed escalation in 24 hours after susceptibility results. More than 24-hour delay in de-escalation of meropenem was observed in 82% of gram-negative BSIs. Escalation in 24 hours was achieved in MRSA BSIs. Mean delay of 3.9 days were observed in de-escalation of vancomycin or teicoplanin in methicillin-susceptible S. aureus BSIs. CONCLUSION: Timely transition to targeted therapies is critical for antimicrobial stewardship especially when broad-spectrum antibiotics are preferred in empirical therapy. |
| format | Article |
| id | doaj-art-c2a2023c53dc4d2e90dda9a1ecc5e1f2 |
| institution | Kabale University |
| issn | 2213-7165 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj-art-c2a2023c53dc4d2e90dda9a1ecc5e1f22024-12-27T04:08:27ZengElsevierJournal of Global Antimicrobial Resistance2213-71652024-12-01392829Antimicrobial Resistance Rates and Treatment Options in Bloodstream Infections: A Prospective Observational StudyLal Sude Gücer0Fatihan Pınarlık1Refath Farzana2Nazlı Ataç3ZELİHA GENÇ4Bahar Madran5IREM SENA BULBUL6Feyza Şahin7Buket ERTURK SENGEL8Elif Tukenmez Tigen9Arzu Ilki10NURAN SARI11Özlem Kurt Azap12Fusun can13Timothy R. Walsh14Önder Ergönül15Koç University İşbank Center for Infectious Diseases (KUISCID), İstanbul, TürkiyeKoç University İşbank Center for Infectious Diseases (KUISCID), İstanbul, TürkiyeDepartment of Biology, Ineos Oxford Institute for Antimicrobial Research, University of Oxford. Oxford, UKKoç University İşbank Center for Infectious Diseases (KUISCID), İstanbul, TürkiyeDepartment of Infection Control Nursing, Koç University Hospital, İstanbul, TürkiyePublic Health Department, Koç University School of Medicine, İstanbul, TürkiyeSchool of Medicine, Marmara University, İstanbul, TürkiyeSchool of Medicine, Marmara University, İstanbul, TürkiyeDepartment of Infectious Diseases and Clinical Microbiology, Marmara University, İstanbul, TürkiyeDepartment of Infectious Diseases and Clinical Microbiology, Marmara University, İstanbul, TürkiyeDepartment of Medical Microbiology, Marmara University School of Medicine, İstanbul, TürkiyeDepartment of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, İstanbul, TürkiyeDepartment of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, İstanbul, TürkiyeKoç University İşbank Center for Infectious Diseases (KUISCID), İstanbul, TürkiyeDepartment of Biology, Ineos Oxford Institute for Antimicrobial Research, University of Oxford. Oxford, UKKoç University İşbank Center for Infectious Diseases (KUISCID), İstanbul, TürkiyeBackground: Emerging antibacterial resistance is a constant threat. Broad-spectrum antibiotics are preferred in empirical treatment for bloodstream infections (BSI) due to increasing resistance rates. METHODS: A prospective observational study was conducted in three tertiary hospitals in Türkiye. Microbiologically documented BSIs were collected between 1 November 2023 and 1 June 2024. Demographics, clinical information, and antimicrobial susceptibility tests for each BSI case were collected. RESULTS: A total of 618 BSI patients were included in the study and 55 (8.9%) of these BSIs were polymicrobial. Among 563 monomicrobial BSIs, the causative agent was gram-negative in 278 (49.4%), gram-positive in 247 (43.9%), and Candida spp. in 38 (6.7%) patients. Gram-positive and gram-negative species distribution is depicted in Figure 1 and 2, respectively. Methicillin-resistant S. aureus (MRSA) rate was 37%. Carbapenem resistance rate for K. pneumoniae was 62%. 30-day mortality was 48% in gram-negative BSI, and it was 66% if the causative agent is carbapenem resistant. BSI caused by MRSA had a 30-day mortality of 36%. The two most common empirical treatment choices were meropenem and piperacillin-tazobactam. Of patients receiving ineffective empirical treatment, 35% failed escalation in 24 hours after susceptibility results. More than 24-hour delay in de-escalation of meropenem was observed in 82% of gram-negative BSIs. Escalation in 24 hours was achieved in MRSA BSIs. Mean delay of 3.9 days were observed in de-escalation of vancomycin or teicoplanin in methicillin-susceptible S. aureus BSIs. CONCLUSION: Timely transition to targeted therapies is critical for antimicrobial stewardship especially when broad-spectrum antibiotics are preferred in empirical therapy.http://www.sciencedirect.com/science/article/pii/S2213716524002650Antimicrobial managementAntimicrobial stewardshipAntimicrobial resistance |
| spellingShingle | Lal Sude Gücer Fatihan Pınarlık Refath Farzana Nazlı Ataç ZELİHA GENÇ Bahar Madran IREM SENA BULBUL Feyza Şahin Buket ERTURK SENGEL Elif Tukenmez Tigen Arzu Ilki NURAN SARI Özlem Kurt Azap Fusun can Timothy R. Walsh Önder Ergönül Antimicrobial Resistance Rates and Treatment Options in Bloodstream Infections: A Prospective Observational Study Journal of Global Antimicrobial Resistance Antimicrobial management Antimicrobial stewardship Antimicrobial resistance |
| title | Antimicrobial Resistance Rates and Treatment Options in Bloodstream Infections: A Prospective Observational Study |
| title_full | Antimicrobial Resistance Rates and Treatment Options in Bloodstream Infections: A Prospective Observational Study |
| title_fullStr | Antimicrobial Resistance Rates and Treatment Options in Bloodstream Infections: A Prospective Observational Study |
| title_full_unstemmed | Antimicrobial Resistance Rates and Treatment Options in Bloodstream Infections: A Prospective Observational Study |
| title_short | Antimicrobial Resistance Rates and Treatment Options in Bloodstream Infections: A Prospective Observational Study |
| title_sort | antimicrobial resistance rates and treatment options in bloodstream infections a prospective observational study |
| topic | Antimicrobial management Antimicrobial stewardship Antimicrobial resistance |
| url | http://www.sciencedirect.com/science/article/pii/S2213716524002650 |
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