Molecular characteristics and predictors of mortality among Gram-positive bacteria isolated from bloodstream infections in critically ill patients during a 5-year period (2012-2016).
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State: Public
Version: author
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Serval ID
serval:BIB_2103EAC277F7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Molecular characteristics and predictors of mortality among Gram-positive bacteria isolated from bloodstream infections in critically ill patients during a 5-year period (2012-2016).
Journal
European journal of clinical microbiology & infectious diseases
ISSN
1435-4373 (Electronic)
ISSN-L
0934-9723
Publication state
Published
Issued date
05/2020
Peer-reviewed
Oui
Volume
39
Number
5
Pages
863-869
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
To identify the molecular characteristics of Gram-positive cocci isolated from blood cultures and clinical outcome among critically ill patients. This retrospective study was conducted in the general intensive care unit of the University General Hospital of Patras, Greece, during a 5-year period (2012-2016). All adult patients with a Gram-positive BSI were included. PCR was applied to identify mecA gene (staphylococci); vanA, vanB, and vanC genes (enterococci). Linezolid-resistant S. epidermidis, MRSA, and VRE were further typed by multilocus sequence typing. Mutations in region V of 23S rDNA and ribosomal protein L4were investigated by PCR and sequencing analysis. The presence of the cfr gene was tested by PCR. In total, 141 Gram-positive BSIs were included. Coagulase-negative staphylococci predominated (n = 69; 65 methicillin-resistant, 23 linezolid-resistant carrying both C2534T and T2504A mutations and belonging to the ST22 clone), followed by enterococci (n = 46; 11 vancomycin-resistant carrying vanA gene, classified into four clones), S. aureus (n = 22; 10 methicillin-resistant, classified into three clones) and streptococci (n = 4). The most common type of infection was catheter-related (66; 46.8%), followed by primary BSI (28; 19.9%). Overall 14-day fatality was 24.8%. Multivariate analysis revealed septic shock as independent predictor of fatality, while appropriate empiric antimicrobial treatment and catheter-related BSI were identified as a predictor of good prognosis. Even though most of Gram-positive cocci were multidrug-resistant, fatality rate was low, associated with catheter-related BSIs. Among CNS, LR isolates represented one-third of BSIs due to the dissemination of ST22 S. epidermidis propagated by utilization of linezolid.
Keywords
Adult, Aged, Anti-Bacterial Agents/pharmacology, Bacterial Typing Techniques, Blood Culture, Critical Illness, Drug Resistance, Multiple, Bacterial/genetics, Female, Genes, Bacterial, Gram-Positive Bacteria/classification, Gram-Positive Bacteria/drug effects, Gram-Positive Bacterial Infections/blood, Gram-Positive Bacterial Infections/mortality, Greece, Humans, Intensive Care Units/statistics & numerical data, Male, Microbial Sensitivity Tests, Middle Aged, Multilocus Sequence Typing, Retrospective Studies, Risk Factors, Shock, Septic/etiology, Coagulase-negative staphylococci, Linezolid resistance, Methicillin-resistant S. aureus (MRSA), Septic shock, Vancomycin-resistant enterococci (VRE)
Pubmed
Web of science
Open Access
Yes
Create date
10/01/2020 16:00
Last modification date
25/12/2022 6:51