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Identifier 000379644
Title Επιδημιολογία, μικροβιολογία και έκβαση Gram αρνητικών βακτηριαιμιών με έναρξη στην κοινότητα με βάση το διαχωρισμό τους σε σχετιζόμενες με χώρους παροχής υπηρεσιών υγείας και σε κοινότητες
Alternative Title Epidemiology, microbiology and outcome of community-onset gram negative bacteremias based on their classification as healthcare-associated and community-acquired
Author Χαριτάκη, Γεωργία Χ
Thesis advisor Γκίκας, Αχιλλέας
Abstract Objective: Little data exist to differentiate gram negative healthcare-associated bacteremia from community-acquired bacteremia. The objective of this study was to apply this epidemiological type of bacteremia to a cross sectional study of hospitalized patients with community-onset gram negative bacteremia and to determine differences in the epidemiological characteristics, treatment and outcome of healthcare – associated and community-acquired bacteremia. Methodology: We conducted a cross sectional study at the University Hospital of Heraklion. All adult patients with community-onset gram negative bacteremia were included, from 11 March 2010 to 23 November 2011. Bacteremia was classified as healthcare – associated and community-acquired using pre-defined selection criteria. We examined and compared patient demographic and clinical characteristics, therapy and outcome in both groups. Results: Αmong 145 patients with community-onset gram negative bacteremia, 83 (57,2%) had healthcare – associated bacteremia (Healthcare-Associated Bacteremia-HCAB) and 62 (42,8%) had community-acquired (Community Acquired Bacteremia- CAB). For patients with HCAB compared with patients with CAB, malignant tumors (35 [42,2%] vs. 3 [4,8%]; Plt; .001), renal insufficiency (18 [21,7%] vs. 4 [6,5%]; Plt; .011) and dementia(14 [16,9%] vs. 3 [4,8%]; P=.026) were the most frequent comorbidities. In both groups Δ.Coli was more frequent a causative agent, and urinary tract was the most frequent source of infection. Patients with HCAB compared with patients with CAB had a higher Charlson score (mean [SD], 7 [2,7] vs. 4 [2,3]; Ple; .001), a higher Pitt bacteremia score (median [IQR], 3 [2-4] vs. 0 [0-1]; Ple; 001), higher probability of death (26 [31,3%]) vs. (1 [1,6%]; Ple; 001) and less frequent administration of appropriate empirical antibiotic treatment (53 [63,9%] vs. 51 [82,3%]; P=.015). As far as antimicrobial resistance 27/83 (32,5%) and 4/62 (6,5%) of the gram negative bacteria that were isolated from HCAB and CAB respectively were resistant to third-generation cephalosporins (Plt;.001), 22/82 (26,8%) vs. 7/62 (11,3%) were resistant to aminoglycosides (P=.021), 29/82 (35,4%) vs. 9/62 (14,5%) were resistant to fluoroquinolones (P=.005), 16/76 (21,1%) vs. 2/59 (3,4%) were bacteria that produced ESBL (P=.003), 10/83 (12,0%) vs. 2/62 (3,2%) were resistant to carbapenems (P=.056) and 13/83 (15,7%) vs. 3/62 (4,8%) were multi-drug resistant (P=.040). Conclusions: There are quite substantial differences between the two groups, which justifies the need to establish this classification based on the diversification of community-onset bacteremia in HCAB and CAB.
Language Greek
Subject Bacteremia
Bacteremia outcome
Community -Acquired Infections
Community-acquired bacteremia
Gram negative
Gram-Negative Bacteria
Gram-αρνητικά
Healthcare-associated bacteremia
Έκβαση βακτηριαιμίας
Βακτηριαιμία
Βακτηριαιμία-χώροι παροχής υπηρεσιών υγείας
Issue date 2013-04-16
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/3/4/1/metadata-dlib-1369729072-31056-7020.tkl Bookmark and Share
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