Hospital Pharmacy - November 2017 - 693
693
Nimmich et al
Table 1. Demographics and Clinical Characteristics of Patients
With Gram-Negative Bloodstream Infections.
Variable
(n = 390)
Age, median (IQR)
Female sex
Ethnicity
White
African American
Other
Diabetes mellitus
End-stage renal disease
Liver cirrhosis
Malignancy
Site of acquisition
Community-acquired
Health care-associated
Hospital-acquired
Source of infection
Urinary tract
Gastrointestinal tract
Central venous catheter
Skin and soft tissue
Respiratory tract
Other
Unknown
66 (55-78)
229 (59)
191 (49)
188 (48)
11 (3)
144 (37)
38 (10)
6 (2)
70 (18)
161 (41)
159 (41)
70 (18)
216 (55)
50 (13)
35 (9)
17 (4)
12 (3)
8 (2)
52 (13)
Note. Data are shown as number (%) unless otherwise specified.
IQR = interquartile range.
(controls), including age, sex, ethnicity, chronic comorbidities, and site of infection acquisition.
JMP (version 11.0, SAS Institute Inc, Cary, North
Carolina) was used for statistical analysis. The level of significance for statistical testing was defined as P < .05
(2-sided).
Results
Over the 2-year study period, 390 patients with Gramnegative BSI were included from the 2 hospitals. Overall, the
median age was 66 years, 229 (59%) were women, and the
urinary tract (216; 55%) was the most common source of
infection. The majority of patients had either communityacquired (161; 41%) or health care-associated BSI (159;
41%), whereas the remaining 70 patients (18%) had hospitalacquired infections (Table 1).
Escherichia coli was predominantly the most common
bloodstream isolate among community-acquired and health
care-associated BSI accounting for two-thirds and one-half
of cases, respectively (Table 2). It represented one-third of
hospital-acquired bloodstream isolates, ranking second just
behind Klebsiella species. Combined, P aeruginosa and
CAE were more common in hospital-acquired (16; 23%) and
health care-associated (31; 19%) than in communityacquired BSI (12; 7%). The site of infection acquisition
Table 2. Microbiology of Gram-Negative Bloodstream Infections
by Site of Acquisition.
Bacteria
Escherichia coli
Klebsiella species
Proteus mirabilis
Pseudomonas
aeruginosa
Enterobacter species
Serratia species
Citrobacter species
Other
Communityacquired
(n = 161)
Health care-
associated
(n = 159)
Hospitalacquired
(n = 70)
106 (66)
24 (15)
12 (7)
4 (2)
79 (50)
27 (17)
16 (10)
10 (6)
22 (31)
26 (37)
3 (4)
6 (9)
4 (2)
1 (1)
3 (2)
7 (4)
10 (6)
8 (5)
3 (2)
6 (4)
5 (7)
4 (6)
1 (1)
3 (4)
Note. Data are shown as number (%).
Table 3. Risk Factors of Bloodstream Infections Due to
Pseudomonas aeruginosa or Chromosomally Mediated AmpCProducing Enterobacteriaceae.
Risk factor
Age (per decade)
Male sex
White ethnicity
Diabetes mellitus
Liver cirrhosis
Cancer
Indwelling urinary catheter
Site of acquisition
Community-acquired
Health care-associated
Hospital-acquired
Odds ratio
95% CI
P value
0.96
1.34
0.93
0.86
1.12
1.36
1.45
(0.82-1.31)
(0.77-2.35)
(0.53-1.62)
(0.47-1.52)
(0.06-7.14)
(0.67-2.62)
(0.52-3.50)
.64
.30
.80
.60
.92
.38
.44
3.01
3.68
Referent
(1.52-6.32)
(1.64-8.44)
.001
.002
Note. CI = confidence interval.
identified patients at risk of BSI due to P aeruginosa or CAE.
Patients with health care-associated and hospital-acquired
BSI were nearly 3 times more likely to have BSI due to P
aeruginosa or CAE as compared with those with community-acquired BSI (Table 3).
In vitro antimicrobial susceptibilities of Gram-negative
bloodstream isolates to various antimicrobial agents and combination regimens by site of infection acquisition are demonstrated in Table 4. Ceftriaxone was the only nonrestricted
nonantipseudomonal agent that provided ≥90% in vitro antimicrobial susceptibility for community-acquired Gram-negative
bloodstream isolates. Three nonrestricted antipseudomonal
agents, including two beta-lactams (cefepime and piperacillintazobactam) and gentamicin, had ≥90% susceptibility against
both health care-associated and hospital-acquired Gramnegative bloodstream isolates. Because there was marginal difference between in vitro antimicrobial susceptibility rates of
health care-associated and hospital-acquired Gram-negative
bloodstream isolates, the two groups were merged together.
Table of Contents for the Digital Edition of Hospital Pharmacy - November 2017
AKD—The Time Between AKI and CKD: What Is the Role of the Pharmacist?
Letter to the Editor
Antithrombotic Therapy Post Endovascular Stenting for Superior Vena Cava Syndrome
Pharmaceutical Pipeline Update
Janus Kinase Inhibitors for the Treatment of Rheumatoid Arthritis
Formulary Drug Reviews
Etelcalcetide
Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Insulin, Heparin, and Gemfibrozil: A Case Series
Evaluation of Antimicrobial Stewardship–Related Alerts Using a Clinical Decision Support System
Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution
Development of Institutional Guidelines for Management of Gram-Negative Bloodstream Infections: Incorporating Local Evidence
Underutilization of Aldosterone Antagonists in Heart Failure
Stability of Procainamide Injection in Clear Glass Vials and Polyvinyl Chloride Bags
Development of a Local Health-System Pharmacy Resident Society
Challenges and Solutions to New Manager Onboarding
Hospital Pharmacy - November 2017 - 649
Hospital Pharmacy - November 2017 - 650
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Hospital Pharmacy - November 2017 - AKD—The Time Between AKI and CKD: What Is the Role of the Pharmacist?
Hospital Pharmacy - November 2017 - 662
Hospital Pharmacy - November 2017 - Letter to the Editor
Hospital Pharmacy - November 2017 - Pharmaceutical Pipeline Update
Hospital Pharmacy - November 2017 - Janus Kinase Inhibitors for the Treatment of Rheumatoid Arthritis
Hospital Pharmacy - November 2017 - Formulary Drug Reviews
Hospital Pharmacy - November 2017 - Etelcalcetide
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Hospital Pharmacy - November 2017 - Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution
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Hospital Pharmacy - November 2017 - Underutilization of Aldosterone Antagonists in Heart Failure
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Hospital Pharmacy - November 2017 - 701
Hospital Pharmacy - November 2017 - Stability of Procainamide Injection in Clear Glass Vials and Polyvinyl Chloride Bags
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Hospital Pharmacy - November 2017 - Development of a Local Health-System Pharmacy Resident Society
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Hospital Pharmacy - November 2017 - Challenges and Solutions to New Manager Onboarding
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