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Fevronia Kolonitsiou / Matthaios Papadimitriou-Olivgeris / Anastasia Spiliopoulou / Vasiliki Stamouli / Vasileios Papakostas / Eleni Apostolopoulou / Christos Panagiotopoulos / Markos Marangos / Evangelos D. Anastassiou / Myrto Christofidou / Iris Spiliopoulou *
Citation Information : Polish Journal of Microbiology. Volume 66, Issue 2, Pages 171-180, DOI: https://doi.org/10.5604/01.3001.0010.7834
License : (CC BY-NC-ND 4.0)
Received Date : 18-June-2016 / Accepted: 24-November-2016 / Published Online: 28-June-2017
The aim of the study was to assess the epidemiology, the incidence of multidrug-resistant bacteria and bloodstream infections’ (BSIs) seasonality in a university hospital. This retrospective study was carried out in the University General Hospital of Patras, Greece, during 2011–13 y. Blood cultures from patients with clinical presentation suggestive of bloodstream infection were performed by the BacT/ALERT System. Isolates were identified by Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the disk diffusion method and E-test. Resistance genes (mecA in staphylococci; vanA/vanB/vanC in enterococci; blaKPC/blaVIM/blaNDM in Klebsiella spp.) were detected by PCR. In total, 4607 (9.7%) blood cultures were positive from 47451 sets sent to Department of Microbiology, representing 1732 BSIs. Gram-negative bacteria (52.3%) were the most commonly isolated, followed by Gram-positive (39.5%), fungi (6.6%) and anaerobes bacteria (1.8%). The highest contamination rate was observed among Gram-positive bacteria (42.3%). Among 330 CNS and 150 Staphylococcus aureus, 281 (85.2%) and 60 (40.0%) were mecA-positive, respectively. From 113 enterococci, eight were vanA, two vanB and two vanC-positives. Of the total 207 carbapenem-resistant Klebsiella pneumoniae (73.4%), 202 carried blaKPC, four blaKPC and blaVIM and one blaVIM. A significant increase in monthly BSIs’ incidence was shown (R2: 0.449), which may be attributed to a rise of Gram-positive BSIs (R2: 0.337). Gram-positive BSIs were less frequent in spring (P < 0.001), summer (P < 0.001), and autumn (P < 0.001), as compared to winter months, while Gram-negative bacteria (P < 0.001) and fungi (P < 0.001) were more frequent in summer months. BSIs due to methicillin resistant S. aureus and carbapenem-resistant Gram-negative bacteria increased during the study period. The increasing incidence of BSIs can be attributed to an increase of Gram-positive BSI incidence, even though Gram-negative bacteria remained the predominant ones. Seasonality may play a role in the predominance of Gram-negative’s BSI.
Anderson D.J., R.W. Moehring, R. Sloane, K.E. Schmader,D.J. Weber, V.G. Fowler Jr., E. Smathers and D.J. Sexton. 2014. Bloodstream infections in community hospitals in the 21st century: a multicenter cohort study. PLoS One. 9(3): e91713.
Bouza C., T. Lopez-Cuadrado, Z. Saz-Parkinson and J.M. Amate-Blanco. 2014. Epidemiology and recent trends of severe sepsis in Spain: a nationwide population-based analysis (2006–2011). BMC Infect. Dis. 14: 3863.
Braun E., K. Hussein, Y. Geffen, G. Rabino, Y. Bar-Lavie andM. Paul. 2014. Predominance of Gram-negative bacilli among patients with catheter-related bloodstream infections. Clin. Microbiol. Infect. 20(10): O627–629.
Chang C.J., C.J. Wu, H.C. Hsu, C.H. Wu, F.Y. Shih, S.W. Wang, Y.H. Wu, C.M. Chang, Y.F. Tu, C.H. Chi and others. 2015. Factors Associated with Blood Culture Contamination in the Emergency Department: Critical Illness, End-Stage Renal Disease, and Old Age. PLoS One. 10(10): e0137653.
de Kraker M.E., V. Jarlier, J.C. Monen, O.E. Heuer, N. van de Sande and H. Grundmann. 2013. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin. Microbiol. Infect. 19(9): 860–868.
Drougka E., A. Foka, A. Liakopoulos, A. Doudoulakakis, E. Jelastopulu, V. Chini, A. Spiliopoulou, S. Levidiotou, T. Panagea,A. Vogiatzi and others. 2014. A 12-year survey of methicillin-resistant Staphylococcus aureus infections in Greece: ST80-IV epidemic? Clin. Microbiol. Infect. 20(11): O796–803.
Eber M.R., M. Shardell, M.L. Schweizer, R. Laxminarayan and E.N. Perencevich. 2011. Seasonal and temperature-associated increases in gram-negative bacterial bloodstream infections among hospitalized patients. PLoS One. 6(9):e25298.
European Food Safety Authority and European Centre for Disease Prevention and Control (EFSA and ECDC). 2015. The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in 2013. EFSA Journal. 13(1): 3991.
European Centre for Disease Prevention and Control (ECDC). 2013. Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. ECDC, Stockholm.
European Committee on Antimicrobial Susceptibility Testing (EUCAST). 2015. Breakpoint tables for interpretation of MICs and zone diameters. Version 5.0. EUCAST.
Falagas, M.E., N. Roussos and K.Z. Vardakas. 2010. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int. J. Infect. Dis. 14(11): e954–966.
Fisman D., E. Patrozou, Y. Carmeli, E. Perencevich, A.R. Tuite, L.A. Mermel and Geographical Variability of Bacteremia Study. 2014. Geographical variability in the likelihood of bloodstream infec-tions due to gram-negative bacteria: correlation with proximity to the equator and health care expenditure. PLoS One. 9(12): e114548.
Goto M. and M.N. Al-Hasan. 2013. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin. Microbiol. Infect. 19(6): 501–509.
Gubbels S., J. Nielsen, M. Voldstedlund, B. Kristensen, H.C. Schonheyder, C.M. Vandenbroucke-Grauls, M. Arpi,M.K. Bjornsdottir, J.D. Knudsen, R.B. Dessau and others. 2015. Utilization of blood cultures in Danish hospitals: a population-based descriptive analysis. Clin. Microbiol. Infect. 21(4): 344e313–321.
Hadziyannis A.S., I. Stephanou, K. Dimarogona, A. Pantazatou, D. Fourkas, D. Filiagouridis and A. Avlami. 2004. Blood culture results during the period 1995–2002 in a Greek tertiary care hospital. Clin. Microbiol. Infect. 10(7): 667–670.
Horan T.C., M. Andrus and M.A. Dudeck. 2008. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am. J. Infect. Control. 36(5): 309–332.
Jelastopulu E., C. Bikas, C. Petropoulos and M. Leotsinidis. 2008. Incidence of human brucellosis in a rural area in Western Greece after the implementation of a vaccination programme against animal brucellosis. BMC Public Health. 8: 241.
Kang C.K., E.S. Kim, K.H. Song, H.B. Kim, T.S. Kim, N.H. Kim, C.J. Kim, P.G. Choe, J.H. Bang, W.B. Park and others. 2013. Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? A retrospective case-control study. BMC Infect. Dis. 13: 365.
Karagiannis I., K. Mellou, K. Gkolfinopoulou, G. Dougas, G. Theocharopoulos, D. Vourvidis, D. Ellinas, M. Sotolidou, T. Papadimitriou and R. Vorou. 2012. Outbreak investigation of brucellosis in Thassos, Greece, 2008. Euro Surveill. 17(11):pii: 20116
Karchmer A.W. 2000. Nosocomial bloodstream infections: organisms, risk factors, and implications. Clin. Infect. Dis. 31(Suppl 4): S139–143.
Khatib R., G. Simeunovic, M. Sharma, M.G. Fakih, L.B. Johnson, L. Briski and W. Lebar. 2015. Blood culture series benefit may be limited to selected clinical conditions: time to reassess. Clin. Microbiol. Infect. 21(4): 332–336.
Kitaura T., H. Chikumi, H. Fujiwara, K. Okada, T. Hayabuchi, M. Nakamoto, M. Takata, A. Yamasaki, T. Igishi, N. Burioka and thers. 2014. Positive predictive value of true Bacteremia according to the number of positive culture sets in adult patients. Yonago Acta Med. 57(4): 159–165.
Koupetori M., T. Retsas, N. Antonakos, G. Vlachogiannis, I. Perdios, C. Nathanail, K. Makaritsis, A. Papadopoulos, D. Sinapidis, E.J. Giamarellos-Bourboulis and others. 2014. Bloodstream infections and sepsis in Greece: over-time change of epidemiology and impact of de-escalation on final outcome. BMC Infect. Dis. 14: 272.
Papadimitriou-Olivgeri I., N. Giormezis, M. Papadimitriou-Olivgeris, A. Zotou, F. Kolonitsiou, K. Koutsileou, F. Fligou, M. Marangos, E.D. Anastassiou and I. Spiliopoulou. 2015. Number of positive blood cultures, biofilm formation, and adhesin genes in differentiating true coagulase-negative staphylococci bacteremia from contamination. Eur. J. Clin. Microbiol. Infect. Dis. 35(1): 57–66
Papadimitriou-Olivgeris M., M. Marangos, M. Christofidou,F. Fligou, C. Bartzavali, E.S. Panteli, S. Vamvakopoulou, K.S. Filosand E.D. Anastassiou. 2014a. Risk factors for infection and predictors of mortality among patients with KPC-producing Klebsiella pneumoniae bloodstream infections in the intensive care unit. Scand. J. Infect. Dis. 46(9): 642–648.
Papadimitriou-Olivgeris M., A. Spiliopoulou, F. Fligou, P. Manolopoulou, I. Spiliopoulou, T. Vrettos, V. Dodou, K.S. Filos, E.D. Anastassiou, M. Marangos and others. 2014b. Association of KPC-producing Klebsiella pneumoniae colonization or infection with Candida isolation and selection of non-albicans species. Diagn. Microbiol. Infect. Dis. 80(3): 227–232.
Papadimitriou-Olivgeris M., F. Kolonitsiou, L. Zerva, E. Lebessi,C. Koutsia, E. Drougka, S. Sarrou, N. Giormezis, S. Vourli,A. Doudoulakakis and others. 2015. Activity of vancomycin, linezolid, and daptomycin against staphylococci and enterococci isolated in 5 Greek hospitals during a 5-year period (2008–2012). Diagn. Microbiol. Infect. Dis. 83(4): 386–388.
Paul M. 2012. Seasonality in infectious diseases: does it exist for all pathogens? Clin. Microbiol. Infect. 18(10): 925–926.
Pereira C.A., A.R. Marra, L.F. Camargo, A.C. Pignatari, T. Sukiennik, P.R. Behar, E.A. Medeiros, J. Ribeiro, E. Girao, L. Correa, and others. 2013. Nosocomial bloodstream infections in Brazilian pediatric patients: microbiology, epidemiology, and clinical features. PLoS One. 8(7): e68144.
Queenan A.M. and K. Bush. 2007. Carbapenemases: the versatile beta-lactamases. Clin. Microbiol. Rev. 20(3): 440–458, table of contents.
Rodriguez-Creixems M., P. Munoz, P. Martin-Rabadan, E. Cercenado, M. Guembe and E. Bouza. 2013. Evolution and aetiological shift of catheter-related bloodstream infection in a whole institution: the microbiology department may act as a watchtower. Clin. Microbiol. Infect. 19(9): 845–851.
Schwab F., P. Gastmeier and E. Meyer. 2014. The warmer the weather, the more Gram-negative bacteria – impact of tempera-ture on clinical isolates in intensive care units. PLoS One, 9(3): e91105.
Spiliopoulou A., S. Vamvakopoulou, C. Bartzavali, G. Dimitracopoulos, E.D. Anastassiou and M. Christofidou. 2010. Eleven-year retrospective survey of candidaemia in a university hospital in southwestern Greece. Clin. Microbiol. Infect. 16(9): 1378–1381.
Tsakris A., A. Poulou, S. Pournaras, E. Voulgari, G. Vrioni,K. Themeli-Digalaki, D. Petropoulou and D. Sofianou. 2010.A simple phenotypic method for the differentiation of metallo-beta-lactamases and class A KPC carbapenemases in Enterobacteriaceae clinical isolates. J. Antimicrob. Chemother. 65(8): 1664–1671.
Urban E. 2012. Five-year retrospective epidemiological survey of anaerobic bacteraemia in a university hospital and rewiew of the literature. Eur. J. Microbiol. Immunol. (Bp) 2(2):140–147.
Uyanik M.H., H. Yazgi, K. Ozden, Z. Erdil and A. Ayyildiz. 2014. Comparison of coagulase-negative staphylococci isolated from blood cultures as a true bacteremia agent and contaminant in terms of slime production and methicillin resistance. Eurasian J. Med. 46(2): 115–119.
Wisplinghoff H., T. Bischoff, S.M. Tallent, H. Seifert, R.P. Wenzel and M.B. Edmond. 2004. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin. Infect. Dis. 39(3): 309–317.