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Epidemiology and clinical features of bloodstream infections in hematology wards: One year experience at the catholic blood and marrow transplantation centeropen access

Authors
Kwon J.-C.Kim S.-H.Choi J.-K.Cho S.-Y.Park Y.-J.Park S.H.Choi S.-M.Lee D.-G.Choi J.-H.Yoo J.-H.
Issue Date
2013
Keywords
Bacteremia; Blood-borne pathogens; Epidemiology; Fungemia; Hematology
Citation
Infection and Chemotherapy, v.45, no.1, pp 51 - 61
Pages
11
Indexed
SCOPUS
KCI
Journal Title
Infection and Chemotherapy
Volume
45
Number
1
Start Page
51
End Page
61
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/34986
DOI
10.3947/ic.2013.45.1.51
ISSN
2093-2340
2092-6448
Abstract
Background: The aim of this study was to investigate the clinical features and epidemiology of bloodstream infections (BSIs) in 2 distinctive hematological wards of the Catholic Blood and Marrow Transplantation (BMT) center. Materials and Methods: We retrospectively reviewed the medical data of patients who developed BSIs from June 2009 to May 2010 in 2 hematologic wards at the Catholic BMT center. Ward A is a 44-bed unit mainly conducting conventional high dose chemotherapy and ward B is a 23-bed unit exclusively conducting BMT. Results: Overall, 222 BSI episodes were developed from 159 patients. Acute myeloid leukemia in ward A and multiple myeloma in ward B were more frequent than in ward B and A, respectively. Sex, age, presence of neutropenia, shock, Pitt bacteremia score, type of central catheter, level of C-reactive protein, duration of admission days, type of BSI, overall mortality and distribution of organisms were not different between the 2 wards. There were 202 monomicrobial and 20 polymicrobial BSI episodes, including 2 fungemia episodes. The incidence rate of overall BSIs per 1,000 patient-days was higher in ward A than in ward B (incidence rate ratio 2.88, 95% confidence interval 1.97-4.22, P<0.001). Among 243 organisms isolated, the number of gram positives, gram negatives and fungi were 122, 119 and 2, respectively. Escherichia coli was the most common organism in both ward A and B (27.6% and 42.4%), followed by viridians streptococci (18.6% and 15.2%) and Klebsiella pneumoniae (13.3% and 9.0%). Extended spectrum beta-lactamase (ESBL) producers accounted for 31.9% (23/72) of E. coli and 71.0% (22/31) of K. pneumoniae. Out of 19 Enterococcus faecium, 7 isolates (36.8%) were resistant to vancomycin. The crude mortality rates at 7 and 30 days after each BSI episode were 4.5% (10/222) and 13.1% (29/222), and were significantly higher in the patients with shock compared with those without shock (20.5% vs. 1.1%, P<0.001 and 38.5% vs. 7.7%, P<0.001, respectively). Conclusions: The incidence rate of BSIs was higher in patients receiving chemotherapy than those receiving BMT, but the distribution of organisms was not different between the 2 wards. E. coli was the most common causative BSI organism in hematologic wards followed by viridians streptococci and K. pneumoniae. © 2013 by The Korean Society of Infectious Diseases.
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