PMID- 31858141
OWN - NLM
STAT- MEDLINE
DCOM- 20210428
LR  - 20210428
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Print)
IS  - 1058-4838 (Linking)
VI  - 71
IP  - 12
DP  - 2020 Dec 15
TI  - Impact of Baseline Characteristics on Future Episodes of Bloodstream Infections: 
      Multistate Model in Septic Patients With Bloodstream Infections.
PG  - 3103-3109
LID - 10.1093/cid/ciz1206 [doi]
AB  - BACKGROUND: Looking only at the index infection, studies have described risk 
      factors for infections caused by resistant bacteria. We hypothesized that septic 
      patients with bloodstream infections may transition across states characterized 
      by different microbiology and that their trajectory is not uniform. We also 
      hypothesized that baseline risk factors may influence subsequent blood culture 
      results. METHODS: All adult septic patients with positive blood cultures over a 
      7-year period were included in the study. Baseline risk factors were recorded. We 
      followed all survivors longitudinally and recorded subsequent blood culture 
      results. We separated states into bacteremia caused by gram-positive cocci, 
      susceptible gram-negative bacilli (sGNB), resistant GNB (rGNB), and Candida spp. 
      Detrimental transitions were considered when transitioning to a culture with a 
      higher mortality risk (rGNB and Candida spp.). A multistate Markov-like model was 
      used to determine risk factors associated with detrimental transitions. RESULTS: 
      A total of 990 patients survived and experienced at least 1 transition, with a 
      total of 4282 transitions. Inappropriate antibiotics, previous antibiotic 
      exposure, and index bloodstream infection caused by either rGNB or Candida spp. 
      were associated with detrimental transitions. Double antibiotic therapy 
      (beta-lactam plus either an aminoglycoside or a fluoroquinolone) protected 
      against detrimental transitions. CONCLUSION: Baseline characteristics that 
      include prescribed antibiotics can identify patients at risk for subsequent 
      bloodstream infections caused by resistant bacteria. By altering the initial 
      treatment, we could potentially influence future bacteremic states.
CI  - (c) The Author(s) 2019. Published by Oxford University Press for the Infectious 
      Diseases Society of America. All rights reserved. For permissions, e-mail: 
      journals.permissions@oup.com.
FAU - Guillamet, M Cristina Vazquez
AU  - Guillamet MCV
AD  - Division of Infectious Diseases, Washington University School of Medicine, St. 
      Louis, Missouri, USA.
AD  - Division of Pulmonary and Critical Care Medicine, Washington University School of 
      Medicine, St. Louis, Missouri, USA.
FAU - Vazquez, Rodrigo
AU  - Vazquez R
AD  - Division of Pulmonary and Critical Care Medicine, Washington University School of 
      Medicine, St. Louis, Missouri, USA.
FAU - Noe, Jonas
AU  - Noe J
AD  - Department of Internal Medicine, John Cochran Veterans Affairs Hospital, St. 
      Louis, Missouri, USA.
FAU - Micek, Scott T
AU  - Micek ST
AD  - Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, 
      Missouri, USA.
FAU - Fraser, Victoria J
AU  - Fraser VJ
AD  - Department of Medicine, Washington University School of Medicine, St. Louis, 
      Missouri, USA.
FAU - Kollef, Marin H
AU  - Kollef MH
AD  - Division of Pulmonary and Critical Care Medicine, Washington University School of 
      Medicine, St. Louis, Missouri, USA.
LA  - eng
GR  - UL1 TR002345/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Adult
MH  - Anti-Bacterial Agents/therapeutic use
MH  - *Bacteremia/drug therapy/epidemiology
MH  - Gram-Negative Bacteria
MH  - *Gram-Negative Bacterial Infections/drug therapy/epidemiology
MH  - Humans
MH  - Retrospective Studies
MH  - *Sepsis/drug therapy/epidemiology
PMC - PMC7947980
OTO - NOTNLM
OT  - Markov model
OT  - bloodstream infections
OT  - combination therapy
OT  - sepsis
OT  - transitions
EDAT- 2019/12/21 06:00
MHDA- 2021/04/29 06:00
PMCR- 2020/12/20
CRDT- 2019/12/21 06:00
PHST- 2019/10/22 00:00 [received]
PHST- 2019/12/17 00:00 [accepted]
PHST- 2019/12/21 06:00 [pubmed]
PHST- 2021/04/29 06:00 [medline]
PHST- 2019/12/21 06:00 [entrez]
PHST- 2020/12/20 00:00 [pmc-release]
AID - 5681567 [pii]
AID - ciz1206 [pii]
AID - 10.1093/cid/ciz1206 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2020 Dec 15;71(12):3103-3109. doi: 10.1093/cid/ciz1206.