Vancomycin-Resistant Enterococcus-Positive Blood Cultures: Results From a Province-Wide Multisite Case Series Analysis in Ontario, Canada, January 2009-December 2013
Notice bibliographique
Résumé
Background. Since 2009, all Ontario hospitals are mandated to report vancomycin-resistant Enterococcus (VRE)-positive (+) blood cultures to a provincial public reporting database. The objective of this study was to better understand the clinical characteristics, microbiology and outcomes of patients with VRE+ blood cultures in Ontario, Canada. Methods. A chart review of all cases reported by Ontario hospitals between January 2009 and December 2013 was performed by the Institute for Clinical and Evaluative Sciences using a standardized clinical data abstraction tool. False positives, incomplete or duplicate cases, as well as cases with a missing or invalid health card number were excluded from the analysis. Descriptive statistics were generated using SAS. Results. In total, 311 VRE+ blood cultures were reported. After exclusions, the final study sample was n = 232. Mean age was 61 years (range 1–97 years), 60% were male and 91% had at least one comorbidity, including: renal disease (34%), diabetes (28%), hematological malignancy (23%), non-hematological malignancy (11%) and transplant (solid organ [9%] and bone marrow [3%]); 42% were immunocompromised during their admission prior to their confirmed VRE+ blood culture and over half of patients (55%) were known to be VRE colonized. At the time of blood culture draw, 84% had a central line and 18% were neutropenic. Most VRE+ blood cultures (93%) were due to E. faecium. Although 72% were given empiric antibiotics at the time of blood culture draw, only 17% of patients received effective empiric anti-VRE therapy (linezolid 14%, daptomycin 3%). Overall, 74% of patients with VRE+ blood cultures received effective anti-VRE therapy; not receiving effective anti-VRE therapy was associated with an increased risk of death within 7 days (OR = 4.5; 95% CI, 2.3–9.0). In total, 48% of patients died during their hospitalization. A review of death certificates found that 1% of deaths indicated VRE infection as the primary cause of death. Conclusion. Most VRE+ blood cultures occurred in immunocompromised patients with invasive devices; nearly half of patients died during their hospital admission. Lack of effective anti-VRE therapy was associated with a significantly increased risk of death. Disclosures. All authors: No reported disclosures.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».