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Objective: The aim of this study was to determine the epidemiology, clinical manifestations, and outcome of health-care associated bacteremia in geriatric cancer patients with febrile neutropenia., Materials and Methods: We retrospectively evaluated cancer patients with febrile neutropenia aged ≥60years with culture proven health-care associated bacteremia between January 2005 and December 2011. The date of the first positive blood culture was regarded as the date of bacteremia onset. Primary outcome was the infection related mortality, defined as the death within 14days of bacteremia onset., Results: The two most common pathogens responsible for bacteremia were Staphylococcus epidermidis (36.1%) and Escherichia coli (31.5%), with high rates of methicillin resistance and extended-spectrum β-lactamase (ESBL) production, respectively. There were no statistically significant differences in infection related mortality rate according to the type of malignancy (p=0.776). By the univariate analysis, factors associated with 14day mortality among febrile neutropenic episodes were prolonged neutropenia (p=0.024), persistent fever (p=0.001), hospitalization in ICU (p<0.001) and the initial clinical presentations including respiratory failure (p<0.001), hepatic failure (p=0.013), hematological failure (p<0.001), neurological failure (p<0.001), severe sepsis (p<0.001), and septic shock (p=0.036). Multivariate analysis showed that persistent fever was an independent factor associated with infection related mortality (odds ratio, 18.0; 95% confidence interval, 5.2-62.6; p<0.001)., Conclusions: The only independent risk factor for mortality was persistent fever. Although the most frequently isolated pathogens were S. epidermidis and E. coli, high rates of methicillin resistance and ESBL production were found respectively., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in intensive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors., Methods: Between April and October 2008, all adult catheterized patients admitted to the ICUs of Zonguldak Karaelmas University Hospital were screened daily, and clinical and microbiological data were collected for each patient., Results: Two hundred and four patients were included and 85 developed a nosocomial infection. Among these patients, 22 developed a CAUTI alone, 38 developed a CAUTI with an additional nosocomial infection, either concomitantly or prior to the onset of the CAUTI, and 25 developed nosocomial infections at other sites. The CAUTI rate was 19.02 per 1000 catheter-days. A Cox proportional hazard model showed that in the presence of other site nosocomial infections, immune suppression (hazard ratio (HR) 3.73, 95% CI 1.47-9.46; p = 0.006), previous antibiotic usage (HR 2.06, 95% CI 1.11-3.83; p = 0.023), and the presence of a nosocomial infection at another site (HR 1.82, 95% CI 1.04-3.20; p = 0.037) were the factors associated with the acquisition of CAUTIs with or without a nosocomial infection at another site. When we excluded the other site nosocomial infections to determine if the risk factors differed depending on the presence of other nosocomial infections, female gender (HR 2.67, 95% CI 1.03-6.91; p = 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01-1.13; p = 0.019) were found to be the risk factors for the acquisition of CAUTIs alone., Conclusions: Our results showed that the presence of nosocomial infections at another site was an independent risk factor for the acquisition of a CAUTI and that their presence alters risk factors.

This study was performed to compare the mortality associated with carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-sensitive A. baumannii (CSAB) infections, to identify potential risk factors for CRAB infections, and to investigate the effects of potential risk factors on mortality in CRAB and CSAB patients. This retrospective case-control study was conducted in a university hospital between January 1, 2005 and December 30, 2006. One hundred and ten patients with CRAB and 55 patients with CSAB infection were identified during the study period. The mortality rate was 61.8% and 52.7% in CRAB and CSAB cases, respectively (P = 0.341). In CRAB cases, the risk factors for mortality were identified as intubation (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.0-10.1; P = 0.042) and high APACHE II score (OR, 1.2; 95% CI, 1.1-1.3; P = 0.000), by multivariate analysis. Previous use of carbapenem (OR, 6.1; 95% CI, 2.2-17.1; P = 0.001) or aminopenicillin (OR, 2.5; 95% CI, 1.2-5.1; P = 0.013) were independently associated with carbapenem resistance. Although the mortality rate was higher among patients with CRAB infections, this difference was not found to be statistically significant. Previous use of carbapenem and aminopenicillin were found to be independent risk factors for infections with CRAB.