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Статті в журналах з теми "Gram Negative Baterial Infections"

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Автор: Grafiati

Опубліковано: 6 вересня 2023

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1

Calvo Bernal, B., and M. A. López Rus. "Current status of carbapenem resistance: epidemiology and microbiological aspects." ACTUALIDAD MEDICA 107, no. 107(816) (2022): 102–9. http://dx.doi.org/10.15568/am.2022.816.rev02.

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Nowadays, the infections due to carbapenem-resistant microorganism represent a global public health issue; the microorganisms most frequently involved are the gram-negative bacteria. This infections pose a major threat because of their elevated mortality, the lack of appropiate antibiotics and its rapid spread arround the world. The emergence of carbapenemases, which are a type of enzimes that hydrolize carbapenems, is the resistance mecanism more frequently involved. The aim of this literature review is to analyse the epidemiology arround the world and ,overall, in Europe; as well as the microbiological aspects of the carbapenem restistant bateria: carbapenemases can be classified into different types and are detected by several laboratory methods as well as its detection methods in laboratory. All this are key aspects and have a great impact on the clinical management of these infections.

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2

Hawkey, P. M. "Gram-negative infections." Current Opinion in Infectious Diseases 1, no. 5 (September 1988): 727–34. http://dx.doi.org/10.1097/00001432-198809000-00011.

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3

Duma, Richard J. "Gram-negative bacillary infections." American Journal of Medicine 78, no. 6 (June 1985): 154–64. http://dx.doi.org/10.1016/0002-9343(85)90119-6.

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4

Fraimow, Henry, and Raquel Nahra. "Resistant Gram-Negative Infections." Critical Care Clinics 29, no. 4 (October 2013): 895–921. http://dx.doi.org/10.1016/j.ccc.2013.06.010.

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5

Stryjewski, Martin E., and Helen W. Boucher. "Gram-negative bloodstream infections." International Journal of Antimicrobial Agents 34 (January 2009): S21—S25. http://dx.doi.org/10.1016/s0924-8579(09)70561-8.

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6

Muñoz, Patricia, Ana Fernandez Cruz, Marta Rodríguez-Créixems, and Emilio Bouza. "Gram-negative bloodstream infections." International Journal of Antimicrobial Agents 32 (November 2008): S10—S14. http://dx.doi.org/10.1016/j.ijantimicag.2008.06.015.

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7

Pasternak, Jacyr. "Antibiotics for Gram-negative infections." Einstein (São Paulo) 13, no. 3 (September 2015): 7–8. http://dx.doi.org/10.1590/s1679-45082015ed3451.

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8

Giamarellou, Helen, and Garyphallia Poulakou. "Multidrug-Resistant Gram-Negative Infections." Drugs 69, no. 14 (October 2009): 1879–901. http://dx.doi.org/10.2165/11315690-000000000-00000.

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9

Chan-Tompkins, Noreen H. "Multidrug-Resistant Gram-Negative Infections." Critical Care Nursing Quarterly 34, no. 2 (2011): 87–100. http://dx.doi.org/10.1097/cnq.0b013e31820f6e88.

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10

Pitout, Johann D. D., and Deirdre L. Church. "Emerging gram-negative enteric infections." Clinics in Laboratory Medicine 24, no. 3 (September 2004): 605–26. http://dx.doi.org/10.1016/j.cll.2004.05.006.

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11

Naheed, Nargis, Maqsood Alam, and Larry I. Lutwick. "Gram-negative diplococcal respiratory infections." Current Infectious Disease Reports 5, no. 3 (May 2003): 238–45. http://dx.doi.org/10.1007/s11908-003-0079-6.

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12

Brown, S. Anthony. "Treatment of Gram-Negative Infections." Veterinary Clinics of North America: Small Animal Practice 18, no. 6 (November 1988): 1141–65. http://dx.doi.org/10.1016/s0195-5616(88)50128-6.

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13

Uaekay, I., and L. Bernard. "Gram-Negative versus Gram-Positive Prosthetic Joint Infections." Clinical Infectious Diseases 50, no. 5 (March 1, 2010): 795. http://dx.doi.org/10.1086/650540.

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14

Lugowski, C. "Immunotherapy in gram-negative bacterial infections." Acta Biochimica Polonica 42, no. 1 (March 31, 1995): 19–24. http://dx.doi.org/10.18388/abp.1995_4661.

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Анотація:

Endotoxins are responsible for initiation of septic shock which increases the number of fatalities in Gram-negative bacteremia among hospital patients. The mortality from septic shock is still high despite recent developments in antibiotic therapy because antibiotics are unable to decrease the level of free lipopolysaccharide in the blood stream. Another approach to the treatment and prevention of septicaemia involves stimulation of an immune response against LPS. It was found that immunization with the core structures of endotoxin conjugated with proteins protected animals against infections and endotoxic shock. Anticonjugate sera are of great interest because they are directed against conserved parts of LPS and therefore could have cross-reactive and cross-protective properties with respect to many Gram-negative rods.

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15

Arnold, Tamra M., Graeme N. Forrest, and Karen J. Messmer. "Polymyxin antibiotics for gram-negative infections." American Journal of Health-System Pharmacy 64, no. 8 (April 15, 2007): 819–26. http://dx.doi.org/10.2146/ajhp060473.

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16

Rutgers, H., R. Stepien, C. Elwood, K. Simpson, and R. Batt. "Enrofloxacin treatment of gram-negative infections." Veterinary Record 135, no. 15 (October 8, 1994): 357–59. http://dx.doi.org/10.1136/vr.135.15.357.

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17

Chartrand, Stephen A., Kenneth J. Thompson, and Christine C. Sanders. "Antibiotic-resistant, gram-negative bacillary infections." Seminars in Pediatric Infectious Diseases 7, no. 3 (July 1996): 187–203. http://dx.doi.org/10.1016/s1045-1870(96)80007-0.

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18

Feris, J., N. Moledina, W. J. Rodriguez, W. N. Khan, J. P. Puig, B. L. Wiedermann, and S. Ahmad. "Aztreonam in the Treatment of Gram-Negative Meningitis and Other Gram-Negative Infections." Chemotherapy 35, no. 1 (1989): 31–38. http://dx.doi.org/10.1159/000238718.

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19

Aragón-Sánchez, Javier, Benjamin A. Lipsky, and Jose L. Lázaro-Martínez. "Gram-Negative Diabetic Foot Osteomyelitis." International Journal of Lower Extremity Wounds 12, no. 1 (February 26, 2013): 63–68. http://dx.doi.org/10.1177/1534734613477423.

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Osteomyelitis frequently complicates infections in the feet of patients with diabetes. Gram-positive cocci, especially Staphylococcus aureus, are the most commonly isolated pathogens, but gram-negative bacteria also cause some cases of diabetic foot osteomyelitis (DFO). These gram-negatives require different antibiotic regimens than those commonly directed at gram-positives. There are, however, few data on factors related to their presence and how they influence the clinical picture. We conducted a retrospective study to determine the variables associated with the isolation of gram-negative bacteria from bone samples in cases of DFO and the clinical presentation of these infections. Among 341 cases of DFO, 150 had a gram-negative isolate (alone or combined with a gram-positive isolate) comprising 44.0% of all patients and 50.8% of those with a positive bone culture. Compared with gram-positive infections, wounds with gram-negative organisms more often had a fetid odor, necrotic tissue, signs of soft tissue infection accompanying osteomyelitis, and clinically severe infection. By multivariate analysis, the predictive variables related to an increased likelihood of isolating gram-negatives from bone samples were glycated hemoglobin <7% (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.1-3.5) and a wound caused by traumatic injury (OR = 2.0, 95% CI = 1.0-3.9). Overall, patients whose bone samples contained gram-negatives had a statistically significantly higher prevalence of leukocytosis and higher white blood cell counts than those without gram-negatives. In conclusion, gram-negative organisms were isolated in nearly half of our cases of DFO and were associated with more severe infections, higher white blood cell counts, lower glycated hemoglobin levels, and wounds of traumatic etiology.

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20

Patel, A., P. Parikh, A. Deshpande, JA Otter, P. Thota, CJ Donskey, and TG Fraser. "ID: 98: EFFECTIVENESS OF DAILY CHLORHEXIDINE BATHING FOR REDUCING GRAM NEGATIVE INFECTIONS: A META-ANALYSIS." Journal of Investigative Medicine 64, no. 4 (March 22, 2016): 951.2–952. http://dx.doi.org/10.1136/jim-2016-000120.81.

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BackgroundMultiple studies have demonstrated that daily chlorhexidine gluconate (CHG) bathing is associated with a significant reduction in infections caused by Gram positive pathogens. However, there is limited data on the effectiveness of daily CHG bathing on gram negative infections. The aim of this study was to determine if daily CHG bathing is effective in controlling and preventing gram negative infections in adult ICU patients.MethodsWe searched MEDLINE and 3 other databases for original studies comparing daily CHG bathing to soap and water bathing. All studies investigating the effectiveness of daily CHG bathing on gram negative infections were eligible. Two investigators extracted data independently on baseline characteristics, study design, form and concentration of CHG, incidence and outcomes related to gram negative infections. Data were combined by means of a random-effects model and pooled relative risk ratios (RRs) and 95% confidence intervals (CIs) were derived for overall gram negative infections and individual gram negative pathogens.ResultsEleven studies (n=27,793 patients) met the inclusion criteria. Of these, 13,852 patients received daily CHG bathing, and 13,941 patients daily bathing with soap and water. Daily CHG bathing was not associated with a lower risk of gram negative infections (2.03% vs. 2.38%; RR 0.84; 95%CI: 0.64–1.09, P=.19). Subgroup analysis demonstrated that daily CHG bathing significantly reduced the risk of gram negative infections caused by Acinetobacter (RR, 0.33; 95% CI: 0.17–0.66, P<.00001) but was not effective for E. coli, Klebsiella, Enterobacter and Pseudomonas associated gram negative infections.ConclusionsIn a meta-analysis of 11 studies, the use of daily CHG was not associated with a lower risk of gram negative infections. However, daily CHG bathing appears to be effective for Acinetobacter associated gram negative infections. There is a need for larger and better designed trials with adequate power with gram negative infections as the primary endpoint to determine the effectiveness of daily CHG bathing.Abstract ID: 98 Figure 1

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21

Ghose, Chandrabali, and Chad W. Euler. "Gram-Negative Bacterial Lysins." Antibiotics 9, no. 2 (February 11, 2020): 74. http://dx.doi.org/10.3390/antibiotics9020074.

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Antibiotics have had a profound impact on human society by enabling the eradication of otherwise deadly infections. Unfortunately, antibiotic use and overuse has led to the rapid spread of acquired antibiotic resistance, creating a major threat to public health. Novel therapeutic agents called bacteriophage endolysins (lysins) provide a solution to the worldwide epidemic of antibiotic resistance. Lysins are a class of enzymes produced by bacteriophages during the lytic cycle, which are capable of cleaving bonds in the bacterial cell wall, resulting in the death of the bacteria within seconds after contact. Through evolutionary selection of the phage progeny to be released and spread, these lysins target different critical components in the cell wall, making resistance to these molecules orders of magnitude less likely than conventional antibiotics. Such properties make lysins uniquely suitable for the treatment of multidrug resistant bacterial pathogens. Lysins, either naturally occurring or engineered, have the potential of being developed into fast-acting, narrow-spectrum, biofilm-disrupting antimicrobials that act synergistically with standard of care antibiotics. This review focuses on newly discovered classes of Gram-negative lysins with emphasis on prototypical enzymes that have been evaluated for efficacy against the major antibiotic resistant organisms causing nosocomial infections.

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22

Kunishima, Hiroyuki. "6. Multidrug Resistant Gram-negative Bacterial Infections." Nihon Naika Gakkai Zasshi 102, no. 11 (2013): 2839–45. http://dx.doi.org/10.2169/naika.102.2839.

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23

Hudson, Ryan, and Brooke Olson Blair. "Inhaled antibiotics for Gram-negative respiratory infections." Future Medicinal Chemistry 3, no. 13 (October 2011): 1663–77. http://dx.doi.org/10.4155/fmc.11.114.

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24

Wenzler, Eric, Dustin R. Fraidenburg, Tonya Scardina, and Larry H. Danziger. "Inhaled Antibiotics for Gram-Negative Respiratory Infections." Clinical Microbiology Reviews 29, no. 3 (May 25, 2016): 581–632. http://dx.doi.org/10.1128/cmr.00101-15.

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SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

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25

Edens, Chris, Jacklyn Wong, Meghan Lyman, Kyle Rizzo, Duc Nguyen, Michela Blain, Sam Horwich-Scholefield, et al. "Hemodialyzer Reuse and Gram-Negative Bloodstream Infections." American Journal of Kidney Diseases 69, no. 6 (June 2017): 726–33. http://dx.doi.org/10.1053/j.ajkd.2016.09.022.

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26

Ho, Jennifer, Paul A. Tambyah, and David L. Paterson. "Multiresistant Gram-negative infections: a global perspective." Current Opinion in Infectious Diseases 23, no. 6 (December 2010): 546–53. http://dx.doi.org/10.1097/qco.0b013e32833f0d3e.

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27

Azzopardi, Ernest A., Sarah M. Azzopardi, Dean E. Boyce, and William A. Dickson. "Emerging Gram-Negative Infections in Burn Wounds." Journal of Burn Care & Research 32, no. 5 (September 2011): 570–76. http://dx.doi.org/10.1097/bcr.0b013e31822ac7e6.

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28

Al-Hasan, M. N., J. E. Eckel-Passow, and L. M. Baddour. "Cefepime effectiveness in Gram-negative bloodstream infections." Journal of Antimicrobial Chemotherapy 66, no. 5 (March 8, 2011): 1156–60. http://dx.doi.org/10.1093/jac/dkr061.

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29

Rello, J. "S286 Treatments for serious Gram-negative infections." International Journal of Antimicrobial Agents 29 (March 2007): S58—S59. http://dx.doi.org/10.1016/s0924-8579(07)70188-7.

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30

Simons, William J., and Terrence J. Lee. "Treatment of gram-negative infections with aztreonam." American Journal of Medicine 78, no. 2 (February 1985): 27–30. http://dx.doi.org/10.1016/0002-9343(85)90199-8.

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31

Jain, S., and S. Rai. "Unusual Gram-negative infections: An emerging threat." International Journal of Infectious Diseases 21 (April 2014): 336. http://dx.doi.org/10.1016/j.ijid.2014.03.1114.

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32

Mozingo, D. W. "Emerging Gram-Negative Infections in Burn Wounds." Yearbook of Surgery 2012 (January 2012): 72–73. http://dx.doi.org/10.1016/j.ysur.2012.03.075.

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33

Folgori, Laura, Julia Bielicki, Paul T. Heath, and Mike Sharland. "Antimicrobial-resistant Gram-negative infections in neonates." Current Opinion in Infectious Diseases 30, no. 3 (June 2017): 281–88. http://dx.doi.org/10.1097/qco.0000000000000371.

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34

Stamos, Julie Kim, Bruce A. Kaufman, and Ram Yogev. "Ventriculoperitoneal Shunt Infections with Gram-Negative Bacteria." Neurosurgery 33, no. 5 (November 1993): 858–62. http://dx.doi.org/10.1227/00006123-199311000-00011.

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35

Gray, J., B. Oppenheim, and N. Mahida. "Preventing healthcare-associated Gram-negative bloodstream infections." Journal of Hospital Infection 98, no. 3 (March 2018): 225–27. http://dx.doi.org/10.1016/j.jhin.2018.01.008.

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36

Stamos, Julie Kim, Bruce A. Kaufman, and Ram Yogev. "Ventriculoperitoneal Shunt Infections with Gram-Negative Bacteria." Neurosurgery 33, no. 5 (November 1, 1993): 858–62. http://dx.doi.org/10.1097/00006123-199311000-00011.

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37

Xu, Ze-Qi, Michael T. Flavin, and John Flavin. "Combating multidrug-resistant Gram-negative bacterial infections." Expert Opinion on Investigational Drugs 23, no. 2 (November 11, 2013): 163–82. http://dx.doi.org/10.1517/13543784.2014.848853.

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38

Leli, Christian, Marta Ferranti, Amedeo Moretti, Zainab Salim Al Dhahab, Elio Cenci, and Antonella Mencacci. "Procalcitonin Levels in Gram-Positive, Gram-Negative, and Fungal Bloodstream Infections." Disease Markers 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/701480.

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Procalcitonin (PCT) can discriminate bacterial from viral systemic infections and true bacteremia from contaminated blood cultures. The aim of this study was to evaluate PCT diagnostic accuracy in discriminating Gram-positive, Gram-negative, and fungal bloodstream infections. A total of 1,949 samples from patients with suspected bloodstream infections were included in the study. Median PCT value in Gram-negative (13.8 ng/mL, interquartile range (IQR) 3.4–44.1) bacteremias was significantly higher than in Gram-positive (2.1 ng/mL, IQR 0.6–7.6) or fungal (0.5 ng/mL, IQR 0.4–1) infections (P<0.0001). Receiver operating characteristic analysis showed an area under the curve (AUC) for PCT of 0.765 (95% CI 0.725–0.805,P<0.0001) in discriminating Gram-negatives from Gram-positives at the best cut-off value of 10.8 ng/mL and an AUC of 0.944 (95% CI 0.919–0.969,P<0.0001) in discriminating Gram-negatives from fungi at the best cut-off of 1.6 ng/mL. Additional results showed a significant difference in median PCT values between Enterobacteriaceae and nonfermentative Gram-negative bacteria (17.1 ng/mL, IQR 5.9–48.5 versus 3.5 ng/mL, IQR 0.8–21.5;P<0.0001). This study suggests that PCT may be of value to distinguish Gram-negative from Gram-positive and fungal bloodstream infections. Nevertheless, its utility to predict different microorganisms needs to be assessed in further studies.

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39

Ochieng', Naomi, Humphrey Okechi, Susan Ferson, and A. Leland Albright. "Bacteria causing ventriculoperitoneal shunt infections in a Kenyan population." Journal of Neurosurgery: Pediatrics 15, no. 2 (February 2015): 150–55. http://dx.doi.org/10.3171/2014.10.peds14178.

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OBJECT Ventriculoperitoneal shunt (VPS) infections are a major cause of morbidity and mortality in patients with hydrocephalus. Most data about these infections come from the Western literature. Few data about infecting organisms in Africa are available, yet knowledge of these organisms is important for the prevention and treatment of infectious complications. The purpose of this study was to determine the organisms cultured from infected shunts in a rural Kenyan hospital. METHODS The authors conducted a retrospective study of patients with VPS infections recorded in the neurosurgical database of BethanyKids at Kijabe Hospital between September 2010 and July 2012. RESULTS Among 53 VPS infections confirmed by culture, 68% occurred in patients who were younger than 6 months. Seventy-nine percent of the infections occurred within 2 months after shunt insertion. Only 51% of infections were caused by Staphylococcus species (Staphylococcus aureus 25%, other Staphylococcus species 26%), whereas 40% were caused by gram-negative bacteria. All S. aureus infections and 79% of other Staphylococcus infections were sensitive to cefazolin, but only 1 of 21 gram-negative bacteria was sensitive to it. The majority of gram-negative bacterial infections were multidrug resistant, but 17 of the 20 gram-negative bacteria were sensitive to meropenem. Gram-negative bacterial infections were associated with worse outcomes. CONCLUSIONS The high proportion of gram-negative infections differs from data in the Western literature, in which Staphylococcus epidermidis is by far the most common organism. Once a patient is diagnosed with a VPS infection in Kenya, immediate treatment is recommended to cover both gram-positive and gram-negative bacterial infections. Data from other Sub-Saharan countries are needed to determine if those countries have the same increased frequency of gram-negative infections.

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40

Patel, Aditi, Parth Parikh, Aaron N. Dunn, Jonathan A. Otter, Priyaleela Thota, Thomas G. Fraser, Curtis J. Donskey, and Abhishek Deshpande. "Effectiveness of daily chlorhexidine bathing for reducing gram-negative infections: A meta-analysis." Infection Control & Hospital Epidemiology 40, no. 4 (February 26, 2019): 392–99. http://dx.doi.org/10.1017/ice.2019.20.

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AbstractObjective:Multiple studies have demonstrated that daily chlorhexidine gluconate (CHG) bathing is associated with a significant reduction in infections caused by gram-positive pathogens. However, there are limited data on the effectiveness of daily CHG bathing on gram-negative infections. The aim of this study was to determine whether daily CHG bathing is effective in reducing the rate of gram-negative infections in adult intensive care unit (ICU) patients.Design:We searched MEDLINE and 3 other databases for original studies comparing daily bathing with and without CHG. Two investigators extracted data independently on baseline characteristics, study design, form and concentration of CHG, incidence, and outcomes related to gram-negative infections. Data were combined using a random-effects model and pooled relative risk ratios (RRs), and 95% confidence intervals (CIs) were derived.Results:In total, 15 studies (n = 34,895 patients) met inclusion criteria. Daily CHG bathing was not significantly associated with a lower risk of gram-negative infections compared with controls (RR, 0.89; 95% CI, 0.73–1.08; P = .24). Subgroup analysis demonstrated that daily CHG bathing was not effective for reducing the risk of gram-negative infections caused by Acinetobacter, Escherichia coli, Klebsiella, Enterobacter, or Pseudomonas spp.Conclusions:The use of daily CHG bathing was not associated with a lower risk of gram-negative infections. Further, better designed trials with adequate power and with gram-negative infections as the primary end point are needed.

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41

Mackowiak, P. A., M. Goggans, W. Torres, A. Dal Nogare, J. P. Luby, and H. Helderman. "Relationship between cytomegalovirus and colonization of the oropharynx by Gram-negative bacilli following renal transplantation." Epidemiology and Infection 107, no. 2 (October 1991): 411–20. http://dx.doi.org/10.1017/s0950268800049050.

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SUMMARYNumerous investigators have reported an increased incidence of pneumonia caused by Gram-negative bacilli and other secondary pathogens in transplant recipients infected by cytomegalovirus (CMV). To determine if CMV infections are related to colonization of the upper respiratory tract by Gram-negative bacilli, we examined prospectively 22 renal transplant recipients with sequential bacteriological, virological and biochemical examinations performed just prior to and at various times after transplantation. Only 11% of subjects had Gram-negative bacilli isolated from gargle specimens prior to transplantation, as compared to 54% after transplantation. More importantly, after transplantation, subjects with active CMV infections were more likely to have prolonged oropharyngeal carriage of Gram-negative bacilli than subjects without CMV infections (36%v.. 25%). During active CMV infections, the rate at which Gram-negative bacilli were isolated from gargle specimens rose from 28 to 47%. During culture-positive CMV infections, the isolation rate reached 57% and was significantly different from that of CMV-negative samples (P< 0·01). The increased rate of Gram-negative bacillary isolation from gargle specimens during CMV infections was not a function of type of immunosuppresive agents used, rejection episodes, antibiotic administration, concomitant hepatitis B, Epstein–Barr (EBV) virus, or herpes simplex virus infections, or alterations in salivary fibronectin concentrations.

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Lubwama, Margaret, Freddie Bwanga, David Kateete, Scott Adams, Betty Namubiru, Barbara Nabiryo, Jackson Orem, and Warren Phipps. "226. Multidrug Resistant Polymicrobial Gram-negative Bacteremia in Hematologic Cancer Patients with Febrile Neutropenia at the Uganda Cancer Institute." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S220—S221. http://dx.doi.org/10.1093/ofid/ofab466.428.

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Abstract Background Bloodstream infections (BSI) are associated with significant mortality in hematologic cancer patients with febrile neutropenia. Poor clinical outcomes are associated with presence of multidrug resistant (MDR) organisms and polymicrobial infections. We sought to determine antimicrobial resistance and outcomes of polymicrobial bloodstream infections in hematologic cancer patients with febrile neutropenic episodes (FNEs) at the Uganda Cancer Institute. Methods Blood drawn from participants during an FNE (fever ≥ 37.5°C and neutrophil count ≤ 1000 cells/µL) was cultured in the BACTEC 9120 blood culture system. Bacteria from positive cultures were identified biochemically. Antimicrobial susceptibility testing was performed with the disc diffusion method. Participants were followed for 30 days from first FNE onset for death from any cause. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95%). Results Six hundred and twenty-nine participants were followed for FNE. Two hundred and twenty-eight FNEs in 159 participants were observed. Of 181 FNEs with blood cultures completed, 65 (36%) had pathogenic organism isolated. A total of 74 Gram negative and 18 Gram positive bacteria were isolated. Forty-eight (74%) FNEs had monomicrobial (MBSI) and 17 (26%) had polymicrobial (PBSI) bloodstream infections. Gram negative - Gram negative (10 out of 17, 59%) was the most frequent PBSI combination (Fig 1). Up to 75% (12 out of 16) of Gram-negative PBSI were MDR. The most common organism isolated was E. coli (38% of isolates). Participants with PBSI had higher early mortality rates at 7 days compared to MBSI and negative cultures (44%, 22%, and 16% for PBSI, MBSI, and negative respectively; HR (95% CI): 3.63 (1.49, 8.86) for PBSI v. negative/MBSI cultures). Similarly, PBSI was associated with higher mortality within 30 days of FNE onset (63%, 52%, and 38% for PBSI, MBSI, and negative respectively; HR (95% CI): 2.17 (1.09, 4.32) for PBSI v. negative/MBSI) (Fig 2). Figure 1. Bar graph showing combinations for polymicrobial bloodstream infections (PBSI). GNGN: Gram-negative – Gram-negative; GNGP: Gram-negative – Gram-positive; GNO: Gram-negative – Other (fungi); GPGP: Gram-positive – Gram-positive Figure 2. Kaplan-Meier failure curves of participants with negative cultures, monomicrobial infections and polymicrobial infections Conclusion PBSI episodes were more likely to be multidrug resistant and are associated with higher mortality. Empirical therapy for patients with PBSI should consider multidrug resistant Gram-negative bacteria Disclosures All Authors: No reported disclosures

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Wilkins, E. G. L., and D. V. Seal. "Urinary tract, Gram-negative and equipment-related infections including lithotripsy infections." Current Opinion in Infectious Diseases 2, no. 5 (October 1989): 672–79. http://dx.doi.org/10.1097/00001432-198910000-00012.

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Eckmann, Christian, Laura J. Rojas, and Sue Lyon. "Know your enemy: managing resistant Gram-negative infections." Future Microbiology 13, no. 13 (October 2018): 1457–60. http://dx.doi.org/10.2217/fmb-2018-0202.

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45

Villegas, Maria Virginia, and Sue Lyon. "Gram-negative infections: evolving treatments with expanding options." Future Science OA 4, no. 9 (October 2018): FSO339. http://dx.doi.org/10.4155/fsoa-2018-0071.

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Nutman, Amir, Chaitanya Tellapragada, Christian G. Giske, and Dafna Yahav. "New evidence for managing Gram-negative bloodstream infections." Current Opinion in Infectious Diseases 34, no. 6 (October 11, 2021): 599–610. http://dx.doi.org/10.1097/qco.0000000000000784.

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Tateda, Kazuhiro. "2) Multiple Antibiotic Resistant Gram-negative Bacterial Infections." Nihon Naika Gakkai Zasshi 101, Suppl (2012): 120b—121a. http://dx.doi.org/10.2169/naika.101.120b.

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48

Tateda, Kazuhiro. "2) Multiple Antibiotic Resistant Gram-negative Bacterial Infections." Nihon Naika Gakkai Zasshi 101, no. 9 (2012): 2591–98. http://dx.doi.org/10.2169/naika.101.2591.

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Peleg, Anton Y., and David C. Hooper. "Hospital-Acquired Infections Due to Gram-Negative Bacteria." New England Journal of Medicine 362, no. 19 (May 13, 2010): 1804–13. http://dx.doi.org/10.1056/nejmra0904124.

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50

Wang, Alvin, Colleen Castro, and Erika Taylor. "Inhibiting Heptosyltransferase to Combat Gram‐Negative Bacterial Infections." FASEB Journal 34, S1 (April 2020): 1. http://dx.doi.org/10.1096/fasebj.2020.34.s1.03436.

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