Bloodstream infections in hospitalized adults with dengue fever: Clinical characteristics and recommended empirical therapy.

Abstract

BACKGROUND:

Dengue is an important mosquito-borne tropical viral disease and dual infection, though rare, has been regarded as a risk factor for severe disease and mortality. However, few studies focused on bloodstream infections (BSIs) and empirical antibiotic therapy rarely addressed.

METHODS:

Dengue patients with concurrent or subsequent BSIs between July 1 and December 31, 2015 were included. Clinical information, laboratory data, and drug susceptibility data were collected.

RESULTS:

Totally 80 patients, with an in-hospital mortality rate of 32.5%, were included and categorized into three groups. 32 patients in Group I (BSI onset within 48 h after admission), 32 in Group II (between 48 h and one week), and 16 in Group III (more than one week). Patients in Group I were older (mean age: 75.6 vs. 72.6 or 69.6 years; P = 0.01) and had a higher Charlson comorbidity index (3.1 vs. 1.8 or 1.9; P = 0.02) than those in Group II or III. Streptococcus species (28.9%, 11/38) and Escherichia coli (23.7%, 9/38) were major pathogens in Group I. Enterobacteriaceae (38.2%, 13/34) isolates predominated in Group II. Fatal patients more often received inappropriate empirical antibiotic than the survivors (61.5% vs. 35.2%; P = 0.03). According to susceptibility data, pathogens in Group I and II shared similar susceptibility profiles, and levofloxacin, cefepime, or piperacillin/tazobactam, can be empirically prescribed for those hospitalized within one week.

CONCLUSIONS:

BSI pathogens vary among dengue patients. For adults with dengue and suspected BSI hospitalized within one week, empirical antimicrobial agents are recommended.

• Authors: Ling-Shan Syue, Hung-Jen Tang, Yuan-Pin Hung, Po-Lin Chen, Chia-Wen Li, Ming-Chi Li, Pei-Fang Tsai, Ching-Chuan Liu, Nan-Yao Lee, Wen-Chien Ko
• Journal: Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi (J Microbiol Immunol Infect) Vol. 52 Issue 2 Pg. 225-232 (Apr 2019) ISSN: 1995-9133 [Electronic] England
• PMID: 30528336 (Publication Type: Journal Article)
• Copyright: Copyright © 2018. Published by Elsevier B.V.

Chemical References

• Anti-Bacterial Agents
• Piperacillin, Tazobactam Drug Combination
• Levofloxacin
• Cefepime

Topics

• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Bacteremia (complications, drug therapy, microbiology)
• Candidemia (complications, drug therapy, microbiology)
• Cefepime (therapeutic use)
• Coinfection (drug therapy)
• Dengue (complications)
• Enterobacteriaceae (isolation & purification, pathogenicity)
• Enterobacteriaceae Infections (blood, drug therapy, microbiology)
• Escherichia coli (isolation & purification, pathogenicity)
• Escherichia coli Infections (drug therapy)
• Female
• Hospitals
• Humans
• Levofloxacin (therapeutic use)
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Mortality
• Piperacillin, Tazobactam Drug Combination (therapeutic use)
• Retrospective Studies
• Risk Factors
• Staphylococcal Infections (drug therapy)
• Streptococcus (isolation & purification, pathogenicity)
• Taiwan