Enterobacteriaceae resistant to third generation cephalosporins upon hospital admission: risk factors and clinical outcomes

Oliveira, Mirian Cristina de; Oliveira, Clara Rodrigues Alves de; Gonçalves, Karine Valéria; Santos, Mariana Rates Gonzaga; Tardelli, Amanda Cristina Silva; Nobre, Vandack

doi:10.1016/j.bjid.2015.01.006

Cited by 15 publications

(25 citation statements)

References 34 publications

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“…Most prior studies 23 , 24 demonstrated that the male gender was more frequently observed in patients with infection caused by drug-resistant pathogens, which supported our findings. Complicated UTIs, including presence of hydronephrosis, urinary tract abnormalities, and need for indwelling urinary catheter due to obstructive uropathy, have been shown to be associated with high drug resistance rates, 25 , 26 which were also demonstrated in our study.…”

Section: Discussionsupporting

confidence: 91%

“…Because of more complicated underlying and severe clinical conditions, tendency to develop renal dysfunction and critical sepsis in patients of MDR group was anticipated. Therefore, it seems to be reasonable that ICU admission was also more common in patients with drug-resistant uropathogens, just as reported by Oliveira et al 23 Therefore, for those patients with complex underlying diseases and serious clinical manifestations, clinicians should cautiously consider to use an empirical therapy with coverage of MDR pathogens.…”

Section: Discussionmentioning

confidence: 85%

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Bacteremic Urinary Tract Infection Caused by Multidrug-Resistant Enterobacteriaceae Are Associated With Severe Sepsis at Admission

et al. 2016

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The purpose of this study is to compare the clinical features and treatment outcomes among patients with bacteremic urinary tract infection (UTI) caused by multidrug-resistant (MDR) and non-MDR Enterobacteriaceae and to identify whether MDR pathogens were independently associated with severe sepsis or septic shock at presentation.The clinical data of adult patients visiting and being treated at Chia-Yi Christian Hospital due to bacteremic UTI caused by Enterobacteriaceae from January 2006 to August 2015 were retrospectively analyzed.A total of 585 patients were enrolled. Among them, 220 (37.6%) were caused by the MDR Enterobacteriaceae. A total of 206 patients (35.2%) developed severe sepsis or septic shock at presentation. Patients in the MDR group tend to be male and have a past history of gout, recurrent UTI, prior hospitalization, hydronephrosis, renal stone, ureteral stone, indwelling urinary catheter, newly development of renal dysfunction, severe sepsis or septic shock, intensive care unit (ICU) admission, receipt of ineffective empirical therapy, longer hospital stay, and higher in-hospital mortality (2.7% vs 1.9%, P = 0.569). Using multivariate logistic regression analysis, it is revealed that independent predictors associated with severe sepsis or septic shock at presentation were liver cirrhosis (OR 2.868; 95% CI 1.439–5.716; P = 0.003), indwelling urinary catheter (OR 1.936; 95% CI 1.238–3.027; P = 0.004), and MDR Enterobacteriaceae (OR 1.447; 95% CI 1.002–2.090; P = 0.049).Multidrug resistance was associated with the development of severe sepsis or septic shock upon presentation among patients with bacteremic UTI caused by Enterobacteriaceae. Therefore, empirical antibiotics therapy for patients with UTI presented with severe sepsis and/or septic shock should be more broad-spectrum to effectively cover MDR Enterobacteriaceae.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 85%

Bacteremic Urinary Tract Infection Caused by Multidrug-Resistant Enterobacteriaceae Are Associated With Severe Sepsis at Admission

et al. 2016

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“…Nevertheless, Latin American countries usually have the highest rates of ESBL producers, globally ( 22 – 24 ). These data suggest that patients in DR may have an enhanced risk factor impacting their clinical outcome, which could include inappropriate empirical antibiotic therapy, a longer hospital stay, hospitalization in the ICU, and death ( 1 , 3 , 23 ).…”

Section: Discussionmentioning

confidence: 95%

Antimicrobial resistance profiles of microorganisms isolated from hospitalized patients in Dominican Republic

Luna¹,

Sánchez

Peguero

et al. 2020

Revista Panamericana De Salud Pública

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Objective. To define the antimicrobial resistance profiles of the microorganisms most commonly isolated from hospitalized adult patients in Dominican Republic (DR). Methods. A retrospective, cross-sectional study of phenotypic antimicrobial susceptibility patterns was conducted using data from 3 802 clinical microbiology reports specifying positive bacterial cultures in samples collected from patients admitted to the clinical, surgery, and intensive care units (ICU) at three tertiary-level care hospitals in the city of Santiago de los Caballeros from 1 January 2016 – 31 December 2017. Descriptive statistics and chi-square test (P ≤ 0.05) were used to analyze the qualitative variables. Results. At the three hospitals, there were 932, 1 090, and 1 780 microbiology reports analyzed. Of the total, 1274 were from the ICU, 1 042 from the surgery unit, and 1 486 from the clinical unit. Methicillin resistance was found in 57.3% of the Staphylococcus aureus isolates and 75.3% of the coagulase-negative staphylococci. Third-generation cephalosporin resistance was detected in 54.4% of isolates identified as members of the Enterobacteriaceae family, 67.3% of the Acinetobacter spp., and 91.7% of the Pseudomonas, while carbapenem resistance was shown by 8.0%, 23.8%, and 51.0% of these, respectively. Most of the resistant Acinetobacter spp. isolates were found in just one hospital and the prevalence of Enterobacteriaceae resistant to carbapenems was highest in the ICU. Conclusion. Antimicrobial resistance levels are high among hospitalized patients in Dominican Republic and may cause enhanced risk factors that impact clinical outcomes. Urgent measures are needed to address antimicrobial resistance in DR.

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“…Enterobacteriaceae are well known to be resistant to third-generation cephalosporins. [25] The most common antimicrobial used overall in the ICU in this study was cefuroxime, followed by piperacillin/tazobactam and meropenem. Imipenem use was significantly lower than meropenem.…”

Section: Discussionmentioning

confidence: 82%

Spectrum of microbial growth and antimicrobial usage in an intensive-care unit of a tertiary-care hospital in Trinidad, West Indies

2017

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Background. Intensive-care units (ICUs) are a source of multidrug-resistant organisms, owing to the indiscriminate usage of broad-spectrum antimicrobial drugs. In such settings, one must be aware of the spectrum of microbes and pattern of antibiotic usage. Objectives. To evaluate the spectrum, susceptibility and resistance patterns of microbes found in ICU patients in a tertiary-care teaching hospital in Trinidad, and to quantify antimicrobial usage. Methods. All adult patients (≥15 years of age) admitted to the ICU for ≥48 h who developed nosocomial infections conforming to the Centers for Disease Control and Prevention criteria were included. Demographic data and clinical data, including specimens sent, isolates grown, antimicrobial sensitivity and resistance patterns, the usage of antimicrobials and patient outcomes, were recorded. Variables such as age, admission white blood cell count, duration of first antibiotic used, length of ICU stay, length of hospital stay, organ support and total comorbidities were analysed. Antimicrobial usage was quantified as the defined daily dosage per 1 000 patient-days. Results. A total of 153 patients with 287 microbiological specimens were studied. The mean patient age was 48.4 years, and the mean ICU length of stay was 7.9 days. The most common admitting diagnoses were sepsis and multiple trauma. Staphylococcus aureus was the most common isolate from blood and central venous lines, and Pseudomonas aeruginosa from tracheal aspirates and wound swabs. Non-survivors had significantly higher age, leucocyte count and organ support requirements, and shorter lengths of stay. Cefuroxime was the most-used antimicrobial in the unit. Conclusion. The usage pattern of antimicrobials did not correlate with susceptibility in most instances. There is a need to improve antimicrobial usage by implementing antimicrobial-stewardship programmes to establish an antimicrobial protocol and guidelines for usage in the ICU.

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Enterobacteriaceae resistant to third generation cephalosporins upon hospital admission: risk factors and clinical outcomes

Abstract: Risk factors identified in this study may help in the choice of empirical antibiotic therapy for infected patients suspected of harboring these bacteria and in the early implementation of measures to avoid the spread of these bacteria in the hospital environment.

Cited by 15 publications

References 34 publications

Bacteremic Urinary Tract Infection Caused by Multidrug-Resistant Enterobacteriaceae Are Associated With Severe Sepsis at Admission

Bacteremic Urinary Tract Infection Caused by Multidrug-Resistant Enterobacteriaceae Are Associated With Severe Sepsis at Admission

Antimicrobial resistance profiles of microorganisms isolated from hospitalized patients in Dominican Republic

Spectrum of microbial growth and antimicrobial usage in an intensive-care unit of a tertiary-care hospital in Trinidad, West Indies

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