Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae

Russo, Alessandro; Falcone, Marco; Gutiérrez‐Gutiérrez, Belén; Calbo, Esther; Almirante, Benito; Viale, Pierluigi; Oliver, Antonio; Ruíz-Garbajosa, Patricia; Gasch, Oriol; Gozalo, Mónica; Pitout, Johann; Akova, Murat; Peña, Carmen; Cisneros, José Miguel; Hernández-Torres, Alícia; Farcomeni, Alessio; Prim, Núria; Origüen, Julia; Bou, Germán; Tacconelli, Evelina; Tumbarello, Mario; Hamprecht, Axel; Karaiskos, Ilias; Calle, C. de la; Pérez, Federico; Schwaber, Mitchell J.; Bermejo, Joaquín; Lowman, Warren; Hsueh, Po-Ren; Mora-Rillo, Marta; Rodríguez-Gómez, Jorge; Souli, María; Bonomo, Robert A.; Paterson, David L.; Carmeli, Yehuda; Pascual, Álvaro; Rodríguez-Baño, Jesús; Venditti, Mario; Reipi,; Esgbis,; investigators, Increment

doi:10.1016/j.ijantimicag.2018.06.018

Cited by 40 publications

(28 citation statements)

References 37 publications

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“…Several predictors of mortality; apart from choice of antibiotics; have been identified in various studies for ESBL Enterobacteriaceae bloodstream infections. These include high Charlson comorbidity index, high Pitt bacteremia scores and source of bloodstream infection other than urinary tract (13,14,23). In our study also we found significant association of Pitt bacteremia score of greater than 4 to be significantly associated with in-hospital mortality in patients with Ceftriaxone resistant E.coli Bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Mortality and Treatment Outcomes of Patients With Ceftriaxone Resistant E. Coli Bacteremia Receiving Carbapenem Versus Beta Lactam/Beta Lactamase Inhibitor Therapy

Nasir¹,

Ahmed²,

Razi³

et al. 2019

Preprint

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Background: Extended spectrum β-lactamases (ESBL) producing Enterobacteriaceae predominantly E. coli and K. pneumonia bacteremia have limited treatment options and high mortality. Objective: To determine the risk factors for in-hospital mortality particularly treatment with Carbapenem versus Beta lactam/beta lactamase combination (BL/BLI) in patients with Ceftriaxone resistant E. coli bacteremia. Methods: A retrospective descriptive study was conducted at the Aga Khan University, Karachi, Pakistan. Adult patients with monomicrobial Ceftriaxone resistant E. coli bacteremia were enrolled. Factors associated with mortality in patients were determined using logistic regression analysis. Results: Mortality rate was 37% in those empirically treated with carbapenem compared to 20% treated with BL/BLI combination therapy (p-value: 0.012) and was 21% in those treated with a carbapenem compared to 13% in patients definitively treated with BL/BLI combination therapy (p-value: 0.152). In multivariable logistic regression analysis, only Pitt bacteremia score of ≥ four was significantly associated with mortality (OR: 7.7 CI: 2.6-22.8) while a urinary source of bacteremia was protective (OR: 0.26 CI: 0.11-0.58). Conclusions: In-hospital mortality in patients with Ceftriaxone resistant E. coli bacteremia did not differ in patients treated with either a carbapenem or BL/BLI combination. However, Pitt bacteremia score of ≥ 4 was strongly associated with mortality.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Mortality and Treatment Outcomes of Patients With Ceftriaxone Resistant E. Coli Bacteremia Receiving Carbapenem Versus Beta Lactam/Beta Lactamase Inhibitor Therapy

Nasir¹,

Ahmed²,

Razi³

et al. 2019

Preprint

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“…Generalized purulent peritonitis (GPP) caused by destructive forms of appendicitis is one of the burning issues associated with emergency pediatric surgery and intensive therapy. Unfavorable conditions of the pathology may lead to development of abdominal sepsis, which still has a high mortality rate despite encouraging progress in emergency antibiotic therapy and the adoption of new surgical methods for this type of patient [ 16 , 17 ]. Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Ultrastructural Changes of Blood Cells in Children with Generalized Purulent Peritonitis: A Cross-Sectional and Prospective Study

et al. 2020

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In conditions of abdominal sepsis with indications of first- or second-stage shock, blood cells undergo significant ultrastructural changes that cause impaired gas exchange, changes in reactivity, and decompensation of organs and systems functions. This paper presents a cross-sectional prospective study aimed at researching the ultrastructure of blood cells in children experiencing abdominal septic shock against the background of generalized purulent peritonitis of appendicular origin. This study was conducted with 15 children aged 6–12 who were undergoing treatment for generalized appendicular purulent peritonitis, with first- or second-stage abdominal septic shock, in emergency care. The changes in the ultrastructure of erythrocytes did not correspond to changes characteristic of eryptosis, which confirms their occurrence under the influence of such pathogenic factors as intoxication, metabolic, water–electrolyte balance, and acid–base disorders. Ultrastructural changes of granulocytes indicate their hyperactivation, which leads to the exhaustion of membrane synthetic resources, membrane destruction, ineffective expenditure of bactericidal factors on substrates that are not subject to destruction. In lymphocytes, disorganization of the nuclear membrane and intracellular membranes, uneven distribution of chromatin, the hypertrophied Golgi apparatus, and a large number of young mitochondria, lysosomes, ribosomes, vesicles manifesting the disruption of metabolism, stress and decompensation of energy supply and protein synthesis systems, have been demonstrated. In conditions of abdominal sepsis with indications of first- or second-stage shock, blood cells undergo substantial ultrastructural changes causing gas exchange disruption, changes in reactivity, as well as decompensation of organs and system functioning.

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“…The World Health Organization recognizes antimicrobial resistance (AMR) as a major global public health problem [1,2]. The dissemination of multidrug-resistant (MDR), extended-spectrum β-lactamase (ESBL)producing Enterobacterales is of particular concern limiting treatment options for invasive infections to last line antibiotics [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique

Estaleva

Zimba

Sekyere

et al. 2020

Preprint

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Background: Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1,000-bed reference hospital in Maputo, Mozambique.Methods: A total of 230 clinical isolates of E. coli from urine (n=199) and blood cultures (n=31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR. Results: A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n=75) from urine (n=58/199; 29%) and blood (n=17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of blaCTX-M (n=58/75; 77%) dominated by blaCTX-M-15. All AmpC-phenotype positive isolates (n=25/75; 33 %) scored positive for one or more pAmpC-genes dominated by blaMOX/FOX. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread. Conclusion: We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.

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Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae

Abstract: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.

Cited by 40 publications

References 37 publications

Risk Factors for Mortality and Treatment Outcomes of Patients With Ceftriaxone Resistant E. Coli Bacteremia Receiving Carbapenem Versus Beta Lactam/Beta Lactamase Inhibitor Therapy

Risk Factors for Mortality and Treatment Outcomes of Patients With Ceftriaxone Resistant E. Coli Bacteremia Receiving Carbapenem Versus Beta Lactam/Beta Lactamase Inhibitor Therapy

Ultrastructural Changes of Blood Cells in Children with Generalized Purulent Peritonitis: A Cross-Sectional and Prospective Study

High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique

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