A retrospective analysis of risk factors and outcomes in patients with extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections

Xiao, Tingting; Wu, Zhenzhu; Shi, Qingyi; Zhang, Xiaoli; Zhou, Yanzi; X, Yu; Xiao, Yonghong

doi:10.1016/j.jgar.2018.12.014

Cited by 32 publications

(24 citation statements)

References 26 publications

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“…21 Previous studies revealed cephalosporin exposure as an independent risk factor for ESBL-producing E. coli. 22 This is because when under high cephalosporin stress, E. coli can acquire multiple ESBL genes and increase their transcriptional expression. 23 The broad use of cephalosporins and fluoroquinolones therefore influences the microbiologic environment and antibiotic susceptibility.…”

Section: Comparison Of Esbl-producing Bacteriamentioning

confidence: 99%

Urinary tract infection pathogens and antimicrobial susceptibilities in Kobe, Japan and Taipei, Taiwan: an international analysis

et al. 2019

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Objective This study compared urinary tract infection (UTI) pathogens and antibiotic susceptibilities between Kobe, Japan and Taipei, Taiwan to investigate the regional resistance pattern of UTI-causative bacteria. Methods UTI-causative bacteria and antibiotic susceptibility for 4519 samples from Kobe University Hospital, Kobe and 25,131 samples from Shuang-Ho Hospital, Taipei from 2015 to 2017 were retrospectively analyzed to compare the differences between these hospitals. Results Escherichia coli was the most common pathogen in both areas (30.0% in Kobe, 41.2% in Taipei). The prevalence of cephalosporin and gentamicin-resistant E. coli tended to be higher in Taipei than in Kobe. Additionally, antibiotic susceptibilities of Klebsiella pneumonia and Pseudomonas aeruginosa tended to be higher in Kobe than in Taipei. The ratio of extended-spectrum β-lactamase-producing K. pneumoniae was significantly higher in Taipei than in Kobe (up to 40% vs. 14.8%), but this was not observed for E. coli. Conclusion Variations in the type of UTI-causative bacteria and antibiotic susceptibility between the two hospitals may be influenced by the use of different antibiotics. Further surveillance of resistance patterns is necessary for effective treatment.

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Section: Comparison Of Esbl-producing Bacteriamentioning

confidence: 99%

Urinary tract infection pathogens and antimicrobial susceptibilities in Kobe, Japan and Taipei, Taiwan: an international analysis

et al. 2019

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“…Therefore, we aimed to quantify the potential clinical and economic impact of ESBL production. In some studies, they showed increased mortality associated with ESBL-positive infection, 10,11 while our previous study 12 had come to the opposite conclusion that patients with BSI due to ESBL-EC did not show a higher mortality and a longer hospitalization than patients with BSI due to non-ESBL-EC.…”

Section: Introductionmentioning

confidence: 70%

“…However, in our study, for non-ESBL-EC infection group, only 26% of patients used recommended antimicrobials (cephalosporins, fluoroquinolones and aminoglycosides), 85% of patients used BLBLI and carbapenems. The reason why second-line and thirdline antibiotics are chosen as empirical treatment drugs can be explained in our previous study, 12 older age, the presence of comorbidities, ICU stay, recurrent urinary tract infections (UTI), previous use of antibiotics, previous colonization with ESBL-producing commensal bacteria, and higher ESBL prevalence were identified as risk factors for acquisition of BSI caused by ESBLproducing Enterobacterales. [33][34][35][36] There are many risk factors for ESBL infection in patients with non-ESBL-EC BSI, so clinicians tend to choose antimicrobial agents covering ESBL-producing bacteria as empirical antibiotic therapy.…”

mentioning

confidence: 99%

<p>Economic Burden of Patients with Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing <em>Escherichia coli</em></p>

Wang¹,

Xiao²,

Zhu³

et al. 2020

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Background: The prevalence of infections with extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is increasing worldwide, but the economic impact of ESBL-EC bloodstream infection (BSI) has not been comprehensively evaluated. Patients and Methods: A retrospective cohort including patients hospitalized at a tertiary hospital between January 2013 and December 2016 who were confirmed with a BSI of ESBL-EC or non-ESBL-EC was set. Clinical data and medical costs were collected by chart review of electronic and paper medical records. The economic burden was evaluated with disability-adjusted life years (DALYs). Results: A total of 580 patients with E. coli BSI, comprising 333 patients (57.4%) with ESBL-EC BSI and 247 patients (42.6%) with non-ESBL-EC BSI, were identified. There were no significant differences in comorbidity and severity of patients between ESBL-EC and non-ESBL-EC BSI. The median length of stay (LOS) after bacteremia was 12 days for ESBL-EC (interquartile range, 7 to 21) versus 11 days for non-ESBL-EC (interquartile range, 7 to 21) (P = 0.38), and appropriate empirical antimicrobial therapy occurred in 87.4% versus 89.9% (P = 0.353). The mortalities were 20.1% versus 17.4% (P = 0.41).

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“…Therefore, we aimed to quantify the potential clinial and economic impact of ESBL production. In some studies, they showed increased mortality associated with ESBLpositive infection 8; 9 ,while our previous study 10 had come to the opposite conclusion that patients with BSI due to ESBL-EC did not show a higher mortality and a longer hospitalization than patients with BSI due to non-ESBL-EC.…”

Section: Introductionmentioning

confidence: 78%

Social-Economic Burden of Patients with Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia Coli

Wang

Xiao

Zhu

et al. 2020

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Abstract Background: The prevalence of infections with extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is increasing worldwide, but the economic impact of ESBL-EC bloodstream infections (BSI) has not been comprehensively evaluated.Methods: A retrospective cohort including patients hospitalized at a tertiary hospital between January 2013 and December 2016 who confirmed with BSI of ESBL-EC or non-ESBL-EC was set. Clinical data and medical costs were collected by chart review of electronic and paper medical records. The socio-economic burden was evaluated with DALYs.Results: A total of 580 patients with E. coli BSI, comprising 333 patients (57.4%) with ESBL-EC BSI and 247 patients (42.6%) with non-ESBL-EC BSI, were identified. There were no significant differences in comorbidity and severity of patients between ESBL-EC and non-ESBL-EC BSIs. The median length of stay (LOS) after bacteremia was 12 days for ESBL-EC(interquartile range, 7 to 21), versus 11 days for non-ESBL-EC (interquartile range, 7 to 21) (P =0.38), and appropriate empirical antimicrobial therapy occurred in 87.4% versus 89.9% (P =0.353). The mortalities were 20.1% versus 17.4% (P =0.41). Patients with ESBL-EC did not have significant difference in-hospital medical costs than those with non-ESBL-EC (median, $8048.68 vs $7476.84, respectively,with a difference of $571.84,P=0.321). In non-ESBL-EC group, 247 patients lost 531.05 DALYs in total, with an average of 2.15 DALYs per person,while in ESBL-EC group, 333 patients lost 692.64 DALYs in total, with an average of 2.08 DALYs per person. There is no significant difference in average DALY(P=0.343).Conclusions: In conclusion, patients with BSI due to ESBL-EC did not cost more than patients with BSI due to non-ESBL-EC. This phenomenon may be attributed to timely and effective antibiotic treatment，but the intitial empiric thrapy with second or third line antibitoics in non-ESBL-EC BSI should be corrected.

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A retrospective analysis of risk factors and outcomes in patients with extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections

Cited by 32 publications

References 26 publications

Urinary tract infection pathogens and antimicrobial susceptibilities in Kobe, Japan and Taipei, Taiwan: an international analysis

Urinary tract infection pathogens and antimicrobial susceptibilities in Kobe, Japan and Taipei, Taiwan: an international analysis

<p>Economic Burden of Patients with Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing <em>Escherichia coli</em></p>

Social-Economic Burden of Patients with Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia Coli

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