Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome

Ortega, M.; Marco, Francesc; Soriano, Álex; Almela, Manuel; Martínez, J. A.; Muñoz, Ana; Mensa, José

doi:10.1093/jac/dkn514

Cited by 161 publications

(114 citation statements)

References 30 publications

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“…[60][61][62] Usually, GP BSIs result in a lower mortality than GN ones, 43,63,64 yet the mortality rate is very variable. For instance, it can range from 4% in infections caused by coagulase-negative staphylococci to 40% in a MRSA outbreak involving early post-HSCT patients.…”

Section: Outcomementioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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Section: Outcomementioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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“…Previous β-lactam antibiotics, mainly cephalosporins, have been identified as predictive factors for infection with ESBL-producing E. coli or K. pneumoniae. [10][11][12] In a retrospective analysis of 2,172 episodes of healthcare-associated bacteremia diagnosed during a 3-year period in a teaching hospital, previous use of cephalosporins and carbapenems were significantly associated with ESBL-producing E. coli or Klebsiella spp. 13 In a prospective case-control study of bacteremia caused by E. coli, previous use of oxyimino-β-lactams or fluoroquinolones were independent risk factors among hospitalized patients for ESBLproducing strains.…”

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confidence: 99%

“…Other variables associated with the identification of ESBL-producing strains in patients with bloodstream infection reported in the literature are the patient's age, 15 severe underlying diseases, 13 renal transplantation, 13 previous admission to the ICU, 18 duration of hospitalization before bacteremia, 19 prior exposure to urinary catheters, 10,14,16 invasive procedure within the previous 72 hours, 16 and the nosocomial origin of bacteremia. 10 In a systematic review of studies evaluating the association between inappropriate antibiotic therapy and mortality among bacteremic patients, measurement of severity of illness without specified the time at which it was measured was considered a source of methodological heterogeneity that may explain conflicting findings. 20 Our study adhered to key recommendations of this review to reduce the effect of potential confounders by assessing severity of illness through the SAPS II score.…”

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confidence: 99%

Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Quirante¹,

Cerrato²,

Pardos³

2011

Braz J Infect Dis

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The objective of this study was to identify risk factors for bacteremia by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective casecontrol study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5% vs 17%, p < 0.001). Binary logistic regression showed that the number (> 2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR = 2.29, 95% CI 1.35-3.88, p = 0.002). Conclusion: Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.

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“…18,[20][21][22][23] This can be explained by the previous use of antibiotics to treat these infections, which contributes to the selection of virulent pathogens. The overall cause of increasing antibiotic resistance is selective pressure by antimicrobial substances in various environmental settings.…”

Section: Discussionmentioning

confidence: 99%

Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control

Bouassida¹,

Jaidane²,

Bouallègue³

et al. 2016

CUAJ

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Introduction: Our goal was to investigate the prevalence and antibiogram pattern of extended spectrum beta-lactamase (ESBL) production among uropathogens using isolates from urine samples collected at the Department of Urology in the Sahloul Hospital, Tunisia We also aimed to identify the risk factors for nosocomial urinary tract infections (UTIs) in patients who underwent transurethral resection of the prostate (TURP) and the measures for infection control. Methods: Laboratory records of a five-year period from January 2004 to December 2008 were submitted for retrospective analysis to determine the incidence of ESBL infections. A total of 276 isolates were collected. A case-control study involving comparisons between two groups of patients who underwent TURP was performed to determine the risk factors for ESBL infection. Group 1, designated case subjects, included 51 patients with nosocomial UTI after TURP. Group 2, designated control subjects, consisted of 58 randomly selected patients who underwent TURP without nosocomial UTI in the same period. Factors suspected to be implicated in the emergence of ESBL infection were compared between the two groups in order to identify risk factors for infection. A univariate regression analysis was performed, followed by a multivariate one. Results: The annual prevalence of ESBL infection ranged from 1.3-2.5%. After performing univariate and multivariate regression analysis, the main risk factors for ESBL infections were identified as: use of antibiotics the year preceding the admission, duration of catheter use, and bladder washout (p=0.012, p=0.019, and p<0.001. Conclusions: Urologists have to perform a good hemostasis, especially in endoscopic resections, in order to avoid bladder irrigation and bladder washout and to reduce the time of bladder catheterization, which is a strong risk factor of nosocomial UTIs. IntroductionHospital infections have become a growing healthcare challenge in recent decades and serious concerns have been expressed over the rise in antimicrobial resistance among pathogens causing hospital-acquired infections. Nosocomially acquired urinary tract infection (NAUTI) is one of the most common hospital-acquired infections. 2,3This infection is not already present or incubating at the time of admission, but is acquired during hospital stay. Its definition requires a 48-hour delay after admission before symptoms appear.1,4,5 NAUTI has become one of the most important quality parameters for urological surgery. The problem is further exacerbated by the emergence of drug resistance among uropathogens in the form of extended spectrum beta-lactamase (ESBL) production. In fact, the first outbreak of ESBL-producing organisms was reported in 1983 in Germany 1 and involved chromosomal-or plasmid-mediated beta-lactamases (enzymes that cleave the beta-lactam ring) that had mutated from pre-existing broad-spectrum beta-lactamases as a consequence of the extensive use of third-generation cephalosporins and aztreonam.6 Those ESBL-producing pathogens are now...

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Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome

Cited by 161 publications

References 30 publications

Bloodstream infections in neutropenic cancer patients: A practical update

Bloodstream infections in neutropenic cancer patients: A practical update

Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control

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