Antimicrobial Resistance and Mortality in Hospitalized Patients with Bacteremia in the Greater Paris Area from 2016 to 2019

Abstract

Purpose Antibiotic-resistant bacteremia is a leading global cause of infectious disease morbidity and mortality. Clinical data warehouses (CDWs) allow for the secure, real-time coupling of diverse data sources from real-world clinical settings, including care-based medical-administrative data and laboratory-based microbiological data. The main purpose of this study was to assess the contribution of CDWs in the epidemiological study of antibiotic resistance by constructing a database of bacteremia patients, BactHub, and describing their main clinico-microbiological features and outcomes. Patients and Methods Adult patients with bacteremia hospitalized between January 1, 2016 and December 31, 2019 in 14 acute care university hospitals from the Greater Paris area were identified; their first bacteremia episode was included. Data describing patients, episodes of bacteremia, bacterial isolates, and antimicrobial resistance were structured. Results Among 29,228 patients with bacteremia, 41% of episodes were community-onset (CO) and 59% were hospital-acquired (HA). Thirty-day and ninety-day mortality rates were 15% and 20% in CO episodes, and 18% and 36% in HA episodes. Overall resistance rates were high, including third-generation cephalosporin resistance among Klebsiella pneumoniae (CO 21%, HA 37%) and Escherichia coli (CO 13%, HA 17%), and methicillin resistance among Staphylococcus aureus (CO 11%, HA 14%). Annual incidence rates increased significantly from 2017 to 2019, from 20.0 to 20.9 to 22.1 stays with bacteremia per 1000 stays (p < 0.0001). Conclusion The Bacthub database provides accurate clinico-microbiological data describing bacteremia across France’s largest hospital group. Data from Bacthub may inform surveillance and the clinical decision-making process for bacteremia patients, including choice of antimicrobial therapy. The database also offers opportunities for research, including analysis of hospital care pathways and significant patient outcomes such as mortality and recurrence of infection.

Antimicrobial Resistance as Risk Factor for Recurrent Bacteremia after Staphylococcusaureus, Escherichia coli, or Klebsiella spp. Community-Onset Bacteremia

“…We focused on 14 AP-HP hospitals with acute care activity, covering ≈22% of all short stays in Île-de-France, the largest region in France. The construction of the database and the included variables have been previously described ( 4 ). Available data include medical-administrative data describing patient characteristics and hospital stays, as well as microbiological data including infection etiology and antibiotic-susceptibility results.…”

“…To avoid including early relapses, we defined recurrence as any clinically important episode of bacteremia (whatever the species, wherever the onset) occurring 7–365 days after hospital discharge from the incident episode ( 21 ). We identified bacteremia episodes by using microbiologic results (i.e., positive blood cultures) and defined them as previously described ( 4 ). For statistical analysis, we considered 2 main patient groups: those with recurrence and those without.…”

“…For each incident stay, other variables considered include patient length of stay (LOS) with bacteremia (the number of days in hospital from the first positive blood culture to the end of the stay), surgery, ICU admission, presence of septic shock, identified bacterial species ( S. aureus , E. coli , or Klebsiella spp. ), antibiotic susceptibility results, and infection sources (defined according to ICD-10 codes, as previously described) ( 4 ). Because the effect of resistance may differ according to bacterial species, we considered a 6-class bacteria resistance composite variable (methicillin-susceptible S. aureus [MSSA] and methicillin-resistant S. aureus [MRSA], 3GC-susceptible and resistant E. coli , and 3GC-susceptible and resistant Klebsiella spp.)…”

“…Although the effects of AMR on clinical and economic outcomes have been studied extensively, relatively little is known about the effects of AMR on infection recurrence, a significant event that results in substantial illness, death, and healthcare costs (3). Recurrence is of particular concern among bacteremia patients, who are often fragile and have underlying conditions, because bacteremia is associated with high rates of death and AMR (4). AMR in bacteremia is associated with greater infection severity, higher risk for treatment failure, and longer length of hospital stay, all of which may affect risk for recurrence (5)(6)(7).…”

The versatile defender: exploring the multifaceted role of p62 in intracellular bacterial infection

“…Despite the progress achieved with the development and use of antibiotics and vaccines, the mortality rates associated with infectious diseases remains high. Moreover, antibiotic resistance amongst pathogenic microorganisms has emerged as an alarming global challenge (Rex et al, 2017;Abbara et al, 2022). Intracellular bacterial infections have long been a severe threat to public health.…”