Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended-spectrum-<b>β</b>-lactamase-producing Enterobacteriaceae

Palacios‐Baena, Zaira R.; Gutiérrez‐Gutiérrez, Belén; Cueto, Marina de; Viale, Pierluigi; Venditti, Mario; Hernández-Torres, Alícia; Oliver, Antonio; Martínez-Martínez, Luis; Calbo, Esther; Pintado, Vicente; Gasch, Oriol; Almirante, Benito; Lepe, José Antonio; Pitout, Johann; Akova, Murat; Peña-Miralles, Carmen; Schwaber, Mitchell J.; Tumbarello, Mario; Tacconelli, Evelina; Origüen, Julia; Prim, Núria; Bou, Germán; Giamarellou, Helen; Bermejo, Joaquín; Hamprecht, Axel; Pérez, Federico; Almela, Manuel; Lowman, Warren; Hsueh, Po-Ren; Francisco, Carolina Navarro-San; Torre‐Cisneros, Julián; Carmeli, Yehuda; Paterson, David L.; Pascual, Álvaro

doi:10.1093/jac/dkw513

Cited by 50 publications

(54 citation statements)

References 22 publications

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“…Another old antibiotic is fosfomycin that inhibits bacterial cell wall synthesis [6]. In Turkey, colistin is used for the treatment of the multidrugresistant strains of CRE by either monotherapy or combination therapy [7]. Although the intravenous formulation of fosfomycin (fosfomycin disodium) is not available in Turkey, its use in the treatment of CRE has been reported to be quite safe [8].…”

Section: Introductionmentioning

confidence: 99%

High rate of colistin and fosfomycin resistance among carbapenemase-producing Enterobacteriaceae in Turkey

Yıldız

Kaşkatepe

Şimşek

et al. 2018

AMicr

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When the problem with carbapenem-resistant Enterobacteriaceae (CRE) increases, the older antimicrobial agents such as colistin and fosfomycin are used for the treatment of these infections. In this study, the broth microdilution method for colistin and the agar dilution method for fosfomycin were used for a total of 147 multidrug-resistant (MDR) or extensively drug-resistant (XDR) strains of CRE. The study included Klebsiella pneumoniae (91.16%), Escherichia coli (7.48%), Enterobacter cloacae (0.68%), and Serratia marcescens (0.68%). All these strains produce various types of carbapenemase, including OXA-48, NDM, and KPC. Some of these strains also have three different carbapenemase mechanisms, including OXA-48 (78.23%), NDM (2.04%), and KPC (0.68%) or OXA-48 and NDM (10.88%), or OXA-48 and KPC (0.68%). About 76.19% of the strains and 67.35% of the strains were resistant for colistin and fosfomycin, respectively. A total of 21 out of 35 colistin-susceptible strains were found to be susceptible to fosfomycin. This study showed that the resistance rates of colistin and fosfomycin are high. The MDR and XDR strains of CRE are spreading in our region and thus a monitoring system for CRE should be followed. Moreover, the applicability of antimicrobial stewardship programs should be increased in all inpatient and outpatient settings.

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Section: Introductionmentioning

confidence: 99%

High rate of colistin and fosfomycin resistance among carbapenemase-producing Enterobacteriaceae in Turkey

Yıldız

Kaşkatepe

Şimşek

et al. 2018

AMicr

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“…34 Another study showed no difference in readmission rates between methicillin-sensitive and MRSA when adjusting for other comorbidities and severity of illness. 35 In the context of our study, it is important to recognize that our patients were likely at high risk of readmission due to their high baseline severity of illness and their infections. Because we did not include a group of patients with non-MDRO infections as a comparator, the impact of drug resistance on readmission rates cannot be deduced from the present study.…”

Section: Discussionmentioning

confidence: 98%

Readmissions With Multidrug-Resistant Infection in Patients With Prior Multidrug Resistant Infection

Burnham

Kwon

Olsen

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To determine incidence of and risk factors for readmissions with multidrug-resistant organism (MDRO) infections among patients with previous MDRO infection. DESIGN Retrospective cohort of patients admitted between January 1, 2006, and October 1, 2015. SETTING Barnes-Jewish Hospital, a 1,250-bed academic tertiary referral center in St Louis, Missouri. METHODS We identified patients with MDROs obtained from the bloodstream, bronchoalveolar lavage (BAL)/bronchial wash, or other sterile sites. Centers for Disease Control and prevention (CDC) and European CDC definitions of MDROs were utilized. All readmissions ≤1 year from discharge from the index MDRO hospitalization were evaluated for bloodstream, BAL/bronchial wash, or other sterile site cultures positive for the same or different MDROs. RESULTS In total, 4,429 unique patients had a positive culture for an MDRO; 3,453 of these (78.0%) survived the index hospitalization. Moreover, 2,127 patients (61.6%) were readmitted ≥1 time within a year, for a total of 5,849 readmissions. Furthermore, 512 patients (24.1%) had the same or a different MDRO isolated from blood, BAL/bronchial wash, or another sterile site during a readmission. Bone marrow transplant, end-stage renal disease, lymphoma, methicillin-resistant Staphylococcus aureus, or carbapenem-resistant Pseudomonas aeruginosa during index hospitalization were factors associated with increased risk of having an MDRO isolated during a readmission. MDROs isolated during readmissions were in the same class of MDRO as the index hospitalization 9%-78% of the time, with variation by index pathogen. CONCLUSIONS Readmissions among patients with MDRO infections are frequent. Various patient and organism factors predispose to readmission. When readmitted patients had an MDRO, it was often a pathogen in the same class as that isolated during the index admission, with the exception of Acinetobacter (~9%). Infect Control Hosp Epidemiol 2018;39:12-19.

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“…First, patients with bloodstream infections caused by ESBL-producing Enterobacteriaceae are more likely to receive inappropriate empiric antibiotics compared with patients with infections caused by susceptible strains. Inappropriate empiric treatment for bloodstream infections caused by ESBL-producing Enterobacteriaceae is an independent risk factor for mortality [15], and we could assume that patients who survived would have more organ dysfunction, which could prolong LOS. Second, patients with bloodstream infections caused by ESBL-producing Enterobacteriaceae have more serious illnesses and/or comorbidities, which would lead to higher mortality, and when patients survive the episode, to a longer LOS compared with patients with susceptible bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis

et al. 2020

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Excess length of stay (LOS) is an important outcome when assessing the burden of nosocomial infection, but it can be subject to survival bias. We aimed to estimate the change in LOS attributable to hospital-onset (HO) Escherichia coli/Klebsiella spp. bacteremia using multistate models to circumvent survival bias. We analyzed a cohort of all patients with HO E. coli/Klebsiella spp. bacteremia and matched uninfected control patients within the U.S. Veterans Health Administration System in 2003–2013. A multistate model was used to estimate the change in LOS as an effect of the intermediate state (HO-bacteremia). We stratified analyses by susceptibilities to fluoroquinolones (fluoroquinolone susceptible (FQ-S)/fluoroquinolone resistant (FQ-R)) and extended-spectrum cephalosporins (ESC susceptible (ESC-S)/ESC resistant (ESC-R)). Among the 5964 patients with HO bacteremia analyzed, 957 (16.9%) and 1638 (28.9%) patients had organisms resistant to FQ and ESC, respectively. Any HO E.coli/Klebsiella bacteremia was associated with excess LOS, and both FQ-R and ESC-R were associated with a longer LOS than susceptible strains, but the additional burdens attributable to resistance were small compared to HO bacteremia itself (FQ-S: 12.13 days vs. FQ-R: 12.94 days, difference: 0.81 days (95% CI: 0.56–1.05), p < 0.001 and ESC-S: 11.57 days vs. ESC-R: 16.56 days, difference: 4.99 days (95% CI: 4.75–5.24), p < 0.001). Accurate measurements of excess attributable LOS associated with resistance can help support the business case for infection control interventions.

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Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended-spectrum-β-lactamase-producing Enterobacteriaceae

Abstract: We developed and validated an easy-to-collect predictive scoring model for all-cause 30 day mortality useful for identifying patients at high and low risk of mortality.

Cited by 50 publications

References 22 publications

High rate of colistin and fosfomycin resistance among carbapenemase-producing Enterobacteriaceae in Turkey

High rate of colistin and fosfomycin resistance among carbapenemase-producing Enterobacteriaceae in Turkey

Readmissions With Multidrug-Resistant Infection in Patients With Prior Multidrug Resistant Infection

Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis

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