Impact of antibiotic resistance and of adequate empirical antibiotic treatment in the prognosis of patients with Escherichia coli bacteraemia

Peralta, Galo; Sánchez, María Blanca; Garrido, Jose C Martinez; Benito, I. De; Cano, María Eliecer; Martínez-Martínez, Luis; Roiz, M. P.

doi:10.1093/jac/dkm279

Cited by 155 publications

(120 citation statements)

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“…29 In the current study, we found significantly higher rates of infectious complications and early and overall case fatality for the infants with MDR GNB bacteremia, which is consistent with previous reports. [30][31][32] The durations of mechanical ventilation and hospitalization were comparable between the MDR GNB group and the controls, but these results may be masked by the higher proportions of neonates in the MDR GNB group who died within 30 days after the onset of bacteremia. Although inappropriate empirical antibiotic therapy has been related to higher mortality in GNB bacteremia, [31][32][33] we were unable to establish a direct association between increased mortality in neonates with MDR GNB bacteremia and a delay in appropriate antibiotics.…”

Section: Discussionmentioning

confidence: 91%

“…[30][31][32] The durations of mechanical ventilation and hospitalization were comparable between the MDR GNB group and the controls, but these results may be masked by the higher proportions of neonates in the MDR GNB group who died within 30 days after the onset of bacteremia. Although inappropriate empirical antibiotic therapy has been related to higher mortality in GNB bacteremia, [31][32][33] we were unable to establish a direct association between increased mortality in neonates with MDR GNB bacteremia and a delay in appropriate antibiotics. We found initial inappropriate antibiotic therapy to be significantly related to overall mortality (OR: 2.35; 95% CI: 1.23-4.51; P = .010) and infectious complications (OR: 3.27; 95% CI: 1.71-6.23; P , .001) but not early case-fatality rate.…”

Section: Discussionmentioning

confidence: 91%

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Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:There is a perception that Gram-negative bacilli (GNB) bloodstream infection is increasing in the NICU, and those infections caused by a multidrug-resistant (MDR) strain are a growing threat to hospitalized patients. WHAT THIS STUDY ADDS:Exposure to broad-spectrum antibiotics is the most important risk factor for MDR GNB bacteremia, which is associated with higher mortality. Neonates with risk factors for bacteremia caused by a MDR GNB strain may benefit from empirical antimicrobial therapy with carbapenem. abstract OBJECTIVES: To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients. METHODS:Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study. RESULTS:Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum b-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37-15.08; P , .001) and carbapenem (OR: 3.60; 95% CI: 1.26-10.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74-28.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P , .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality 1rate (28.6% vs 10.5%; P , .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41-7.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88-20.31; P = .003).CONCLUSIONS: MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum b-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate. Pediatrics 2014;133:e322-e329

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

et al. 2014

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“…La principal utilidad de predecir una infección por BLEE es que la cobertura antimicrobiana inapropiada durante la fase empírica en espera de los cultivos se asocia a mayor mortalidad en pacientes con infecciones graves por BLEE 11,[29][30][31][32][33] . El uso de un modelo predictor puede entregar una información útil para la toma de decisiones, más aún con variables de fácil acceso en la clínica, teniendo en cuenta el de-escalamiento terapéutico una vez obtenidos los cultivos.…”

Section: Artículo Originalunclassified

Factores asociados a infecciones urinarias producidas por enterobacterias productoras de β-lactamasas de espectro extendido: una cohorte prospectiva

Avilés

Betancour

Velasco

et al. 2016

Rev. chil. infectol.

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“…As the clinical outcome is influenced by the adequacy of the empiric antibiotic treatment [21,22], knowledge about the supposed probability of a resistant E. coli strain in a individual patient is crucial. As such, current guidelines based on overall cumulative antimicrobial suscepti-bility test data may be intrinsically limited.…”

Section: Introductionmentioning

confidence: 99%

Secular Trend and Risk Factors for Antimicrobial Resistance in Escherichia coli Isolates in Switzerland 1997–2007

et al. 2009

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Background: Antibacterial resistance in Escherichia coli isolates of urinary infections, mainly to fluoroquinolones, is emerging. The aim of our study was to identify the secular trend of resistant E. coli isolates and to characterize the population at risk for colonization or infections with these organisms. Patients and Methods: Retrospective analysis of 3,430 E.coli first isolates of urine specimens from patients admitted to the University Hospital Basel in 1997Basel in , 2000Basel in , 2003Basel in , and 2007. Results: Resistance to ciprofloxacin, trimethoprim/sulfamethoxazole, and amoxicillin/clavulanate has increased over the 10-year study period (from 1.8% to 15.9%, 17.4% to 21.3%, and 9.5% to 14.5%, respectively). A detailed analysis of the 2007 data revealed that independent risk factors for ciprofloxacin resistance were age (5.3% < 35 years of age to 21.9% in patients > 75 years; odds ratio [OR] 1.29 per 10 years, 95% confidence interval [CI] 1.15-1.45, p < 0.001) and male gender (OR 1.59, 95% CI 1.05-2.41, p = 0.04). In contrast, nosocomial E. coli isolates were associated with lower odds of ciprofloxacin resistance (OR 0.51, 95% CI 0.28-0.67, p < 0.001). The frequency of resistant isolate rates was not influenced by the clinical significance (i.e., colonization vs urinary tract infection, UTI) or by whether the urine was taken from a urinary catheter. Importantly, the increase in ciprofloxacin resistance paralleled the increase in ciprofloxacin consumption in Switzerland (Pearson's correlation test R 2 = 0.998, p = 0.002). Of note, resistance was less frequent in isolates sent in by general practitioners. However, after adjustment for age and gender, only resistance against amoxicillin/clavulanate was found to be less frequent (OR 0.34, p = 0.03). Conclusion: Our study reveals that resistance rates have been increasing during the last decade. Published resistance rates may lack information due to important differences regarding age, gender, and probable origin of the isolates. Empirical therapy for UTI should be guided more on individual risk profile and local resistance data than on resistance data banks.

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Impact of antibiotic resistance and of adequate empirical antibiotic treatment in the prognosis of patients with Escherichia coli bacteraemia

Abstract: Adequacy of empirical antibiotic treatment is an independent risk factor for mortality in patients with E. coli bacteraemia. MDR E. coli bacteraemia had a worse prognosis due, at least in part, to a lower frequency of correct empirical treatment.

Cited by 155 publications

References 49 publications

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Factores asociados a infecciones urinarias producidas por enterobacterias productoras de β-lactamasas de espectro extendido: una cohorte prospectiva

Secular Trend and Risk Factors for Antimicrobial Resistance in Escherichia coli Isolates in Switzerland 1997–2007

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Impact of antibiotic resistance and of adequate empirical antibiotic treatment in the prognosis of patients with Escherichia coli bacteraemia

Abstract: Adequacy of empirical antibiotic treatment is an independent risk factor for mortality in patients with E. coli bacteraemia. MDR E. coli bacteraemia had a worse prognosis due, at least in part, to a lower frequency of correct empirical treatment.

Cited by 155 publications

References 49 publications

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Factores asociados a infecciones urinarias producidas por enterobacterias productoras de &#946;-lactamasas de espectro extendido: una cohorte prospectiva

Secular Trend and Risk Factors for Antimicrobial Resistance in Escherichia coli Isolates in Switzerland 1997–2007

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Factores asociados a infecciones urinarias producidas por enterobacterias productoras de β-lactamasas de espectro extendido: una cohorte prospectiva