Impact of empirical treatment in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. bacteremia. A multicentric cohort study

Peralta, Galo; Lamelo, María; Álvarez-García, Patricia; Velasco, María; Delgado, Alberto Álvarez; Horcajada, Juan Pablo; Montero, Milagro; Roiz, M. P.; Fariñas, María Carmen; Alonso, J.; Martínez-Martínez, Luis; Gutiérrez-Macías, Alfonso; Alava, J.A.; Rodríguez, Azucena; Fleites, Ana; Navarro, Vicente; Sirvent, Elia; Capdevila, J.A.

doi:10.1186/1471-2334-12-245

Cited by 81 publications

(51 citation statements)

References 24 publications

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“…Clinical severity of systemic inflammatory response syndrome at the onset of infection is one of the most important predictors of mortality in Enterobacteriaceae invasive infections [Peralta et al 2012]. Therefore, providing adequate antibiotic coverage is especially important in these situations and the use of broader spectrum antibiotics or combined therapy might be justified even in the absence of individual risk factors when a multidrug-resistant organism is to be considered according to the local epidemiology.…”

Section: Clinical Severitymentioning

confidence: 99%

“…Several studies demonstrated that inactive empirical therapy is independently associated with worse outcomes in patients with bacteraemia due to Enterobacteriaceae [Kang et al 2005;Peralta et al 2012;Retamar et al 2012;RodriguezBañ o et al 2010]. The fact that antimicrobial resistance to first-line agents has been increasing makes the selection of empirical therapy more difficult [Livermore et al 2008;Canton et al 2012].…”

Section: Molecular Class Enzymesmentioning

confidence: 99%

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Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

Delgado-Valverde

Sojo-Dorado

Pascual

2013

Therapeutic Advances in Infection

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Enterobacteriaceae showing resistance to cephalosporins due to extended-spectrum b-lactamases (ESBLs) or plasmid-mediated AmpC enzymes, and those producing carbapenemases have spread worldwide during the last decades. Many of these isolates are also resistant to other first-line agents such as fluoroquinolones or aminoglycosides, leaving few available options for therapy. Thus, older drugs such as colistin and fosfomycin are being increasingly used. Infections caused by these bacteria are associated with increased morbidity and mortality compared with those caused by their susceptible counterparts. Most of the evidence supporting the present recommendations is from in vitro data, animal studies, and observational studies. While carbapenems are considered the drugs of choice for ESBL and AmpC producers, recent data suggest that certain alternatives may be suitable for some types of infections. Combined therapy seems superior to monotherapy in the treatment of invasive infections caused by carbapenemase-producing Enterobacteriaceae. Optimization of dosage according to pharmacokinetics/pharmacodynamics data is important for the treatment of infections caused by isolates with borderline minimum inhibitory concentration due to lowlevel resistance mechanisms. The increasing frequency and the rapid spread of multidrug resistance among the Enterobacteriaceae is a true and complex public health problem. IntroductionThe traditional first-line available options for treating serious infections caused by enterobacteria include penicillins, cephalosporins, monobactams, carbapenems, fluorquinolones, and in certain situations, aminoglycosides. The frequency of resistance to these first-line agents has been rising worldwide during the last decades [Paterson 2006;Rhomberg and Jones 2009;Houghton et al. 2010;Nordmann, et al. 2011] and now reach high proportions in many areas of the world.

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Section: Clinical Severitymentioning

confidence: 99%

Section: Molecular Class Enzymesmentioning

confidence: 99%

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

Delgado-Valverde

Sojo-Dorado

Pascual

2013

Therapeutic Advances in Infection

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“…A recent study by Peralta et al, conducted in 19 Spanish hospitals, found that the ESBLE causing bacteremia were mainly from the urinary (55.3%) and biliary (12.7%) tracts. E. coli accounted for 89% of all ESBLE strains, and 45.7% of these were multidrug resistant (e.g., resistant to ␤-lactam-␤-lactamase inhibitor combinations, cephalosporins, quinolones, and aminoglycosides) (3). Furthermore, empirical antibiotic treatment was adequate in only 48.8% of the cases, and the in-hospital mortality was 20.9% (3).…”

mentioning

confidence: 99%

The β-Lacta Test for Direct Detection of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Urine

et al. 2014

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cWith the ␤-Lacta test, production of extended-spectrum ␤-lactamases (ESBLs) was assayed in 200 urine samples showing Gramnegative bacilli during direct microscopic examination. While 168 samples tested negative, all samples yielding ESBL-producing Enterobacteriaceae after culture gave positive (n ‫؍‬ 30) or uninterpretable (n ‫؍‬ 2) results. The sensitivity and specificity of ESBL detection were 94% and 100%, respectively. A survey conducted from 2002 to 2010 by the French national infection control program demonstrated an increase of 282% in the incidence of extended-spectrum ␤-lactamase-producing Enterobacteriaceae (ESBLE), particularly ESBL-producing Escherichia coli (1). The increasing importance of multiresistant ESBL-producing E. coli strains in the community should make clinicians aware of potential treatment failures associated with serious and potentially life-threatening infections (2). A recent study by Peralta et al., conducted in 19 Spanish hospitals, found that the ESBLE causing bacteremia were mainly from the urinary (55.3%) and biliary (12.7%) tracts. E. coli accounted for 89% of all ESBLE strains, and 45.7% of these were multidrug resistant (e.g., resistant to ␤-lactam-␤-lactamase inhibitor combinations, cephalosporins, quinolones, and aminoglycosides) (3). Furthermore, empirical antibiotic treatment was adequate in only 48.8% of the cases, and the in-hospital mortality was 20.9% (3). ESBL-producing E. coli isolates, particularly those producing CTX-M enzymes, account for a significant number of cases of bacteremia in hospitalized and nonhospitalized patients (4). Moreover, Livermore has reported that, since 2003, 90% of ESBL-producing E. coli isolates in the United Kingdom produce CTX-M-15 (5).Urinary tract infections (UTI) are among the most frequent bacterial infections in the community and in the health care setting (6). Broad-spectrum cephalosporins, ␤-lactam-␤-lactamase inhibitor combinations, or fluoroquinolones are recommended for first-line empirical therapy of sepsis arising from the urinary tract in community-acquired and nosocomially acquired cases (4, 7). These recommendations might be difficult to apply if a significant proportion of such infections is caused by ESBLE (4).A new chromogenic test (␤-Lacta test [BLT]; Bio-Rad, MarnesLa-Coquette, France) was developed for the rapid detection (in less than 15 min) of strains of Enterobacteriaceae with decreased susceptibility or resistance to third-generation cephalosporins (3GC) conferred by enzymes such as ESBLs and carbapenemases. This test provides useful information to guide antibiotic treatment before full results of antimicrobiotic susceptibility testing are available (8). The aim of this study was to highlight the time saved in cases of UTI when the BLT is performed directly with urine rather than bacterial colonies.Urine samples. All urine samples received over a 3-month period and showing Gram-negative bacilli (GNB) upon direct microscopic examination and on Gram stains of uncentrifuged urine were prospectively included. Urin...

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“…Wound biomaterial was the most common source of biomaterial for ESBL producing Enterobacteriaceae isolation in this study, while urine was the most commonly used biomaterial in other studies (Peralta et al, 2012;Kassakian & Mermel, 2014;Moor et al, 2008;Ruiz de Alegría et al, 2011;Kolar et al, 2006). The frequency of other biomaterial for ESBL producing bacteria detection, including abdominal cavity and abscess biomaterial, bronchoalveolar fluid, blood, and cerebrospinal fluid was approximately the same as that described in other literature sources (Peralta et al, 2012;Kassakian & Mermel, 2014;Ruiz de Alegría et al, 2011;Kolar et al, 2006;Mengistu et al, 2013). The frequency of other Enterobacteriaceae found in this study, including P. mirablis, S. marcescens, and K. oxytoca, was similar to that in other studies (Sasirekha, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…This is often challenging due to high antimicrobial resistance and lack of local resistance pattern data (The New β-Lactamases -NEJM, 2015 ; Peralta et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Higher CTX-M, Tem, and SHV Extended-Spectrum Beta-Lactamase Plasmid Gene Combination Frequency in Esbl Producing Klebsiella Pneumoniae Compared With Esbl Producing Escherichia Coli

Skuja

Pekarska

Derovs

et al. 2016

CBUP

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Impact of empirical treatment in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. bacteremia. A multicentric cohort study

Cited by 81 publications

References 24 publications

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

The β-Lacta Test for Direct Detection of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Urine

Higher CTX-M, Tem, and SHV Extended-Spectrum Beta-Lactamase Plasmid Gene Combination Frequency in Esbl Producing Klebsiella Pneumoniae Compared With Esbl Producing Escherichia Coli

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