Impact of Inadequate Initial Antimicrobial Therapy on Mortality in Infections Due to Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae

Hyle, Emily P; Lipworth, Adam D.; Zaoutis, Theoklis E.; Nachamkin, Irving; Bilker, Warren B.; Lautenbach, Ebbing

doi:10.1001/archinte.165.12.1375

Cited by 175 publications

(106 citation statements)

References 20 publications

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“…Unfortunately, isolates from respiratory tract infection and bacteremia are being seen with increasing frequency. Data from our institution are consistent with data summarized by Hyle et al [1]. Treatment becomes more complicated as many ESBL strains are coresistant to other antimicrobials across other drug classes (i.e., aminoglycosides, trimetheprim/sulfamethoxazole and fluoroquinolones).…”

Section: Editorialsupporting

confidence: 88%

“…Similar observations were seen for inadequate antibiotic therapy in patients with bacteremia and severe sepsis/early septic shock -that is, mortality was higher than in patients receiving adequate therapy. Similarly, Hyle et al commented on the impact of initial antimicrobial therapy on mortality in ESBL infections [1]. Inadequate initial antimicrobial therapy was an independent risk factor for mortality in nonurinary ESBL infection.…”

Section: Editorialmentioning

confidence: 99%

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Gram-negative superbugs: inappropriate antimicrobial therapy and mortality

Blondeau¹

2013

Expert Review of Clinical Pharmacology

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Section: Editorialsupporting

confidence: 88%

Section: Editorialmentioning

confidence: 99%

Gram-negative superbugs: inappropriate antimicrobial therapy and mortality

Blondeau¹

2013

Expert Review of Clinical Pharmacology

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“…32 The first is inadequate controlling for confounding covariates intrinsic to either the patient, such as severity of illness and comorbid conditions, or the infecting agent, such as the presence of a hypervirulent ESBL-positive clone. 33 The second is treatment related, such as delay of appropriate antimicrobial therapy, 6,34 increased treatment toxicity (such as renal impairment secondary to aminoglycosides), need for surgery, or lack of an active oral agent to facilitate early discharge with outpatient completion of antibiotic therapy. In our study, patients with ESBL-positive BSI were less likely to receive appropriate antibiotic treatment within 24 hours (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…1,2 ESBLs threaten the utility of commonly used empiric antibiotic therapy and have been associated with both delayed initiation of appropriate antibiotic therapy and excess mortality. [3][4][5][6] It is important to gain an accurate appreciation of the economic burden of ESBLproducing bacteria to justify the prioritization of infection control and antibiotic stewardship interventions required to confront this problem. 7 The excess length of stay (LOS) associated with an infection is the key driver of its cost from the hospital perspective.…”

mentioning

confidence: 99%

Burden of Bloodstream Infection Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model

Stewardson

Fankhauser

Angelis

et al. 2013

Infect. Control Hosp. Epidemiol.

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JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. results. Thirty ESBL-positive and 96 ESBL-negative BSI cases were included. The excess LOS attributable to ESBL-positive and ESBLnegative BSI was 9.4 (95% confidence interval [CI], 0.4-18.4) and 2.6 (95% CI, 0.7-5.9) days, respectively. ESBL positivity was therefore associated with 6.8 excess days and CHF 9,473 per BSI. The adjusted end-of-LOS HRs for ESBL-positive and ESBL-negative BSI were 0.62 (95% CI, 0.43-0.89) and 0.90 (95% CI, 0.74-1.10), respectively. After reimbursement, the average financial loss per acute care episode in ESBL-positive BSI, ESBL-negative BSI, and control cohorts was CHF 48,674, 48,131, and 13,532, respectively. Our predictive model estimated that the nationwide cost of third-generation cephalosporin resistance would increase from CHF 2,084,000 in 2010 to CHF 3,526,000 in 2015.conclusions. This is the first hospital-wide analysis of excess LOS attributable to ESBL positivity determined using multistate modeling to avoid time-dependent bias. These results may inform health-economic evaluations of interventions targeting ESBL control.

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“…7,[23][24][25][26] However, there are studies showing no significant impact of antibiotic resistance on mortality. 27 FI GU RE 1: Kap lan-Me i er sur vi val es ti ma tes by su i ta bi lity of the tre at ment.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Mortality in Patients with Nosocomial Gram-Negative Bacteremia

Gözel¹,

Erbay²,

Bodur³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Nosocomial bloodstream infections are serious health problems in hospitals all over the world. They are associated with a high rate of morbidity and mortality, prolonged hospital stay and higher costs. The aim of this study was to evaluate the clinical outcomes of the patients with gram-negative bacteremia and to identify the risk factors for mortality. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A prospective observational study was performed in the 1196-bed Ankara Numune Education and Research Hospital. The patients with nosocomial gram-negative bacteremia were included in the study from July 2006 to June 2008. Bacteremia was considered to be nosocomial when it was diagnosed at least 48 h after hospital admission. Gram-negative bacteremia was defined as the presence of gram-negative bacteria in the blood, documented by at least 1 positive hemoculture. In patients who had more than one episode of gram-negative bacteremia, only the first episode was considered. Antibiotic therapy was considered to be appropriate if the drugs used had in vitro activity against the isolated strain. R Re es su ul lt ts s: : Among the 253 cases (mean age: 54.5± 20 years old, male/female: 159/94) of Gram-negative bacteremia included in the study, the most frequently detected microorganisms were Escherichia coli (n=96, 37.9%), Acinetobacter spp. (n=54, 21.33%), Pseudomonas aeruginosa (n=41, 16.2%), Klebsiella spp. (n=39, 15.4%), Enterobacter spp. (n=9, 3.5%) and Stenotrophomonas maltophilia (n=6, 2.3%). The mean duration of hospital stay until Gram-negative bacteremia was 19 ±17 (range 3-82) days. Mortality rates at 14 days and at 30 days after the bacteremia were, respectively, 28.5% and 38.4%. We found that Acute Physiology and Chronic Health Evaluation (APACHE) II score over 20, inappropriate antibiotic treatment, receiving total parenteral nutrition, unconsciousness and thrombocytopenia were significant independent risk factors for mortality at day 30 after the Gramnegative bacteremia. C Co on nc cl lu us si io on n: : Awareness of mortality risk factors is important for the prognosis. Appropriate antibiotic treatment could decrease deaths associated with Gram-negative bacteremia.

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Impact of Inadequate Initial Antimicrobial Therapy on Mortality in Infections Due to Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae

Abstract: Inadequate initial antimicrobial therapy is an independent risk factor for mortality in ESBL-EK infections, but only among nonurinary infections. Multidrug resistance was a strong risk factor for IIAT.

Cited by 175 publications

References 20 publications

Gram-negative superbugs: inappropriate antimicrobial therapy and mortality

Gram-negative superbugs: inappropriate antimicrobial therapy and mortality

Burden of Bloodstream Infection Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model

Risk Factors for Mortality in Patients with Nosocomial Gram-Negative Bacteremia

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