Long-term outcome and risk factors for late mortality in Gram-negative bacteraemia: a retrospective cohort study

Baltas, Ioannis; Stockdale, Thomas; Tausan, Matija; Kashif, Areeba; Anwar, Javeria; Anvar, Junaid; Koutoumanou, Eirini; Sidebottom, David B.; Garcia-Arias, Veronica; Wright, Melanie; Democratis, Jane

doi:10.1016/j.jgar.2021.03.019

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…Indeed, the febrile response can be more frequently blunted than in younger subjects and may be replaced by other less evocative signs, such as weakness, confusion, falls, or loss of appetite [ 17 ]. Moreover, the prognosis for Gram-negative BSI is particularly poor due to virulence factors and antibiotic resistance [ 18 , 19 , 20 ]. However, the prevalence of ESBL was relatively low in our study, in line with current epidemiological data in France, which show significant differences among Enterobacterales but low levels of ESBL in E. coli species, the most frequently encountered organism in this study [ 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Wild-Type AmpC Beta-Lactamase-Producing Enterobacterales Are a Risk Factor for Empirical Treatment Failure in Patients with Bloodstream Infection

Vassallo,

Fabre,

Lotte

et al. 2024

Diseases

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Introduction: Beta-lactamases are frequently prescribed for Gram-negative bloodstream infections (BSIs). However, chromosomally encoded AmpC-producing Enterobacterales (AE) could overproduce beta-lactamases when exposed to third-generation cephalosporins (3GCs), with a risk of clinical failure. There are few available in vivo data on the subject. Our goal was to assess the potential role of AE as a predictive factor for clinical failure in patients with BSIs. Materials and Methods: We retrospectively analyzed patients admitted to Cannes hospital between 2021 and 2022 for BSIs due to Enterobacterales. Patient demographics, comorbidities, and main clinical and laboratory parameters during hospitalization were collected. The risk factors for clinical instability after 48 h or death, as well as for ineffective initial empirical therapy, were assessed using univariate and multivariate analyses. Results: From January 2021 to December 2022, 101 subjects were included (mean age 79 years, 60% men, 97% with comorbidities, 17% with healthcare-associated infection, 13% with septic shock, 82% with qPitt severity score < 2, 58% with urinary tract infection, and 18% with AE). Septic shock [adjusted odds ratio (ORadj) = 5.30, 95% confidence interval (CI): 1.47–22.19, p = 0.014] and ineffective initial empirical therapy [ORadj 5.54, 95% CI: 1.95–17.01, p = 0.002] were independent predictive factors for clinical instability or death. Extended-spectrum beta-lactamases [ORadj 9.40, 95% CI: 1.70–62.14, p = 0.012], AE group [ORadj 5.89, 95% CI: 1.70–21.40, p = 0.006], and clinical instability or death [ORadj 4.71, 95% CI: 1.44–17.08, p = 0.012] were independently associated with ineffective empirical therapy. Conclusions: Infection with AE was associated with treatment failure. Empirical therapy may result in failure if restricted to 3GC.

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Section: Discussionmentioning

confidence: 99%

Wild-Type AmpC Beta-Lactamase-Producing Enterobacterales Are a Risk Factor for Empirical Treatment Failure in Patients with Bloodstream Infection

Vassallo,

Fabre,

Lotte

et al. 2024

Diseases

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“…O Blandy et al also demonstrated that presence of antimicrobial resistance, increasing age and comorbidities as main contributing factors for increased mortality [ 35 ], similar to our results, with the majority of cases being of community-onset, highlighting the need for improving antimicrobial use and reduce the burden of E. coli infections in the community. Similarly, increasing co-morbidity and an adverse antimicrobial resistance profile have been described as risk factors for poorer outcomes in studies looking more widely at Gram-negative bacteraemias [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

E. coli bacteraemia and antimicrobial resistance following antimicrobial prescribing for urinary tract infection in the community

et al. 2022

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Background Urinary tract infections are one of the most common infections in primary and secondary care, with the majority of antimicrobial therapy initiated empirically before culture results are available. In some cases, however, over 40% of the bacteria that cause UTIs are resistant to some of the antimicrobials used, yet we do not know how the patient outcome is affected in terms of relapse, treatment failure, progression to more serious illness (bacteraemia) requiring hospitalization, and ultimately death. This study analyzed the current patterns of antimicrobial use for UTI in the community in Scotland, and factors for poor outcomes. Objectives To explore antimicrobial use for UTI in the community in Scotland, and the relationship with patient characteristics and antimicrobial resistance in E. coli bloodstream infections and subsequent mortality. Methods We included all adult patients in Scotland with a positive blood culture with E. coli growth, receiving at least one UTI-related antimicrobial (amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, trimethoprim, and nitrofurantoin) between 1st January 2009 and 31st December 2012. Univariate and multivariate logistic regression analysis was performed to understand the impact of age, gender, socioeconomic status, previous community antimicrobial exposure (including long-term use), prior treatment failure, and multi-morbidity, on the occurrence of E. coli bacteraemia, trimethoprim and nitrofurantoin resistance, and mortality. Results There were 1,093,227 patients aged 16 to 100 years old identified as receiving at least one prescription for the 5 UTI-related antimicrobials during the study period. Antimicrobial use was particularly prevalent in the female elderly population, and 10% study population was on long-term antimicrobials. The greatest predictor for trimethoprim resistance in E. coli bacteraemia was increasing age (OR 7.18, 95% CI 5.70 to 9.04 for the 65 years old and over group), followed by multi-morbidity (OR 5.42, 95% CI 4.82 to 6.09 for Charlson Index 3+). Prior antimicrobial use, along with prior treatment failure, male gender, and higher deprivation were also associated with a greater likelihood of a resistant E. coli bacteraemia. Mortality was significantly associated with both having an E. coli bloodstream infection, and those with resistant growth. Conclusion Increasing age, increasing co-morbidity, lower socioeconomic status, and prior community antibiotic exposure were significantly associated with a resistant E. coli bacteraemia, which leads to increased mortality.

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“…A idade mais avançada é um fator de risco para infecções, devido a imunossenescência e involução tímica, que deprime a produção e funcionamento dos linfócitos T (ROWE; MCKOY, 2017), o que reforça a susceptibilidade para aquisição de IPCS-CVC, conforme observados nos estudos incluídos (APOSTOLOPOULOU et al, 2013;PAWAR et al, 2004;ATILLA et al, 2017;LEE et al, 2018;CALÒ et al, 2020). Nessa população, a infecção por bactérias gram-negativas (MARTIN; MANNINO;MOSS, 2006, LAUPLAND et al, 2021 as quais possuem um perfil de resistência antibiótica Elevado (BALTAS et al, 2021) também são associadas ao incremento da mortalidade, As comorbidades foram associadas ao aumento da mortalidade de paciente, (BURNHAM; ROJEK; KOLLEF, 2018;LEE et al, 2018;CALÒ et al, 2020). Uma vez que, influenciam na severidade das IPCS (VAQUERO-HERRERO et al, 2017;SINÉSIO et al, 2018).…”

Section: Discussionunclassified

Preditores de mortalidade em infecções da corrente sanguínea relacionadas ao cateter venoso central: revisão integrativa

Costa¹,

Pina²,

Aguiar

et al. 2022

CLIUM

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Objetivo: identificar os fatores preditores de mortalidade em pacientes com infecção da corrente sanguínea (IPCS) em uso do cateter venoso central (CVC). Métodos: revisão integrativa realizada nas bases dados: Cinhal, EMBASE, LILACS, Livivo, PubMed, Scopus, Web of Science, e na literatura cinzenta. Os estudos selecionados foram lidos na íntegra para extração, interpretação, síntese e categorização conforme nível de evidência. Resultados: Foram incluídos 12 estudos, todos observacionais. As IPCS por germes Gram negativos (61,53%) foram mais frequentes. Foram fatores preditores de mortalidade: maior gravidade clínica, idade avançada, presença de comorbidades, antibioticoterapia prévia, infecções por microrganismos multirresistentes, Gram negativos, infecções fúngicas e presença de múltiplos dispositivos invasivos. Considerações finais: Os fatores preditores de mortalidade são uma medida para identificação de risco do paciente com IPCS-CVC, de forma guiar a prática clínica baseada em evidências.

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Long-term outcome and risk factors for late mortality in Gram-negative bacteraemia: a retrospective cohort study

Cited by 5 publications

References 25 publications

Wild-Type AmpC Beta-Lactamase-Producing Enterobacterales Are a Risk Factor for Empirical Treatment Failure in Patients with Bloodstream Infection

Wild-Type AmpC Beta-Lactamase-Producing Enterobacterales Are a Risk Factor for Empirical Treatment Failure in Patients with Bloodstream Infection

E. coli bacteraemia and antimicrobial resistance following antimicrobial prescribing for urinary tract infection in the community

Preditores de mortalidade em infecções da corrente sanguínea relacionadas ao cateter venoso central: revisão integrativa

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