The study of risk factors and prognostic indicators in patients with bacteremia due to ESBL producing organisms

Abstract

Background: There is a growing incidence of extended-spectrum beta-lactamases (ESBL) infections worldwide. ESBL bacteremias have been associated with poor outcomes, higher costs and increased durations of hospital stay. The objective of the study was to identify the risk factors in these patients along with antibiotic susceptibility patterns to help identify the patients with poorer prognosis and in guiding treatment decisions more effectively.Methods: An observational case-control study conducted in a tertiary care hospital in south India over a duration of 18 months. Cases were defined as an adult in-patient who had infection with blood cultures showing growth of ESBL-producing bacteria. A total of 70 patients were included in the study group and subjected to evaluation to determine the risk factors, prognostic indicators and the antibiotic susceptibility.Results: The major risk factors for ESBL-bacteremia identified were prior admission, prior antibiotic usage, prior Foleys catheter and the presence of a vascular catheter. Pneumonia as the source of bacteremia and requirement of mechanical ventilation were identified as indicators of poor prognosis. Carbapenems, cefoperazone-sulbactam and piperacillin-tazobactam showed excellent sensitivity against ESBL-bacteremia.Conclusions: The findings of this study emphasizes the importance of recognizing ESBL-bacteremias in patients with risk factors, so that patients who are at risk to have a worse prognosis can be promptly started on a susceptible antibiotic.