A Russo1, M Falcone1, B Gutiérrez-Gutiérrez2, E Calbo3, B Almirante4, P L Viale5, A Oliver6, P Ruiz-Garbajosa7, O Gasch8, M Gozalo9, J Pitout10, M Akova11, C Peña12, J M Cisneros13, A Hernández-Torres14, A Farcomeni1, N Prim15, J Origüen16, G Bou17, E Tacconelli18, M Tumbarello19, A Hamprecht20, I Karaiskos21, C de la Calle22, F Pérez23, M J Schwaber24, J Bermejo25, W Lowman26, P-R Hsueh27, M Mora-Rillo28, J Rodriguez-Gomez29, M Souli30, R A Bonomo31, D L Paterson32, Y Carmeli24, A Pascual2, J Rodríguez-Baño2, M Venditti33. 1. Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy. 2. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain. 3. Hospital Universitari Mútua de Terrassa, Barcelona, Spain. 4. Hospital Universitari Vall d'Hebrón, Barcelona, Spain. 5. Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy. 6. Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain. 7. Hospital Ramón y Cajal, Madrid, Spain. 8. Corporacio Sanitaria Parc Taulí, Sabadell, Barcelona, Spain. 9. Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain. 10. Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada. 11. Hacettepe University School of Medicine, Ankara, Turkey. 12. Hospital Universitari de Bellvitge, Barcelona, Spain. 13. Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, CSIC, University of Seville, Seville, Spain. 14. Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 15. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 16. Hospital Universitario 12 de Octubre, Madrid, Spain. 17. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain. 18. Universitätsklinikum Tübingen, Tübingen, Germany. 19. Catholic University of the Sacred Heart, Rome, Italy. 20. Institut für Mikrobiologie, Immunologie und Hygiene Universitätsklinikum Köln, Cologne, Germany. 21. Hygeia General Hospital, Athens, Greece. 22. Hospital Clinic, Barcelona, Spain. 23. Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA. 24. Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 25. Hospital Español, Rosario, Argentina. 26. Wits Donald Gordon Medical Centre, Johannesburg, South Africa. 27. National Taiwan University Hospital, National Taiwan University Hospital College of Medicine, Taipei, Taiwan. 28. Hospital Universitario La Paz-IdiPAZ, Madrid, Spain. 29. Intensive Care Unit. Biomedical Research Institute of Cordoba (IMIBIC)/ Reina Sofia University Hospital/University of Cordoba, Córdoba, Spain. 30. University General Hospital Attikon, Chaidari, Greece. 31. Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA; Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland Ohio, USA. 32. University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia. 33. Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy. Electronic address: mario.venditti@uniroma1.it.
Abstract
PURPOSE: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E. METHODS: Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. RESULTS: 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. β-lactam/β-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. CONCLUSIONS: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.
PURPOSE: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septicpatients with bloodstream infection (BSI) caused by ESBL-E. METHODS:Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. RESULTS: 367 septicpatients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. β-lactam/β-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. CONCLUSIONS: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.
Authors: Calvina E L Estaleva; Tomas F Zimba; John Osei Sekyere; Usha Govinden; Hafizah Y Chenia; Gunnar S Simonsen; Bjørg Haldorsen; Sabiha Y Essack; Arnfinn Sundsfjord Journal: BMC Infect Dis Date: 2021-01-06 Impact factor: 3.090
Authors: Valentino D'Onofrio; Agnes Meersman; Sara Vijgen; Reinoud Cartuyvels; Peter Messiaen; Inge C Gyssens Journal: Open Forum Infect Dis Date: 2020-12-28 Impact factor: 3.835
Authors: E Cendejas-Bueno; M P Romero-Gómez; I Falces-Romero; A Aranda-Diaz; D García-Ballesteros; J Mingorance; J García-Rodríguez Journal: Rev Esp Quimioter Date: 2022-03-31 Impact factor: 2.515