Análisis clínico y microbiológico de la sepsis grave y el choque séptico por Escherichia coli en Medellín, Colombia

Abstract

Severe sepsis and septic shock by Escherichia coli, clinical and microbiological analysis in Medellin, Colombia Background: Escherichia coli is a common cause of a broad spectrum of infections, from non-complicated urinary tract infection, to severe sepsis and septic shock, that are associated to high impact outcomes, such as ICU admission and mortality. Aims: To establish differences in mortality, ICU admission, ESBL positive strains and antibiotic treatment, between patients with E. coli related severe sepsis and septic shock, with or without bacteremia and its variability based on the source of infection. Method: Secondary data analysis of a multicentric prospective cohort study. Results: From 458 patients with E. coli isolation, 123 had E. coli exclusively in blood culture, 222 solely in urine culture, and 113 in both samples. Escherichia coli isolation exclusively in blood culture was associated with higher frequency of ICU admission (n = 63; 51.2%), higher rate of mechanical ventilation requirement (n = 19; 15.5%), higher mortality and longer hospital stay (n = 22; 18%; median of 12 days, IQR= 7-17, respectively); but with a lower occurrence of ESBL strains, compared to patients with positive urine culture and positive blood/urine cultures (n = 20; 17.7% and n = 46; 20.7%, respectively). 424 patients (92.6%) received antibiotic treatment in the first 24 hours. The most commonly prescribed was piperacilin/tazobactam (n = 256; 60.3%). The proportion of patients empirically treated with carbapenems vs non-carbapenems was similar in the three groups. Discussion: The source of infection, associated with ESBL strains risk factors, are useful tools to define prognosis and treatment in this population, because of their clinical and microbiological variability. Conclusion: Patients with E. coli isolation exclusively in the blood culture had higher frequency of non-favorable outcomes in comparison to patients with E. coli in urine culture with or without bacteremia. Additionally, in our population patients with E. coli solely in blood culture have lower prevalence of ESBL positive strains.

Review of sepsis in Pakistan: how far have we come?

“…Similar to scientific evidence in Pakistan, international literature has also reflected our findings. A study conducted at a center in Colombia showed poor outcomes in sepsis patients where E. coli was exclusively isolated in blood culture, as opposed to those where E. coli was isolated in urine culture with or without bacteremia [19] . Furthermore, a sepsis study conducted in India reports that the predominant infection site leading to sepsis is the respiratory tract and the most frequently isolated organisms were Gram-negatives.…”

Development of Loop-Mediated Isothermal Amplification Rapid Diagnostic Assays for the Detection of Klebsiella pneumoniae and Carbapenemase Genes in Clinical Samples

“…Our current LAMP assay has been developed for the detection of K. pneumoniae . Additional investigations are being pursued to design similar LAMP tests for E. coli , a particular concern for AMR ( Alvarez-Uria et al, 2018 ) and a microorganism commonly responsible for sepsis ( Restrepo-Alvarez et al, 2019 ).…”

Perfil bacteriano del shock séptico en una unidad de cuidados intensivos de la altitud del seguro social del Perú.

“…Los carbapenémicos se reservan para el shock séptico por Escherichia coli productor de "BLEE". El principal mecanismo de resistencia fue "BLEE" muy superior a lo reportado 10,23,24 .…”