Association of high mortality with extended–spectrum β-lactamase (ESBL) positive cultures in community acquired infections

Ray, Sumit; Anand, Dimple; Purwar, Sankalp; Samanta, Arijit; Upadhye, Kaustubh V.; Gupta, Prakamya; Dhar, Debashis

doi:10.1016/j.jcrc.2017.10.036

Cited by 25 publications

(17 citation statements)

References 16 publications

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“…Enterobacteriaceae , a family encompassing many clinically important bacterial species, exhibits rising levels of AMR. Infection with either extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE) is associated with increased mortality rates, time to effective therapy, length of stay and overall healthcare costs [ 1–8 ]. The impact of the continued spread of AMR could have repercussions in multiple sectors.…”

Section: Introductionmentioning

confidence: 99%

Extended-spectrum β-lactamase-producing and carbapenemase-producing Enterobacteriaceae

Wilson

Török

2018

Microbial Genomics

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Antimicrobial resistance (AMR) is a global public-health emergency, which threatens the advances made by modern medical care over the past century. The World Health Organization has recently published a global priority list of antibiotic-resistant bacteria, which includes extended-spectrum β-lactamase-producing Enterobacteriaceae and carbapenemase-producing Enterobacteriaceae. In this review, we highlight the mechanisms of resistance and the genomic epidemiology of these organisms, and the impact of AMR.

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Section: Introductionmentioning

confidence: 99%

Extended-spectrum β-lactamase-producing and carbapenemase-producing Enterobacteriaceae

Wilson

Török

2018

Microbial Genomics

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“…Full-text screening excluded an additional 5 articles, providing an evidence base of 87 studies (figure 1). 10–96 The 87 studies included in the qualitative analysis were conducted between 1991 and 2017 in 25 countries, mainly in South Korea (14 studies), Thailand (7), USA (7), Taiwan (7) and Spain (7). Sixty (68.9%) studies were performed in HICs, 26 (29.9%) in LMICs and 1 included both HICs and LMICs 56.…”

Section: Resultsmentioning

confidence: 99%

Variation of effect estimates in the analysis of mortality and length of hospital stay in patients with infections caused by bacteria-producing extended-spectrum beta-lactamases: a systematic review and meta-analysis

Shamsrizi

Gladstone

Carrara³

et al. 2020

BMJ Open

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ObjectiveTo assess the variation of effect estimates in the analysis of mortality and length of stay (LOS) in patients with infections caused by extended-spectrum beta-lactamase (ESBL)-producingEnterobacteriaceae.DesignSystematic review and meta-analysisMethodsLiterature search for clinical studies from 1 January 1960 to 1 October 2018 was conducted in PubMed. Primary outcomes were risk ratios (RRs) of all-cause and attributable mortality and weighted mean differences (WMDs) in LOS in patients with bloodstream infections (BSIs) and non-invasive infections. Any change in the effect estimates was assessed by grouping studies according to design, setting, economy-based country classification, reporting period, microbiological aetiology, infection type and adjustment for appropriateness of empirical treatment. The impact of ESBL production was calculated using random-effect meta-analysis and heterogeneity was evaluated by I2statistics and metaregression.ResultsEighty-four studies including 22 030 patients and 149 outcome measures were included in the meta-analysis. Most studies were retrospective cohorts from high-income countries, providing unadjusted estimates. ESBL production in patients with BSIs (56 studies) increased the RR for all-cause mortality by a factor of 1.70 (95% CI 1.52 to 1.90; p<0.001), attributable mortality (16 studies) by 1.75 (95% CI 1.448 to 2.108; p<0.001) and WMD in the intensive care unit by 3.07 days (95% CI 1.61 to 4.54; p<0.001). WMD in hospital LOS was significantly higher in BSIs (4.41 days; 95% CI 3.37 to 5.46; p<0.001) and non-invasive (2.19 days; 95% CI 1.56 to 2.81; p<0.001). Subgroup analyses showed variation of estimates by study design, population, strain and assessment of appropriateness of empiric treatment. High heterogeneity was observed in all analyses.ConclusionsCurrent evidence of the clinical burden of infections caused by ESBL-producing bacteria is highly heterogeneous and based mainly on unadjusted estimates derived from retrospective studies. Despite these limitations, ESBL production in strains causing BSIs seems associated with higher all-cause and attributable mortality and longer hospitalisation.

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“…These bacteria are of increasing concern as ESBL encoding genes are usually harboured on plasmids, which co-harbour multiple resistance genes [1] leading to multi-drug resistance (MDR, defined as resistance to 3 or more antimicrobial classes). Clinical infections caused by MDR bacteria are particularly difficult to treat and are a leading cause of morbidity and mortality in human and veterinary medicine [2, 3]. The initially identified β-lactamase enzymes such as TEM and SHV are now becoming less prevalent in ESBL-producing E. coli, while CTX-M is now the most predominant mechanism in both humans and animals [4].…”

Section: Introductionmentioning

confidence: 99%

Emergence of carriage of CTX-M-15 in faecal Escherichia coli in horses at an equine hospital in the UK; increasing prevalence over a decade (2008–2017)

et al. 2019

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Background This study investigated changes over time in the epidemiology of extended-spectrum β-lactamase (ESBL) producing Escherichia coli within a single equine referral hospital in the UK. Faecal samples were collected from hospitalised horses in 2008 and 2017, processed using selective media and standard susceptibility laboratory methods. A novel real-time PCR with high resolution melt analysis was used to distinguish bla CTX-M-1 and bla CTX-M-15 within CTX-M-1 group. Results In 2008, 457 faecal samples from 103 horses were collected, with ESBL-producing E. coli identified in 131 samples (28.7, 95% CI 24.6–33.1). In 2017, 314 faecal samples were collected from 74 horses with ESBL-producing E. coli identified in 157 samples (50.0, 95% CI 44.5–55.5). There were 135 and 187 non-duplicate ESBL-producing isolates from 2008 and 2017, respectively. In 2008, 12.6% of isolates belonged to CTX-M-1 group, all carrying bla CTX-M-1 , whilst in 2017, 94.1% of isolates were CTX-M-1 group positive and of these 39.2 and 60.8% of isolates carried bla CTX-M-1 and bla CTX-M-15 , respectively. In addition, the prevalence of doxycycline, gentamicin and 3rd generation cephalosporin resistance increased significantly from 2008 to 2017 while a decreased prevalence of phenotypic resistance to potentiated sulphonamides was observed. Conclusions The real-time PCR proved a reliable and high throughput method to distinguish between bla CTX-M-1 and bla CTX-M-15 . Furthermore, its use in this study demonstrated the emergence of faecal carriage of CTX-M-15 in hospitalised horses, with an increase in prevalence of ESBL-producing E. coli as well as increased antimicrobial resistance to frequently used antimicrobials.

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Association of high mortality with extended–spectrum β-lactamase (ESBL) positive cultures in community acquired infections

Cited by 25 publications

References 16 publications

Extended-spectrum β-lactamase-producing and carbapenemase-producing Enterobacteriaceae

Extended-spectrum β-lactamase-producing and carbapenemase-producing Enterobacteriaceae

Variation of effect estimates in the analysis of mortality and length of hospital stay in patients with infections caused by bacteria-producing extended-spectrum beta-lactamases: a systematic review and meta-analysis

Emergence of carriage of CTX-M-15 in faecal Escherichia coli in horses at an equine hospital in the UK; increasing prevalence over a decade (2008–2017)

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