Prevalence, risk factors and outcomes of patients coming from the community with sepsis due to multidrug resistant bacteria

Abstract

Background Although previous studies showed an increasing prevalence of infections due to multi-drug resistant (MDR) bacteria in the community, specific data on sepsis are lacking. We aimed to assess prevalence, risk factors and outcomes of patients with sepsis due to MDR bacteria. Methods An observational, retrospective study was conducted on consecutive adult patients coming from the community and admitted to the Policlinico Hospital, Milan, Italy, with a diagnosis of sepsis between January 2011 and December 2015. Primary study outcome was in-hospital mortality. Results Among 518 patients, at least one MDR bacteria was isolated in 88 (17%). ESBL+ Enterobacteriaceae were the most prevalent MDR bacteria (9.7%) followed by MRSA (3.9%). Independent risk factors for sepsis due to MDR bacteria were septic shock (OR: 2.2; p = 0.002) and hospitalization in the previous 90 days (OR: 2.3; p = 0.003). Independent risk factors for sepsis due to ESBL+ bacteria were hospitalization in the previous 90 days (OR: 2.1; p = 0.02) and stroke (OR: 2.1; p = 0.04). A significantly higher mortality was detected among patients with vs. without MDR bacteria (40.2% vs. 23.1% respectively, p = 0.001). Independent risk factors for mortality among patients with sepsis were coagulation dysfunction (OR: 3.2; p = 0.03), septic shock (OR: 3.2; p = 0.003), and isolation of a MDR bacteria (OR: 4.6; p < 0.001). Conclusion In light of the prevalence and impact of MDR bacteria causing sepsis in patients coming from the community, physicians should consider ESBL coverage when starting an empiric antibiotic therapy in patients with specific risk factors, especially in the presence of septic shock. Electronic supplementary material The online version of this article (10.1186/s40248-019-0185-4) contains supplementary material, which is available to authorized users.

Antimicrobial resistance profile in clinical isolates of Pseudomonas aeruginosa producing Extended-spectrum beta-lactamase (ESBL) at a teaching tertiary care hospital, Tamilnadu

“…Capsoni et al in his recent study reported MDR isolates should be considered as a signi icant independent risk factor for mortality. This clearly indicates variable incidence rate of MDRPA and the need for judicious use of empirical drugs in Pseudomanas infections (Capsoni et al, 2019).…”

Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores

“…Regarding multidrug-resistant organisms, Mangioni and others [ 25 ] stressed the importance of triage in sepsis patients. Capsoni et al [ 26 ] described that ESBLs were life-threatening in sepsis patients. Our study disclosed, however, that MRSA was a significant factor in morbidity.…”

Advances in sepsis diagnosis and management: a paradigm shift towards nanotechnology

“…A mild form with single organ system dysfunction can be managed by moderate support, while multiple organ dysfunction requires invasive therapies [23]. Although broad-spectrum antibiotics are integral in the management of sepsis, a major challenge associated with antibiotic therapy in sepsis is resistance by pathogens that adversely affects sepsis outcomes and increases mortality rates by approximately two-fold [7,25]. Globally, an estimated 214,000 deaths due to neonatal sepsis are thought to be caused by resistant pathogens [26,27].…”