Risk factors and outcomes in non-transplant patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia: a retrospective study from 2013 to 2016

Abstract

Background Escherichia coli is one of the most common strains of extended-spectrum β-lactam (ESBL)-producing bacteria, and the prevention and treatment of ESBL-producing E. coli infections is an ongoing challenge. The clinical characteristics and outcomes of ESBL-producing E. coli bacteremia in non-transplant patients remain to be elucidated. Methods This retrospective study included 491 non-transplant patients with E. coli bloodstream infections (BSIs) from January 2013 to December 2016 and was conducted to investigate the risk factors, clinical features, and outcomes of these infections. Results Of the 491 E. coli BSI patients, 57.6% suffered from infections with ESBL-producing strains. A multivariate analysis showed that urinary tract infection, prior use of cephalosporin, and treatment with β-lactam-β-lactamase inhibitor (BLBLI) combination antibiotics were independent risk factors for the development of ESBL-producing E. coli BSIs. The overall mortality rate in E. coli BSI patients was 14.46%, and there was no significant difference in the 28 day mortality rate between ESBL-producing E. coli and non-ESBL-producing E. coli BSI patients (14.8% vs. 14.0%, respectively; P = 0.953). Similarly, there was no difference between the community-acquired infection group and the nosocomial infection group. Hepatobiliary disease, carbapenem exposure, high APACHE II score, and hypoproteinemia were independent risk factors for death in E. coli BSI patients. Multivariate analysis showed that hypoproteinemia and severe disease were independent risk factors for death from ESBL -producing E. coli BSIs. Furthermore, there was no significant difference in the 28 day mortality between patients with ESBL -producing E. coli BSIs treated with carbapenem monotherapy versus those treated with BLBLI combination antibiotics (12.8% vs. 17.9%, respectively; P = 0.384). Conclusions Prior use of cephalosporin or BLBLI combination antibiotics increased the risk ratio for ESBL -producing E. coli infection. Hypoproteinemia and severe disease are independent risk factors for death in patients with E. coli BSIs. There was no significant difference in the 28 day prognosis of patients with ESBL-producing E. coli and those with non-ESBL-producing E. coli BSIs. These data do not support the conclusion that carbapenems might be more effective than BLBLI antibiotics for treatment of patients with BSIs cau...

Clinical characteristics, antibiotic-resistant patterns and prognostic factors in cancer patients with nosocomial infections caused by extended-spectrum beta-lactamase-producing Escherichia coli: a retrospective study from 2013 to 2019

“…This could be explained by the fact that the prevalence of nosocomial infections among cancer patients varies widely from region to region. Our study demonstrated that ESBL-PE was primarily derived from urinary tract infections, followed by the bloodstream and abdominal cavity infections, which is consistent with the findings of many previous studies [16][17][18][19].…”

“…This may be attributed to the use of many broad-spectrum antibiotics in the clinic due to the current high prevalence of ESBL-PE. In multivariate analysis, we found that ECOG performance status score more than 2 is an independent risk factor for 30-day mortality in cancer patients with nosocomial infections caused by ESBL-PE, which is consistent with the previous study [19]. An interesting finding of our study is that the presence of respiratory tract infection is an independent risk factor for 30-day mortality in these patients as well despite its small proportion in our cohort.…”

“…Several studies [14,15,20] reported that the overall case-fatality was significantly higher in the ESBL-positive group compared with ESBL-negative group. Conversely, there was no significant difference in the 30-day mortality between patients with nosocomial infections caused by ESBL-PE and those infected with non-ESBL-PE in this study, similar to the findings of some previous studies [19,21,22]. This may be attributed to the use of many broad-spectrum antibiotics in the clinic due to the current high prevalence of ESBL-PE.…”

“…Lymphocytopenia has been identified as a prognostic factor in several solid tumors since it was associated with a condition of cancer-induced immunodeficiency, which can limit tumor control following radiation and chemotherapy [24]. Several studies have shown that patients with hypoproteinemia were correlated with worse prognosis in hospitalized patients, and serum albumin level is generally used to evaluating patients' nutritional status, organ function, and comorbidity [19,25].…”

Epidemiology, Risk Factors and Outcomes of Bloodstream Infection Caused by ESKAPEEc Pathogens Among Hospitalized Children

“…This discrepancy may be associated with geographical regions and study population. Previous frequently reported MDR bacteria were Escherichia coli and Klebsiella pneumoniae, most of which trend to be ESBL-producing organisms [23][24][25]. Furthermore, a upward trend in the proportion of ESBL-producing Enterobacteriaceae ESKAPEEc BSI was found [12].…”