Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Quirante, Olivia Ferrández; Cerrato, Santiago Grau; Pardos, S Luque

doi:10.1016/s1413-8670(11)70207-0

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…[21][22][23][24][25][26] Furthermore, prior use of several different classes of antimicrobials, including extended-spectrum cephalosporins, fluoroquinolones, aminoglycosides, co-trimoxazole, and carbapenems, has repeatedly been associated with ESBLproducing E. coli and K. pneumoniae bacteremia, 23,24,[27][28][29][30][31][32] and a study from Spain showed that receipt of more than two different antibiotic classes in the preceding 90 days was the only predictor of ESBL production in patients with E. coli or K. pneumoniae bacteremia (OR 2.29, 95% CI: 1.35-3.88). 33 Whether the link observed in our study was causal or was simply a reflection of the fact that blood cultures are more likely to be positive in patients on antibiotics who are infected with multiresistant organisms than with susceptible organisms is impossible to say. However, inappropriate antibiotic prescribing is common in Laos and there is a clear need to educate local clinicians about diagnostic stewardship and the prudent use of antibiotics.…”

Section: Discussionmentioning

confidence: 78%

Bacteremia Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae in Vientiane, Lao PDR: A 5-Year Study

Chang

Rattanavong

Mayxay

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Although there has been an increasing incidence of bacteremia caused by extended-spectrum betalactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) across South East Asia, there are sparse data from the Lao PDR, where laboratory capacity for antimicrobial resistance surveillance is limited. We, therefore, retrospectively reviewed bacteremia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae between 2010 and 2014 at Mahosot Hospital, Vientiane, Lao PDR. Clinical and laboratory data relating to all episodes of ESBL-E bacteremia were reviewed over the 5-year period and compared with non-ESBL-E bacteremia. Blood cultures positive for E. coli or K. pneumoniae were identified retrospectively from laboratory records. Clinical and laboratory data were extracted from research databases and case notes and analyzed using STATA. Between 2010 and 2014, we identified 360 patients with E. coli (n = 249) or K. pneumoniae (n = 111) bacteremia, representing 34.8% of all patients with clinically significant bacteremia. Seventy-two (20%) isolates produced ESBL; E. coli accounted for 15.3% (55/360) and K. pneumoniae for 4.7% (17/360), respectively. The incidence of ESBL-producing E. coli bacteremia rose during the study period. By multiple logistic analysis, reported antibiotic use in the previous week was significantly associated with ESBL positivity (P < 0.001, odds ratio 3.89). Although multiresistant, most ESBL-producing E. coli and K. pneumoniae remained susceptible to meropenem (65/65; 100%) and amikacin (64/65; 98.5%). We demonstrated an alarming increase in the incidence of ESBL-E as a cause of bacteremia in Vientiane during the study period. This has implications for empiric therapy of sepsis in Laos, and ongoing surveillance is essential.

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Section: Discussionmentioning

confidence: 78%

Bacteremia Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae in Vientiane, Lao PDR: A 5-Year Study

Chang

Rattanavong

Mayxay

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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“…Despite renal insufficiency being the strongest risk factor in the current study, there remains inconsistency in the literature with regard to this comorbidity as a risk factor for ESBL-related infections. 7,21,22,27 The current literature suggests that international travelparticularly to the Indian subcontinent, Southeast Asia, and the Middle East-is a risk factor for fecal colonization and infection by multidrug-resistant organisms, including ESBL-producing bacteria. 9,[12][13][14][15]28,29 In the COMBAT study, a large-scale longitudinal study, 34.3% of Dutch travellers returning from international travel had newly acquired colonization with ESBL-producing Enterobacteriaceae, and 11.3% of these individuals had persistent colonization at 12 months following return.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19] Numerous studies have attempted to elucidate risk factors for acquiring infections secondary to ESBL-producing organisms; these factors have included prior hospitalization, admission to the intensive care unit, recurrent UTIs, previous exposure to antibiotics (particularly oxyimino ß-lactams), previous invasive procedures of the urinary tract, and international travel. 14,15,[20][21][22][23][24] The primary objectives of the current study were to evaluate the cumulative incidence of ESBL urosepsis at Surrey Memorial Hospital and to identify major risk factors and the impact of international travel on development of active ESBL infections in an ethnically diverse Canadian population. The secondary objective was to characterize the outcomes of patients with ESBL urosepsis.…”

Section: Introductionmentioning

confidence: 99%

Urosepsis Due to Extended-Spectrum ß-Lactamase–Producing Escherichia coli: A Retrospective, Single-Centre Review of Risk Factors and Clinical Outcomes

Huang

Alleyne

Leung

et al. 2018

CJHP

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ABSTRACTBackground: Extended-spectrum ß-lactamase (ESBL)–producing Enterobacteriaceae are pathogens that are implicated in urosepsis and may be associated with greater morbidity and mortality than non-ESBL Enterobacteriaceae. Identification of risk factors for ESBL infection may facilitate the selection of appropriate empiric therapy.Objectives: The primary objectives were to determine the cumulative incidence of ESBL urosepsis, to identify major risk factors for ESBL urosepsis, and to determine the impact of international travel on development of ESBL urosepsis in an ethnically diverse Canadian population. The secondary objective was to characterize the outcomes of patients with ESBL urosepsis.Methods: A single-centre retrospective nested case–control study was conducted from January 2011 to June 2013. The study cohort consisted of adult patients with urosepsis and positive results on blood culture for ESBL-producing and non–ESBL-producing Enterobacteriaceae. Multivariate analysis was then used to determine risk factors for ESBL urosepsis.Results: The cumulative incidence of ESBL urosepsis at the study site was 19.4% (58/299) over 2.5 years. The 58 cases of ESBL urosepsis were compared with 118 controls (patients with urosepsis caused by non-ESBL Enterobacteriaceae). Significant predictors of ESBL urosepsis were chronic renal insufficiency (odds ratio [OR] 4.66, 95% confidence interval [CI] 1.96–11.08; p < 0.001) and travel to an endemic region in the previous 6 months (OR 4.62, 95% CI 1.17–18.19; p = 0.029), as well as Punjabi or Hindi as the primary language (OR 3.25, 95% CI 1.45–7.29; p = 0.004) and male sex (OR 2.65, 95% CI 1.21–5.80; p = 0.015). Patients with ESBL urosepsis had worse prognosis—in terms of death or discharge with palliative measures only—than those with non-ESBL urosepsis (7/58 [12.1%] versus 4/118 [3.4%]; p = 0.042).Conclusions: Institution-specific data support prompt recognition of patients at risk for ESBL infections. Chronic renal insufficiency, recent travel to regions endemic for ESBL-producing organisms, primary language of Punjabi or Hindi, and male sex were the strongest risk factors for ESBL urosepsis at the study centre. However, findings from this single-centre study may not be generalizable to other institutions.RÉSUMÉContexte : Les entérobactériacées productrices de ß-lactamases à spectre étendu (BLSE) sont des pathogènes en cause dans les cas d’urosepsie et peuvent être associées à des taux de morbidité et de mortalité supérieurs à ceux liés aux entérobactériacées ne produisant pas de BLSE. L’identification des facteurs de risque pour l’infection à BLSE pourrait faciliter le choix d’une antibiothérapie empirique appropriée.Objectifs : Les objectifs principaux étaient de déterminer l’incidence cumulative des cas d’urosepsie à BLSE, d’identifier les facteurs de risqué importants d’urosepsie à BLSE et de découvrir les effets des voyages à l’étranger sur l’apparition d’urosepsie à BLSE dans une population multiethnique canadienne. L’objectif secondaire était d’offrir un portrait de l’issue des patients atteints d’urosepsie à BLSE.Méthodes : Une étude cas-témoins emboîtée rétrospective a été menée dans un seul centre entre janvier 2011 et juin 2013. La cohorte était composée de patients adultes atteints d’urosepsie dont les résultats d’hémoculture étaient positifs pour des entérobactériacées produisant des BLSE ou pour des entérobactériacées ne produisant pas de BLSE. Une analyse multivariée a ensuite été utilisée afin de discerner les facteurs de risque pour l’urosepsie à BLSE.Résultats : L’incidence cumulative des cas d’urosepsie à BLSE dans l’établissement à l’étude était de 19,4 % (58/299) sur 2,5 ans. Les 58 cas d’urosepsie à BLSE ont été comparés à 118 témoins (des patients atteints d’urosepsie causée par des entérobactériacées ne produisant pas de BLSE). Les meilleures variables explicatives d’urosepsie à BLSE étaient : l’insuffisance rénale chronique (risque relatif approché [RRA] de 4,66, intervalle de confiance [IC] à 95 % de 1,96–11,08; p < 0,001) et les voyages dans une région endémique au cours des six derniers mois (RRA de 4,62, IC à 95 % de 1,17–18,19; p = 0,029) ainsi que le punjabi ou l’hindi comme langue principale (RRA de 3,25, IC à 95 % de 1,45–7,29; p = 0,004) et le sexe masculin (RRA de 2,65, IC à 95 % de 1,21–5,80; p = 0,015). Les patients atteints d’urosepsie à BLSE présentaient un pronostic plus sombre – en ce qui touche le décès ou le congé avec pour seule prescription des mesures palliatives – que ceux atteints d’urosepsie causée par des entérobactériacées non productrices de BLSE (7/58 [12,1 %] contre 4/118 [3,4 %], p = 0,042).Conclusions : Des données propres à l’établissement incitent à dépister rapidement les patients à risque d’infection à BLSE. L’insuffisance rénale chronique, les voyages récents dans des régions où les organismes producteurs de BLSE sont endémiques, le punjabi ou l’hindi comme langue principale et le sexe masculin représentaient les facteurs de risques les plus importants pour l’urosepsie à BLSE au centre à l’étude. Cependant, il se pourrait que les résultats provenant de la présente étude réalisée dans un seul centre ne puissent pas être généralisés à d’autres établissements.

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“…Interventions and surgery performed on the urinary tract can also lead to urosepsis [ 15 ]. Advanced age and comorbidities, such as diabetes mellitus, kidney failure, and immune deficiencies, are considered risk factors of urosepsis [ 6 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Study of the Etiology, Laboratory Findings, and Management of Patients with Urinary Tract Infections and Urosepsis from a Urology Center in Silesia, Southern Poland Between 2017 and 2020

et al. 2022

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Background Recent studies have shown that up to 25% of sepsis cases originate in the urinary tract. Urosepsis can be associated with cystitis, lower urinary tract infections (UTIs), and upper UTIs and is most commonly caused by gram-negative bacteria. This retrospective study from a urology center in southern Poland, was conducted between 2017 and 2020 and aimed to investigate the causes, microbiology laboratory findings, and management in 138 patients with UTIs and urosepsis. Material/Methods Records of patients with UTIs with urosepsis admitted to the Urology Department of the hospital in Silesia, Poland, between 2017 and 2020 were analyzed retrospectively, and clinical and laboratory data were evaluated. Results The 138 included patients were admitted to the hospital between 2017 and 2020. The median age of patients was 67 (20–94) years, and 59.9% (82/137) were men. The most common reasons for admission to the Urology Department were hydronephrosis due to dysfunction of urinary drainage in 36.5% (50/137) of patients and hydronephrosis due to urolithiasis in 22.6% (31/137) of patients. The main etiological agents responsible for the development of urosepsis were strains of Enterobacteriaceae in 85% of patients, of which 41.4% (48/116) produced extended-spectrum beta-lactamases (ESBL), accounting for 35.0% (48/137) of patients with urosepsis. In 83.3% (80/96) of patients, the pathogen cultured from the urine was identical to that cultured from the blood. Conclusions The identification of an increasing prevalence of urosepsis associated with ESBL-producing gram-negative rods from this single-center study highlights the importance of infection monitoring, rapid diagnosis, and multidisciplinary patient management.

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Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Cited by 3 publications

References 19 publications

Bacteremia Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae in Vientiane, Lao PDR: A 5-Year Study

Bacteremia Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae in Vientiane, Lao PDR: A 5-Year Study

Urosepsis Due to Extended-Spectrum ß-Lactamase–Producing Escherichia coli: A Retrospective, Single-Centre Review of Risk Factors and Clinical Outcomes

Retrospective Study of the Etiology, Laboratory Findings, and Management of Patients with Urinary Tract Infections and Urosepsis from a Urology Center in Silesia, Southern Poland Between 2017 and 2020

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