Risk factors for mortality of patients with ceftriaxone resistant e. Coli bacteremia receiving carbapenem versus beta lactam/beta lactamase inhibitor therapy

Abstract

Objective: Extended spectrum β-lactamases (ESBL) producing Enterobacteriaceae predominantly E. coli and K. pneumoniae bacteremia have limited treatment options and high mortality. The objective was to determine the risk factors for in-hospital mortality particularly treatment with Carbapenem versus Beta lactam/beta lactamase combination (BL/BLI) in patients with Ceftriaxone resistant E. coli bacteremia. A retrospective cohort study was conducted at the Aga Khan University, Karachi, Pakistan. Adult patients with sepsis and monomicrobial Ceftriaxone resistant E. coli bacteremia were enrolled. Factors associated with mortality in patients were determined using logistic regression analysis. Results: Mortality rate was 37% in those empirically treated with carbapenem compared to 20% treated with BL/BLI combination therapy (p-value: 0.012) and was 21% in those treated with a carbapenem compared to 13% in patients definitively treated with BL/BLI combination therapy (p-value: 0.152). In multivariable logistic regression analysis, only Pitt bacteremia score of ≥ four was significantly associated with mortality (OR: 7.7 CI: 2.6-22.8) while a urinary source of bacteremia was protective (OR: 0.26 CI: 0.11-0.58). In-hospital mortality in patients with Ceftriaxone resistant E. coli bacteremia did not differ in patients treated with either a carbapenem or BL/BLI combination. However, Pitt bacteremia score of ≥ 4 was strongly associated with mortality.

Antibacterial activity of Piper betle ethanolic extract against ESBL producing Escherichia coli in sepsis induced BALB/c mice

“…The most common bacteria causing sepsis is Escherichia coli (E. coli). The emergence of extended spectrum beta lactamase (ESBL) producing E. coli leads to the therapeutic failure and excess mortality [4,5]. The previous studies reported that the incidence of ESBL producing E. coli infection in England was 10%, there were 925 cases of ESBL producing E. coli infection in USA noted by The Duke Infection Control Outreach Network and there were 883 cases of ESBL producing E. coli infection in Thailand and the incidence tends to increase every year.…”