Risk Factors and Prognosis of Nosocomial Bloodstream Infections Caused by Extended-Spectrum-beta-Lactamase-Producing Escherichia coli
Por:
Rodriguez-Bano, J, Picon, E, Gijon, P, Hernandez, JR, Cisneros, JM, Pena, C, Almela, M, Almirante, B, Grill, F, Colomina, J, Molinos, S, Oliver, A, Fernandez-Mazarrasa, C, Navarro, G, Coloma, A, Lopez-Cerero, L, Pascual, A
Publicada:
1 may 2010
Resumen:
Extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.4 to 15.7), the previous use of oxyimino-beta-lactams (OR = 6.0; 95% CI = 3.0 to 11.8), and unknown BSI source (protective; OR = 0.4; 95% CI = 0.2 to 0.9), and duration of hospital stay (OR = 1.02; 95% CI = 1.00 to 1.03). The variables independently associated with mortality were a Pitt score of > 1 (OR = 3.9; 95% CI = 1.2 to 12.9), a high-risk source (OR = 5.5; 95% CI = 1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR = 6.5; 95% CI = 1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-beta-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality.
Filiaciones:
Rodriguez-Bano, J:
Univ Seville, Dept Med, Seville, Spain
Hosp Univ Virgen Macarena, Secc Enfermedades Infecciosas, Seville 41009, Spain
Picon, E:
Hosp Univ Virgen Macarena, Microbiol Serv, Seville 41009, Spain
Gijon, P:
Hosp Univ Gregorio Maranon, Microbiol Serv, Madrid, Spain
Hernandez, JR:
Hosp Univ Virgen Macarena, Microbiol Serv, Seville 41009, Spain
Cisneros, JM:
Hosp Univ Virgen del Rocio, Serv Enfermedades Infecciosas, Seville, Spain
Pena, C:
Hosp Univ Bellvitge, Serv Enfermedades Infecciosas, Barcelona, Spain
Almela, M:
Hosp Clin Barcelona, Serv Enfermedades Infecciosas, Barcelona, Spain
Almirante, B:
Hosp Univ Vall Hebron, Serv Enfermedades Infecciosas, Barcelona, Spain
Grill, F:
Hosp Univ Ramon & Cajal, Serv Enfermedades Infecciosas, Madrid, Spain
Colomina, J:
Hosp Univ Ribera, Microbiol Serv, Alcira, Spain
Molinos, S:
Hosp Badalona Germans Trias & Pujol, Microbiol Serv, Badalona, Spain
Oliver, A:
Hosp Univ Son Dureta, Microbiol Serv, Palma de Mallorca, Spain
Fernandez-Mazarrasa, C:
Hosp Univ Marques de Valdecilla, Microbiol Serv, Santander, Spain
Navarro, G:
Corp Sanitaria Parc Tauli, Serv Epidemiol, Sabadell, Spain
Coloma, A:
Hosp Santa Creu & Sant Pau, Unidad Enfermedades Infecciosas, Barcelona, Spain
Lopez-Cerero, L:
Hosp Univ Virgen Macarena, Microbiol Serv, Seville 41009, Spain
Univ Seville, Dept Microbiol, Seville, Spain
Pascual, A:
Hosp Univ Virgen Macarena, Microbiol Serv, Seville 41009, Spain
Univ Seville, Dept Microbiol, Seville, Spain
Green Published, Bronze
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