Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum beta-lactamase-producing Enterobacteriaceae
Por:
Russo, A, Falcone, M, Gutierrez-Gutierrez, B, Calbo, E, Almirante, B, Viale, PL, Oliver, A, Ruiz-Garbajosa, R, Gasch, O, Gozalo, M, Pitout, J, Akova, M, Pena, C, Cisneros, JM, Hernandez-Torres, A, Farcomeni, A, Prim, N, Origun, J, Bou, G, Tacconelli, E, Tumbarello, M, Hamprecht, A, Karaiskos, I, de la Calle, C, Perez, F, Schwaber, MJ, Bermejo, J, Lowman, W, Hsueh, RR, Mora-Rillo, M, Rodriguez-Gomez, J, Souli, M, Bonomo, RA, Paterson, DL, Carmeli, Y, Pascual, A, Rodriguez-Bano, J, Venditti, M
Publicada:
1 nov 2018
Resumen:
Purpose: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum fi-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E.
Methods: Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts.
Results: 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. fi-lactam/fi-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy.
Conclusions: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome. (C) 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
Filiaciones:
Russo, A:
Univ Roma La Sapienza, Dept Publ Hlth & Infect Dis, Policlin Umberto 1, Viale Univ 37, I-00161 Rome, Italy
Falcone, M:
Univ Roma La Sapienza, Dept Publ Hlth & Infect Dis, Policlin Umberto 1, Viale Univ 37, I-00161 Rome, Italy
Gutierrez-Gutierrez, B:
Univ Seville, Inst Biomed Sevilla, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Calbo, E:
Hosp Univ Mutua Terrassa, Barcelona, Spain
Almirante, B:
Hosp Univ Vall dHebron, Barcelona, Spain
Viale, PL:
Teaching Hosp Policlin S Orsola Malpighi, Bologna, Italy
Oliver, A:
Hosp Univ Son Espases, Inst Invest Illes Balears IdISBa, Palma De Mallorca, Spain
Ruiz-Garbajosa, R:
Hosp Ramon & Cajal, Madrid, Spain
Gasch, O:
Corp Sanitaria Parc Tauli, Barcelona, Spain
Gozalo, M:
Hosp Univ Marques Valdecilla IDIVAL, Santander, Spain
Pitout, J:
Univ Calgary, Dept Pathol & Lab Med, Calgary, AB, Canada
Akova, M:
Hacettepe Univ, Sch Med, Ankara, Turkey
Pena, C:
Hosp Univ Bellvitge, Barcelona, Spain
Cisneros, JM:
Univ Seville, Univ Hosp Virgen Rocio, Inst Biomed Seville IBiS, Infect Dis Microbiol & Prevent Med,CSIC, Seville, Spain
Hernandez-Torres, A:
Hosp Univ Virgen Arrixaca, Murcia, Spain
Farcomeni, A:
Univ Roma La Sapienza, Dept Publ Hlth & Infect Dis, Policlin Umberto 1, Viale Univ 37, I-00161 Rome, Italy
Prim, N:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Origun, J:
Hosp Univ 12 Octubre, Madrid, Spain
Bou, G:
Complejo Hosp Univ A Coruna, La Coruna, Spain
Tacconelli, E:
Univ Klinikum Tubingen, Tubingen, Germany
Tumbarello, M:
Univ Cattolica Sacro Cuore, Rome, Italy
Hamprecht, A:
Univ Klinikum Koln, Inst Mikrobiol Immunol & Hyg, Cologne, Germany
Karaiskos, I:
Hygeia Gen Hosp, Athens, Greece
de la Calle, C:
Hosp Clin Barcelona, Barcelona, Spain
Perez, F:
Vet Affairs Med Ctr, Louis Stokes Cleveland Dept, Res Serv, Cleveland, OH USA
Schwaber, MJ:
Israel Minist Hlth, Natl Ctr Infect Control, Tel Aviv, Israel
Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel
Bermejo, J:
Hosp Espanol, Rosario, Santa Fe, Argentina
Lowman, W:
Wits Donald Gordon Med Ctr, Johannesburg, South Africa
Hsueh, RR:
Natl Taiwan Univ Hosp, Coll Med, Taipei, Taiwan
Mora-Rillo, M:
Hosp Univ La Paz IdiPAZ, Madrid, Spain
Rodriguez-Gomez, J:
Univ Cordoba, Reina Sofia Univ Hosp, Biomed Res Inst Cordoba IMIBIC, Intens Care Unit, Cordoba, Spain
Souli, M:
Univ Gen Hosp Attikon, Chaidari, Greece
Bonomo, RA:
Case Western Reserve Univ, Sch Med, Dept Mol Biol, Cleveland, OH USA
Case Western Reserve Univ, Sch Med, Dept Med, Cleveland, OH 44106 USA
Vet Affairs Med Ctr, Louis Stokes Cleveland Dept, Res Serv, Cleveland, OH USA
Case Western Reserve Univ, Sch Med, Dept Microbiol, Cleveland, OH USA
Case Western Reserve Univ, Sch Med, Dept Pharmacol, Cleveland, OH 44106 USA
Paterson, DL:
Univ Queensland, Ctr Clin Res, Brisbane, Qld, Australia
Carmeli, Y:
Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel
Israel Minist Hlth, Natl Ctr Infect Control, Tel Aviv, Israel
Pascual, A:
Univ Seville, Inst Biomed Sevilla, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Rodriguez-Bano, J:
Univ Seville, Inst Biomed Sevilla, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Venditti, M:
Univ Roma La Sapienza, Dept Publ Hlth & Infect Dis, Policlin Umberto 1, Viale Univ 37, I-00161 Rome, Italy
Green Accepted
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