Bloodstream infections caused by Escherichia coli producing AmpC beta-lactamases: epidemiology and clinical features
Por:
Pascual, V, Alonso, N, Simo, M, Ortiz, G, Garcia, MC, Xercavins, M, Rivera, A, Morera, MA, Miro, E, Espejo, E, Navarro, F, Gurgui, M, Perez, J, Rodriguez-Carballeira, M, Garau, J, Calbo, E
Publicada:
1 dic 2016
Resumen:
The aim of the study was to investigate the epidemiology and clinical features of bloodstream infections due to Escherichia coli producing AmpC beta-lactamases (AmpC-Ec-BSI). In a multi-centre case-control study, all third-generation-cephalosporin-resistant Escherichia coli BSI (3GC-Ec-BSI) isolates were analysed. Acquired bla (AmpC) (bla (ac-AmpC)) detection was done by polymerase chain reaction (PCR) and sequencing. Chromosomal bla (AmpC) (bla (c-AmpC)) expression was quantified by real-time PCR. Cases were patients with AmpC-Ec-BSI. Controls were patients with cephalosporin-susceptible E. coli BSI, matched 1:1 by sex and age. Demographics, comorbidities, intrinsic and extrinsic risk factors for antimicrobial resistance, clinical presentation and outcomes were investigated. Among 841 E. coli BSI, 17 were caused by AmpC-Ec (2 %). Eleven isolates (58.8 %) had bla (ac-AmpC) and six were bla (c-AmpC) overproducers. The mean age of cases was 66.2 years and 71 % were men. Cases were more frequently healthcare-related (82 vs. 52 % controls, p < 0.05) and presented more intrinsic and extrinsic risk factors. At least one risk factor was present in 94.1 % of cases vs. 41.7 % of controls (p = 0.002). Severity and length of stay (LOS) were higher among cases (mean Pitt Score 2.6 vs. 0.38 in controls, p = 0.03; LOS 17.5 days vs. 6 in controls, p = 0.02). Inappropriate empirical therapy (IET) was administered to 70.6 % of cases and 23.5 % of controls (p < 0.003). No differences were found in terms of cure rate at the 14th day and mortality. Bloodstream infections due to AmpC-Ec (mostly plasmid-mediated) are infrequent in our area. AmpC-Ec-BSI affects mainly patients with intrinsic risk factors and those with previous antibiotic exposure. A high proportion received IET.
Filiaciones:
Pascual, V:
Hosp Univ Mutua Terrassa, Serv Internal Med, Infect Dis Unit, Plaza Dr Robert 5, Barcelona 08021, Spain
Alonso, N:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Inst Salud Carlos III, REIPI, Madrid, Spain
Simo, M:
CatLab, Barcelona, Spain
Ortiz, G:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
IIB St Pau, Barcelona, Spain
Garcia, MC:
Consorci Sanitari Terrassa, Barcelona, Spain
Xercavins, M:
CatLab, Barcelona, Spain
Rivera, A:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
IIB St Pau, Barcelona, Spain
Morera, MA:
CatLab, Barcelona, Spain
Miro, E:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
IIB St Pau, Barcelona, Spain
Inst Salud Carlos III, REIPI, Madrid, Spain
Espejo, E:
Consorci Sanitari Terrassa, Barcelona, Spain
Navarro, F:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Inst Salud Carlos III, REIPI, Madrid, Spain
Gurgui, M:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Inst Salud Carlos III, REIPI, Madrid, Spain
Perez, J:
CatLab, Barcelona, Spain
Rodriguez-Carballeira, M:
Hosp Univ Mutua Terrassa, Serv Internal Med, Infect Dis Unit, Plaza Dr Robert 5, Barcelona 08021, Spain
Garau, J:
Hosp Univ Mutua Terrassa, Serv Internal Med, Infect Dis Unit, Plaza Dr Robert 5, Barcelona 08021, Spain
Calbo, E:
Hosp Univ Mutua Terrassa, Serv Internal Med, Infect Dis Unit, Plaza Dr Robert 5, Barcelona 08021, Spain
Univ Int Catalunya, Barcelona, Spain
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