Publication: Comparison of Predictors and Mortality between Bloodstream Infections Caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae
Authors
Scheuerman, O ; Schechner, V ; Carmeli, Y ; Gutiérrez-Gutiérrez, B ; Calbo, E ; Almirante, B ; Viale, PL ; Oliver, A ; Ruiz-Garbajosa, P ; Gasch, O ; Gozalo, M ; Pitout, J ; Akova, M ; Peña, C ; Molina, J ; Hernández-Torres, A ; Venditti, M ; Prim, M ; Origüen, J ; Bou, G ; Tacconelli, E ; Tumbarello, M ; Hamprecht, A ; Karaiskos, I ; De La Calle, C ; Pérez, F ; Schwaber, MJ ; Bermejo, J ; Lowman, W ; Hsueh, PR ; Navarro-San Francisco, C ; Bonomo, RA ; Paterson, DL ; Pascual, A ; Rodríguez-Baño, J
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Publisher
Cambridge University Press
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DOI
https://doi.org/10.1017/ice.2018.63
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info:eu-repo/semantics/article
Description
© 2018 by The Society for Healthcare Epidemiology of America.
To access the final edited and published work see: https://doi.org/10.1017/ice.2018.63
Abstract
OBJECTIVETo compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypesMETHODSAs part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.RESULTSThe study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non-CTX-M ESBLs were detected.CONCLUSIONSClinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected
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Citation
Infection Control & Hospital Epidemiology , Volume 39 , Issue 6 , June 2018 , pp. 660 - 667
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