Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae
Journal
International Journal of Antimicrobial Agents
Journal Volume
52
Journal Issue
5
Pages
577-585
Date Issued
2018
Author(s)
Russo A.
Falcone M.
Guti?rrez-Guti?rrez B.
Calbo E.
Almirante B.
Viale P.L.
Oliver A.
Ruiz-Garbajosa P.
Gasch O.
Gozalo M.
Pitout J.
Akova M.
Pe?a C.
Cisneros J.M.
Hern?ndez-Torres A.
Farcomeni A.
Prim N.
Orig?en J.
Bou G.
Tacconelli E.
Tumbarello M.
Hamprecht A.
Karaiskos I.
de la Calle C.
P?rez F.
Schwaber M.J.
Bermejo J.
Lowman W.
Mora-Rillo M.
Rodriguez-Gomez J.
Souli M.
Bonomo R.A.
Paterson D.L.
Carmeli Y.
Pascual A.
Rodr?guez-Ba?o J.
Venditti M.
REIPI/ESGBIS/INCREMENT investigators
Abstract
Purpose: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum β-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. β-lactam/β-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. ? 2018 Elsevier Ltd
SDGs
Other Subjects
beta lactam antibiotic; beta lactamase inhibitor; carbapenem; antiinfective agent; beta lactam; beta lactamase; beta lactamase inhibitor; adult; aged; Article; bacterium isolate; bloodstream infection; Charlson Comorbidity Index; cohort analysis; disease classification; disease course; disease severity; Escherichia coli; extended spectrum beta lactamase producing Enterobacteriaceae; female; groups by age; human; in vitro study; Klebsiella pneumoniae; major clinical study; male; mortality; nonhuman; prediction; priority journal; scoring system; sepsis; septic shock; survival; treatment outcome; combination drug therapy; decision support system; Enterobacteriaceae; Enterobacteriaceae infection; enzymology; isolation and purification; metabolism; microbiology; middle aged; mortality; prognosis; retrospective study; sepsis; survival analysis; treatment outcome; very elderly; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamase Inhibitors; beta-Lactamases; beta-Lactams; Decision Support Techniques; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Sepsis; Survival Analysis; Treatment Outcome
Type
journal article