Risk factors, outcome and impact of empirical antimicrobial treatment in extended-spectrum β-lactamase-producing Escherichia coli bacteraemia.

Stefanie Van Aken, Nathalie Lund, Jonas Ahl, Inga Odenholt, Johan Tham
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引用次数: 35

Abstract

Background: To investigate patient characteristics and empirical antimicrobial treatment of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) bacteraemia, to determine risk factors, outcome and impact of empirical antimicrobial treatment.

Methods: We performed a retrospective case-control study of all patients diagnosed with ESBL-EC from January 2011 to September 2012. The control group consisted of patients with non-ESBL E. coli bacteraemia. The groups were compared with respect to empirical treatment, risk factors and outcome, using univariate and multivariate analysis.

Results: The study consisted of 70 consecutive cases of ESBL-producing and 140 controls of non-ESBL-producing E. coli bacteraemia. ESBL-EC prevalence of bloodstream invasive E. coli isolates was 6.1%. The independent risk factor found for ESBL-EC bacteraemia was a prior culture with ESBL production (p < 0.001). A higher frequency of inappropriate empirical antibiotic treatment (p < 0.001) and a trend towards worse outcome was observed in patients infected with ESBL-EC and empirical guidelines were more often not followed (p = 0.013). If the guidelines were followed this was associated with adequate initial antibiotic treatment (p < 0.001).

Conclusions: Patients with ESBL-EC frequently received inappropriate empirical treatment and guidelines were more often not followed. A prior culture of ESBL-producing bacteria was an independent predictor and risk factor for ESBL-EC bacteraemia. Since the prevalence of ESBL-producing E. coli is increasing the importance of adequate guidelines must be emphasized.

广谱产β-内酰胺酶大肠杆菌血症的危险因素、结局和经验性抗菌治疗的影响。
背景:探讨广谱产β-内酰胺酶大肠杆菌(ESBL-EC)菌血症的患者特点及经验性抗菌治疗,确定经验性抗菌治疗的危险因素、结局及影响。方法:我们对2011年1月至2012年9月诊断为ESBL-EC的所有患者进行回顾性病例对照研究。对照组为非esbl大肠杆菌血症患者。采用单因素和多因素分析比较两组的经验治疗、危险因素和结局。结果:该研究包括70例连续产生esbl的大肠杆菌菌血症和140例不产生esbl的对照组。血流侵袭性大肠杆菌ESBL-EC患病率为6.1%。发现ESBL- ec菌血症的独立危险因素是有ESBL产生的先前培养(p < 0.001)。在感染ESBL-EC的患者中,观察到不适当的经验性抗生素治疗的频率更高(p < 0.001),结果有更差的趋势,并且更经常不遵守经验性指南(p = 0.013)。如果遵循指南,则与适当的初始抗生素治疗相关(p < 0.001)。结论:ESBL-EC患者经常接受不适当的经验治疗,更常不遵守指南。先前培养产生esbl的细菌是ESBL-EC菌血症的独立预测因子和危险因素。由于产生esbl的大肠杆菌的流行率正在增加,必须强调适当指南的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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