Impact of empirical treatment in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. bacteremia. A multicentric cohort study
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AuthorPeralta Fernández, Francisco Galo; Lamelo Otero, María; Álvarez García, Patricia; Velasco Arribas, María; Delgado-Iribarren, Alberto; Horcajada Gallego, Juan Pablo; Montero, María Milagro; Roiz Mesones, María Pía; Fariñas Álvarez, María del Carmen; Alonso Gutiérrez, Juan; Martínez Martínez, Luis; Gutiérrez Macías, Alfonso; Álava Menica, José Ángel; Rodríguez Guardado, Azucena; Fleites, Ana; Navarro López, Vicente; Sirvent Quílez, Elia; Capdevila Morell, José Antonio
The objective of this study is to analyze the factors that are associated with the adequacy of empirical antibiotic therapy and its impact in mortality in a large cohort of patients with extended-spectrum β-lactamase (ESBL)--producing Escherichia coli and Klebsiella spp. bacteremia.
Cases of ESBL producing Enterobacteriaceae (ESBL-E) bacteremia collected from 2003 through 2008 in 19 hospitals in Spain. Statistical analysis was performed using multivariate logistic regression.
We analyzed 387 cases ESBL-E bloodstream infections. The main sources of bacteremia were urinary tract (55.3%), biliary tract (12.7%), intra-abdominal (8.8%) and unknown origin (9.6%). Among all the 387 episodes, E. coli was isolated from blood cultures in 343 and in 45.71% the ESBL-E was multidrug resistant. Empirical antibiotic treatment was adequate in 48.8% of the cases and the in hospital mortality was 20.9%. In a multivariate analysis adequacy was a risk factor for death [adjusted OR (95% CI): 0.39 (0.31-0.97); P = 0.04], but not in patients without severe sepsis or shock. The class of antibiotic used empirically was not associated with prognosis in adequately treated patients.
ESBL-E bacteremia has a relatively high mortality that is partly related with a low adequacy of empirical antibiotic treatment. In selected subgroups the relevance of the adequacy of empirical therapy is limited.
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García Álvarez, Lara; Sanz, María Mercedes; Marín, Mercedes; Fariñas Álvarez, María del Carmen; Armiñanzas Castillo, Carlos; Arnaiz García, Ana María; Berrazueta Fernández, José Ramón; Bellisco, Sara; Cobo Belaustegui, Manuel; Durán, Raquel; Fariñas Álvarez, María Concepción; Fernández Mazarrasa, Carlos; Gómez Izquierdo, Rubén; González Rico, Claudia; Gutiérrez Díez, José Francisco; Martín Durán, Rafael; Pajarón, Marcos; Parra Blanco, José Antonio; Teira Cobo, Ramón María; [et al.] (Lippincott Williams & Wilkins, 2016)