Impact of empirical treatment in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. bacteremia. A multicentric cohort study

BMC Infectious Diseases

Jose Antonio Capdevila⁸  Elia Sirvent⁴  Vicente Navarro⁴  Ana Fleites⁹  Azucena Rodríguez⁹  Jose Angel Alava²  Alfonso Gutiérrez-Macías²  Luis Martínez Martínez⁵  Juan Alonso⁵  Maria Carmen Fariñas⁵  María Pía Roiz⁵  María Montero¹  Juan Pablo Horcajada¹  Alberto Delgado⁶  María Velasco⁶  Patricia Álvarez-García³  María Lamelo³  Galo Peralta⁷ 

[1] Hospital del Mar, Barcelona, Spain;Hospital de Basurto, Bilbao, Spain;Hospital Montecelo, Pontevedra, Spain;Hospital de Torrevieja, Torrevieja, Spain;Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain;Hospital Universitario Fundación Alcorcón, Madrid, Spain;Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), 3ª Planta. Edificio IFIMAV. Avda Cardenal Herrera Oria s/n, 39011, Santander, Spain;Hospital de Mataró, Mataró, Spain;Hospital Central de Asturias, Oviedo, Spain

关键词: Prognosis;    Antibiotic empirical treatment;    Gram negative;    Extended-spectrum β-lactamase;    Bacteremia;   

Others  :  1159646
DOI  :  10.1186/1471-2334-12-245

 received in 2012-01-08, accepted in 2012-10-02,  发布年份 2012

【 摘 要 】

Background

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.

Methods

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.

Results

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.

Conclusion

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.

【 授权许可】

   
2012 Peralta et al.; licensee BioMed Central Ltd.

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