Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome.
J Antimicrob Chemother
; 63(3): 568-74, 2009 Mar.
Article
em En
| MEDLINE
| ID: mdl-19126669
ABSTRACT
OBJECTIVES:
To describe the predictive factors for the isolation of fluoroquinolone-resistant or extended- spectrum beta-lactamase (ESBL)-producing Escherichia coli and their impact on bacteraemia outcome.METHODS:
Analysis of E. coli bacteraemia episodes prospectively collected through a blood culture surveillance programme from January 1991 to December 2007.RESULTS:
Out of 18 080 episodes, 4758 (26%) E. coli bacteraemias were reported in the period of study. Mortality was noted in 440 cases (9%). Fluoroquinolone-resistant strains were reported in 1300 (27%) cases and ESBL-producing strains in 211 cases (4%). One hundred and seventy-eight strains out of 211 (84%) ESBL-producing E. coli were isolated since 2001. The two main independent risk factors for mortality were shock (OR 10.28, P < 0.001) and inappropriate empirical therapy (OR 4.83, P < 0.001). Inappropriate empirical therapy was significantly more frequent for infections caused by fluoroquinolone-resistant strains (n = 203, 16%, P < 0.001) and ESBL-producing strains (n = 110, 52%, P < 0.001). Independent factors associated with the isolation of a fluoroquinolone-resistant strain were nosocomial origin (OR 1.61, P < 0.001); urinary catheterization (OR 2.44, P < 0.001); and previous therapy with a fluoroquinolone (OR 7.41, P < 0.001). The independent risk factors associated with the isolation of an ESBL-producing strain were nosocomial origin (OR 1.68, P = 0.03); urinary catheterization (OR 1.88, P = 0.001); and previous beta-lactam antibiotic therapy (OR 2.81, P < 0.001).CONCLUSIONS:
Inappropriate empirical therapy was the strongest independent factor that we could modify to improve mortality in E. coli bacteraemia and was more frequent in cases caused by fluoroquinolone-resistant or ESBL-producing strains. Nosocomial acquisition, urinary catheterization and previous therapy with a fluoroquinolone or beta-lactam were predictive factors for infection with an antibiotic-resistant strain.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Bacteriemia
/
Fluoroquinolonas
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Farmacorresistência Bacteriana
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Beta-Lactamas
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Escherichia coli
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Infecções por Escherichia coli
/
Antibacterianos
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Espanha