Risk factors and prognosis of nosocomial bloodstream infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli.
Extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR]=4.8; 95% confidence interval [CI]=1.4 to 15.7), the previous use of oxyimino-beta-lactams (OR=6.0; 95% CI=3.0 to 11.8), and unknown BSI source (protective; OR=0.4; 95% CI=0.2 to 0.9), and duration of hospital stay (OR=1.02; 95% CI=1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR=3.9; 95% CI=1.2 to 12.9), a high-risk source (OR=5.5; 95% CI=1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR=6.5; 95% CI=1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-beta-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality.
Rodríguez-Baño
Jesús
J
Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Seville, Avda. Dr. Fedriani, 3, Seville 41009, Spain. jesusrb@us.es
Picón
Encarnación
E
Gijón
Paloma
P
Hernández
José Ramón
JR
Cisneros
Jose M
JM
Peña
Carmen
C
Almela
Manuel
M
Almirante
Benito
B
Grill
Fabio
F
Colomina
Javier
J
Molinos
Sonia
S
Oliver
Antonio
A
Fernández-Mazarrasa
Carlos
C
Navarro
Gemma
G
Coloma
Ana
A
López-Cerero
Lorena
L
Pascual
Alvaro
A
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004363:Drug Utilization; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D001618:beta-Lactamases / Q000096:biosynthesis*
D000900:Anti-Bacterial Agents; D001618:beta-Lactamases