title: National multicenter study of predictors and outcomes of bacteremia upon hospital admission caused by Enterobacteriaceae producing extended-spectrum beta-lactamases.
abstract: Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are pathogens that may lead to a spectrum of clinical syndromes. We aimed to identify predictors and outcomes of ESBL bacteremia upon hospital admission (UHA) in a nationwide prospective study. Thus, a multicenter prospective study was conducted in 10 Israeli hospitals. Adult patients with bacteremia due to Enterobacteriaceae diagnosed within 72 h of hospitalization were included. Patients with ESBL producers (cases) were compared to those with non-ESBL producers (controls), and a 1:1 ratio was attempted in each center. A case-control study to identify predictors and a cohort study to identify outcomes were conducted. Bivariate and multivariate logistic regressions were used for analyses. Overall, 447 patients with bacteremia due to Enterobacteriaceae were recruited: 205 cases and 242 controls. Independent predictors of ESBL were increased age, multiple comorbid conditions, poor functional status, recent contact with health care settings, invasive procedures, and prior receipt of antimicrobial therapy. In addition, patients presenting with septic shock and/or multiorgan failure were more likely to have ESBL infections. Patients with ESBL producers suffered more frequently from a delay in appropriate antimicrobial therapy (odds ratio [OR], 4.7; P, <0.001) and had a higher mortality rate (OR, 3.5; P, <0.001). After controlling for confounding variables, both ESBL production (OR, 2.3; P, 9.1) and a delay in adequate therapy (OR, 0.05; P, 0.001) were significant predictors for mortality and other adverse outcomes. We conclude that among patients with bacteremia due to Enterobacteriaceae UHA, those with ESBL producers tend to be older and chronically ill and to have a delay in effective therapy and severe adverse outcomes. Efforts should be directed to improving the detection of patients with ESBL bacteremia UHA and to providing immediate appropriate therapy.
authors.affiliation: Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel. drormc@hotmail.com
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.forename: Tamar
authors.initials: T
authors.lastname: Gottesman
authors.forename: Orna
authors.initials: O
authors.lastname: Schwartz
authors.forename: Maya
authors.initials: M
authors.lastname: Korem
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Maor
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
authors.forename: Rebekah
authors.initials: R
authors.lastname: Karplus
authors.forename: Tsipora
authors.initials: T
authors.lastname: Lazarovitch
authors.forename: Eyal
authors.initials: E
authors.lastname: Braun
authors.forename: Hana
authors.initials: H
authors.lastname: Sprecher
authors.forename: Tamar
authors.initials: T
authors.lastname: Lachish
authors.forename: Yonit
authors.initials: Y
authors.lastname: Wiener-Well
authors.forename: Danny
authors.initials: D
authors.lastname: Alon
authors.forename: Michal
authors.initials: M
authors.lastname: Chowers
authors.forename: Pnina
authors.initials: P
authors.lastname: Ciobotaro
authors.forename: Rita
authors.initials: R
authors.lastname: Bardenstein
authors.forename: Alona
authors.initials: A
authors.lastname: Paz
authors.forename: Israel
authors.initials: I
authors.lastname: Potasman
authors.forename: Michael
authors.initials: M
authors.lastname: Giladi
authors.forename: Vered
authors.initials: V
authors.lastname: Schechner
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
authors.forename: Shiri
authors.initials: S
authors.lastname: Klarfeld-Lidji
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D004755:Enterobacteriaceae / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases