title: Risk factors and outcomes of carbapenem-nonsusceptible Escherichia coli bacteremia: a matched case-control study.
abstract: BACKGROUND
  Infections due to carbapenem-resistant Enterobacteriaceae have been the emerging problem worldwide. This primary object of this study was to understand the risk factors and clinical outcomes of carbapenem-nonsusceptible Escherichia coli (CNSEc) bacteremia.
  
  
  METHODS
  We conducted a matched case-control study in a 3,715-bed tertiary care medical center in northern Taiwan. The controls were selected among patients with carbapenem-susceptible E coli and were matched with CNSEc for bacteremia.
  
  
  RESULTS
  Fifty-one patients were included in this study (17 cases and 34 controls). Bivariate analysis showed that prior exposure to carbapenems (p<0.001), stay in intensive care units (p=0.016), placement of central venous catheters (p=0.001), chronic liver diseases (p<0.001), uremia with regular dialysis (p=0.004), and mechanical ventilation (p=0.004) were associated with CNSEc bacteremia. Multivariate analysis revealed that prior exposure to carbapenems [odds ratio (OR), 29.17; 95% confidence interval (CI), 1.76-484.70; p=0.019], uremia with regular dialysis (OR, 98.58; 95% CI, 4.02-999; p=0.005) and chronic liver diseases (OR, 27.86; 95% CI, 2.31-335.83; p=0.009) were independent risk factors for CNSEc bacteremia. Compared with carbapenem-susceptible E coli group, CNSEc group had a longer hospital stay (68.4 days vs. 35.8 days; p=0.04) and a higher disease severity, as indicated by a Pittsburgh bacteremia score greater than or equal to 4 (5.6% vs. 2.5%; p=0.015). Patients with CNSEc bacteremia had a higher overall in-hospital mortality rate (94.12% vs. 50.00%; p=0.002), but there was no difference in the 28-day mortality between these two groups.
  
  
  CONCLUSIONS
  CNSEc bacteremia would lead to a poor outcome among patients with prior exposure to carbapenems, chronic liver disease, and uremia with regular dialysis.
authors: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Hong-Jyun
authors: HJ
authors: Chang
authors: Po-Chang
authors: PC
authors: Hsu
authors: Chien-Chang
authors: CC
authors: Yang
authors: An-Jing
authors: AJ
authors: Kuo
authors: Ju-Hsin
authors: JH
authors: Chia
authors: Tsu-Lan
authors: TL
authors: Wu
authors: Ming-Hsun
authors: MH
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy*; D015780:Carbapenems / Q000627:therapeutic use*; D016022:Case-Control Studies; D004926:Escherichia coli / Q000187:drug effects* / Q000254:growth & development; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems