title: Enterobacteriaceae resistant to third generation cephalosporins upon hospital admission: risk factors and clinical outcomes.
abstract: OBJECTIVE
  Evaluate risk factors and clinical outcomes of infections caused by Enterobacteriaceae resistant to third-generation cephalosporins present in samples collected upon hospital admission.
  
  
  METHODS
  Risk factors were evaluated using a 1:2 ratio case-control study. Influence of resistance on the appropriateness of antibiotic therapy, length of stay, and hospital mortality were prospectively evaluated. Characteristics independently associated with the presence of resistant enterobacteria were assessed by logistic regression.
  
  
  RESULTS
  Enterobacteria resistant to third-generation cephalosporins were quite common (26.0%). Male gender (OR: 2.66; 95% CI, 1.17-5.06; p=0.019), invasive prosthesis (OR: 3.79; 95% CI, 1.29-11.08; p=0.015), previous use of cephalosporins (OR: 2.77; 95% CI, 1.10-6.97; p=0.029) and hospitalization in the last 6 months (OR: 5.33; 95% CI, 2.29-12.44; p<0.001) were independently associated with the presence of these microorganisms. These bacteria were associated with higher frequency of inappropriate antimicrobial therapy, worse clinical response, and longer length of stay. Finally, older age, admission to the ICU, and site of infection other than urinary tract were independently associated to higher hospital mortality.
  
  
  CONCLUSIONS
  Risk factors identified in this study may help in the choice of empirical antibiotic therapy for infected patients suspected of harboring these bacteria and in the early implementation of measures to avoid the spread of these bacteria in the hospital environment.
authors.affiliation: Graduate Program in Infectious Diseases and Tropical Medicine, Internal Medicine Department, School of Medicine and University Hospital - Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. Electronic address: miriancoliveira@yahoo.com.br.
authors.forename: Mirian Cristina
authors.initials: MC
authors.lastname: Oliveira
authors.affiliation: Graduate Program in Infectious Diseases and Tropical Medicine, Internal Medicine Department, School of Medicine and University Hospital - Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Clara Rodrigues Alves
authors.initials: CR
authors.lastname: Oliveira
authors.affiliation: Graduate Program in Infectious Diseases and Tropical Medicine, Internal Medicine Department, School of Medicine and University Hospital - Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Karine Valéria
authors.initials: KV
authors.lastname: Gonçalves
authors.affiliation: Graduate Program in Infectious Diseases and Tropical Medicine, Internal Medicine Department, School of Medicine and University Hospital - Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Marciléa Silva
authors.initials: MS
authors.lastname: Santos
authors.affiliation: Laboratory of Microbiology, University Hospital - Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Amanda Cristina Silva
authors.initials: AC
authors.lastname: Tardelli
authors.affiliation: Graduate Program in Infectious Diseases and Tropical Medicine, Internal Medicine Department, School of Medicine and University Hospital - Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Vandack Alencar
authors.initials: VA
authors.lastname: Nobre
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000627:therapeutic use*; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins
keywords: Antibiotic resistance; Enterobacteriaceae; Risk factors; Third generation cephalosporins