Clinical and microbiological determinants of severe and fatal outcomes in patients infected with Enterobacteriaceae producing extended-spectrum β-lactamase.
Although extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have become a worldwide public health concern, little is known regarding the clinical course of colonized or infected individuals. Our objective was to characterize the determinants of fatal outcomes related to ESBL-producing microorganisms at a large hospital in Paris, France. In 2012-2013, all consecutive patients with clinical samples testing positive for ESBL-producing Enterobacteriaceae at Saint-Antoine Hospital were identified. Patient clinical data were obtained at hospital entry, while information on intensive care unit (ICU) admissions and death were prospectively collected. Risk-factors for fatal 1-year outcomes were assessed using logistic regression. In total, 643/4684 (13%) ESBL-positive samples were observed, corresponding to 516 episodes (n = 206, 40% treated) among 330 patients. Most episodes were nosocomial-related (n = 347/516, 67%) involving Escherichia coli (n = 232/516, 45%) or Klebsiella pneumoniae (n = 164/516, 32%). Empirical antibiotic therapy was adequate in 89/206 (43%) infections, while the median length of hospital stay was 30 days [interquartile range (IQR) = 11-55] and 39/201 (19%) were admitted to the ICU. Overall, 104/241 patients (43%) with available data died within 1 year. In the multivariable analysis, 1-year death was associated with age >80 years (p = 0.01), concomitant comorbidity (p = 0.001), nosocomial-acquired infection (p = 0.002), and being infected rather than colonized (p < 0.001). In this series of patients with identified samples of ESBL-producing Enterobacteriaceae, hospital burden was large and 1-year mortality rates high. Understanding which patients in this setting would benefit from broad-spectrum empirical antibiotic therapy should be further examined.
Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. laure.surgers@aphp.fr.|Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France. laure.surgers@aphp.fr.|INSERM U1135, CIMI, Team E13, Paris, France. laure.surgers@aphp.fr.
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Surgers
Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.|INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.
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Boyd
Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.|INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.|Département de Santé Publique, Hôpital Saint Antoine, APHP, Paris, France.
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Boelle
Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France.
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Lalande
Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
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Jolivot
Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.|Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.|INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.
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Girard
Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France.|INSERM U1135, CIMI, Team E13, Paris, France.|Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France.
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Arlet
Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
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Cambier
Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France.
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Homor
Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France.|INSERM U1135, CIMI, Team E13, Paris, France.|Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France.
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Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
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Meynard
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome