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Outcomes and risk factors for mortality in community-onset bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli, with a special emphasis on antimicrobial therapy.
Scand J Infect Dis 2013; 45(7):519-25SJ

Abstract

BACKGROUND

Although extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has emerged as a significant pathogen, there is little information regarding treatment outcomes in community-onset bacteremia due to ESBL E. coli. The purpose of this study was to evaluate treatment outcomes of community-onset bacteremia caused by ESBL-producing E. coli and the factors associated with mortality.

METHODS

A retrospective cohort study was performed, including 92 adult patients with community-onset bacteremia caused by ESBL-producing E. coli.

RESULTS

The 30-day mortality rate was 10.9% (10/92). Independent risk factors for mortality were underlying liver disease and severity of illness (e.g., high Pitt bacteremia score, the presence of severe sepsis or septic shock; p < 0.05). Mortality in patients receiving inappropriate initial antimicrobial therapy was not significantly higher than mortality in those receiving appropriate empirical antimicrobial therapy (10.9 vs 10.7%; p = 0.975), if antimicrobial therapy was adjusted appropriately according to susceptibility results. Carbapenems, piperacillin/tazobactam, fluoroquinolones, and amikacin were the most effective antibiotics for community-onset bacteremia caused by ESBL-producing E. coli, although susceptibility profiles confirmed that alternatives to carbapenems are limited. Of 68 isolates in which the ESBLs and their molecular relationships were studied, all isolates produced ESBLs from the CTX-M family (CTX-M-14, 30 isolates; CTX-M-15, 22; and other CTX-M, 16).

CONCLUSIONS

In patients with community-onset bacteremia caused by ESBL-producing E. coli, severe sepsis and underlying liver disease were significantly associated with mortality, and a delay in appropriate antimicrobial therapy was not associated with a higher mortality if therapy was adjusted appropriately according to the susceptibility results.

Authors+Show Affiliations

Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. collacin@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23509913

Citation

Kang, Cheol-In, et al. "Outcomes and Risk Factors for Mortality in Community-onset Bacteremia Caused By Extended-spectrum Beta-lactamase-producing Escherichia Coli, With a Special Emphasis On Antimicrobial Therapy." Scandinavian Journal of Infectious Diseases, vol. 45, no. 7, 2013, pp. 519-25.
Kang CI, Wi YM, Ko KS, et al. Outcomes and risk factors for mortality in community-onset bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli, with a special emphasis on antimicrobial therapy. Scand J Infect Dis. 2013;45(7):519-25.
Kang, C. I., Wi, Y. M., Ko, K. S., Chung, D. R., Peck, K. R., Lee, N. Y., & Song, J. H. (2013). Outcomes and risk factors for mortality in community-onset bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli, with a special emphasis on antimicrobial therapy. Scandinavian Journal of Infectious Diseases, 45(7), pp. 519-25. doi:10.3109/00365548.2013.775479.
Kang CI, et al. Outcomes and Risk Factors for Mortality in Community-onset Bacteremia Caused By Extended-spectrum Beta-lactamase-producing Escherichia Coli, With a Special Emphasis On Antimicrobial Therapy. Scand J Infect Dis. 2013;45(7):519-25. PubMed PMID: 23509913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes and risk factors for mortality in community-onset bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli, with a special emphasis on antimicrobial therapy. AU - Kang,Cheol-In, AU - Wi,Yu Mi, AU - Ko,Kwan Soo, AU - Chung,Doo Ryeon, AU - Peck,Kyong Ran, AU - Lee,Nam Yong, AU - Song,Jae-Hoon, Y1 - 2013/03/19/ PY - 2013/3/21/entrez PY - 2013/3/21/pubmed PY - 2013/12/29/medline SP - 519 EP - 25 JF - Scandinavian journal of infectious diseases JO - Scand. J. Infect. Dis. VL - 45 IS - 7 N2 - BACKGROUND: Although extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has emerged as a significant pathogen, there is little information regarding treatment outcomes in community-onset bacteremia due to ESBL E. coli. The purpose of this study was to evaluate treatment outcomes of community-onset bacteremia caused by ESBL-producing E. coli and the factors associated with mortality. METHODS: A retrospective cohort study was performed, including 92 adult patients with community-onset bacteremia caused by ESBL-producing E. coli. RESULTS: The 30-day mortality rate was 10.9% (10/92). Independent risk factors for mortality were underlying liver disease and severity of illness (e.g., high Pitt bacteremia score, the presence of severe sepsis or septic shock; p < 0.05). Mortality in patients receiving inappropriate initial antimicrobial therapy was not significantly higher than mortality in those receiving appropriate empirical antimicrobial therapy (10.9 vs 10.7%; p = 0.975), if antimicrobial therapy was adjusted appropriately according to susceptibility results. Carbapenems, piperacillin/tazobactam, fluoroquinolones, and amikacin were the most effective antibiotics for community-onset bacteremia caused by ESBL-producing E. coli, although susceptibility profiles confirmed that alternatives to carbapenems are limited. Of 68 isolates in which the ESBLs and their molecular relationships were studied, all isolates produced ESBLs from the CTX-M family (CTX-M-14, 30 isolates; CTX-M-15, 22; and other CTX-M, 16). CONCLUSIONS: In patients with community-onset bacteremia caused by ESBL-producing E. coli, severe sepsis and underlying liver disease were significantly associated with mortality, and a delay in appropriate antimicrobial therapy was not associated with a higher mortality if therapy was adjusted appropriately according to the susceptibility results. SN - 1651-1980 UR - https://www.unboundmedicine.com/medline/citation/23509913/Outcomes_and_risk_factors_for_mortality_in_community_onset_bacteremia_caused_by_extended_spectrum_beta_lactamase_producing_Escherichia_coli_with_a_special_emphasis_on_antimicrobial_therapy_ L2 - http://www.tandfonline.com/doi/full/10.3109/00365548.2013.775479 DB - PRIME DP - Unbound Medicine ER -