Universität zu Köln

Russo, A., Falcone, M., Gutierrez-Gutierrez, B., Calbo, E., Almirante, B., Viale, P. L., Oliver, A., Ruiz-Garbajosa, R., Gasch, O., Gozalo, M., Pitout, J., Akova, M., Pena, C., Cisneros, J. M., Hernandez-Torres, A., Farcomeni, A., Prim, N., Origun, J., Bou, G., Tacconelli, E., Tumbarello, M., Hamprecht, A., Karaiskos, I, de la Calle, C., Perez, F., Schwaber, M. J., Bermejo, J., Lowman, W., Hsueh, R-R, Mora-Rillo, M., Rodriguez-Gomez, J., Souli, M., Bonomo, R. A., Paterson, D. L., Carmeli, Y., Pascual, A., Rodriguez-Bano, J. and Venditti, M. (2018). Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum beta-lactamase-producing Enterobacteriaceae. Int. J. Antimicrob. Agents, 52 (5). S. 577 - 586. AMSTERDAM: ELSEVIER SCIENCE BV. ISSN 1872-7913

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Abstract

Purpose: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum fi-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E. Methods: Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. Results: 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. fi-lactam/fi-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. Conclusions: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome. (C) 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Russo, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Falcone, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gutierrez-Gutierrez, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Calbo, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Almirante, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Viale, P. L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Oliver, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruiz-Garbajosa, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gasch, O. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gozalo, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pitout, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Akova, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pena, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cisneros, J. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hernandez-Torres, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Farcomeni, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Prim, N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Origun, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bou, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Tacconelli, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Tumbarello, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamprecht, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Karaiskos, I UNSPECIFIED UNSPECIFIED UNSPECIFIED de la Calle, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Perez, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schwaber, M. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bermejo, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lowman, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hsueh, R-R UNSPECIFIED UNSPECIFIED UNSPECIFIED Mora-Rillo, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rodriguez-Gomez, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Souli, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bonomo, R. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Paterson, D. L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Carmeli, Y. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pascual, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rodriguez-Bano, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Venditti, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-167004
DOI:	10.1016/j.ijantimicag.2018.06.018
Journal or Publication Title:	Int. J. Antimicrob. Agents
Volume:	52
Number:	5
Page Range:	S. 577 - 586
Date:	2018
Publisher:	ELSEVIER SCIENCE BV
Place of Publication:	AMSTERDAM
ISSN:	1872-7913
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BLOOD-STREAM INFECTIONS; ESCHERICHIA-COLI BACTEREMIA; POST-HOC ANALYSIS; KLEBSIELLA-PNEUMONIAE; RISK-FACTORS; RESISTANT ENTEROBACTERIACEAE; PIPERACILLIN-TAZOBACTAM; CLINICAL-OUTCOMES; MORTALITY; THERAPY Multiple languages Infectious Diseases; Microbiology; Pharmacology & Pharmacy Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/16700