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Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae
- Publication Year :
- 2018
- Publisher :
- ELSEVIER SCIENCE BV, 2018.
-
Abstract
- Purpose There are few data in the literature regarding sepsis or septic shock due to extended-spectrum β-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. β-lactam/β-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.
- Subjects :
- 0301 basic medicine
Male
Klebsiella pneumoniae
ß-lactam/ß-lactamase inhibitor
extended-spectrum ß-lactamases
sepsis
carbapenems
septic shock
ß-lactam/ß-lactamase inhibitors
Aged
Aged, 80 and over
Anti-Bacterial Agents
Drug Therapy, Combination
Enterobacteriaceae
Enterobacteriaceae Infections
Female
Humans
Middle Aged
Prognosis
Retrospective Studies
Sepsis
Survival Analysis
Treatment Outcome
beta-Lactamase Inhibitors
beta-Lactamases
beta-Lactams
Decision Support Techniques
0302 clinical medicine
Clinical endpoint
80 and over
Medicine
Pharmacology (medical)
030212 general & internal medicine
biology
extended-spectrum ß-lactamase
General Medicine
Infectious Diseases
Combination
sepsi
Settore SECS-S/01 - Statistica
Microbiology (medical)
medicine.medical_specialty
030106 microbiology
Infectious Disease
carbapenem
03 medical and health sciences
Drug Therapy
Internal medicine
In patient
business.industry
Proportional hazards model
Septic shock
bacterial infections and mycoses
medicine.disease
biology.organism_classification
Bacteremia
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....31c18d72506d4fa984413807d1ab4ae8