Appropriateness of empirical treatment and outcome in bacteremia caused by extended-spectrum β-lactamase producing bacteria.
Antimicrob Agents Chemother. 2013 Apr 22;
Authors: Frakking FN, Rottier WC, Dorigo-Zetsma JW, van Hattem JM, van Hees BC, Kluytmans JA, Lutgens S, Prins JM, Thijsen SF, Verbon A, Vlaminckx BJ, Cohen Stuart JW, Leverstein-van Hall MA, Bonten MJ
We studied clinical characteristics, appropriateness of initial antibiotic treatment, and other factors associated with day-30 mortality in patients with ESBL-bacteremia in eight Dutch hospitals. Retrospectively, information was collected from 232 consecutive patients with ESBL-bacteremia (due to Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae) between 2008 and 2010. In this cohort (median age 65 years, 24 patients <18 years of age), many had comorbidities, such as malignancy (34%) or recurrent urinary tract infections (UTI, 15%). One hundred and forty episodes (60%) were nosocomial, 54 (23%) were otherwise healthcare-associated and 38 (16%) were community-acquired. Most frequent sources of infection were UTI (42%) and intra-abdominal infection (28%). Appropriate therapy within 24 hours after bacteremia onset was prescribed to 37% of all patients, and to 54% of known ESBL carriers. Day-30 mortality was 20%. In multivariable analysis, Charlson comorbidity index ≥3, age ≥75 years, ICU stay at bacteremia onset, a non-UTI bacteremia source and presentation with severe sepsis, but not inappropriate therapy <24 hours (adjusted OR 1.53, 95% CI 0.68-3.45), were associated with day-30 mortality. Further assessment of confounding and a stratified analysis for patients with UTI and non-UTI origin of infection did not reveal a statistically significant effect of inappropriate therapy on day-30 mortality, and these results were insensitive to possible misclassification of patients that had received β-lactam/β-lactamase inhibitor combinations or ceftazidime as initial treatment. In conclusion, ESBL-bacteremia mostly occurs in patient with comorbidities requiring frequent hospitalization and 84% of episodes were healthcare-associated. Factors other than inappropriate therapy <24 hours determined day-30 mortality.
PMID: 23612198 [PubMed - as supplied by publisher]