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Risk Factors for Community-Onset Bloodstream Infection with Extended-Spectrum ß-Lactamase-Producing Enterobacteriaceae: National Population-Based Case-Control Study.
Clin Microbiol Infect. 2019 Apr 12;:
Authors: Giske CG, Wisell KT, Ternhag A, Nauclér P, Isendahl J
Abstract
OBJECTIVES: To investigate risk factors for community-onset bloodstream infections with extended-spectrum ß-lactamase-producing Enterobacteriaceae (EPE BSI).
METHODS: EPE BSI is mandatory to report to a national register at the Public Health Agency of Sweden. Using this register, we performed a population-based case-control study from 2007-2012 of 945 cases and 9390 controls. Exposure data on comorbidity, hospitalization, in- and outpatient antibiotic consumption and socio-economic status was collected from health and hospital registers.
RESULTS: The overall incidence was 1.7 per 100 000 person-years. The 30-day mortality was 11.3%. Urological disorders inferred the highest EPE BSI risk, adjusted odds ratio (aOR) 4.32 (95% Confidence Interval (CI) 3.41-5.47), followed by immunological disorders, aOR 3.54 (CI 2.01-6.23), hematological malignancy, aOR 2.77 (CI 1.57-4.87), solid tumors, aOR 2.28 (1.76-2.94), and diabetes, aOR 2.03 (1.58-2.61). Consumption of fluoroquinolones or mostly non-EPE-active antibiotics with selective Gram-negative spectrum of activity within the previous 3 months were associated with EPE BSI, aORs 5.52 (CI 2.8-11.0) and 3.8, CI 1.9-7.7) respectively. There was a dose-response relationship in EPE BSI risk with increasing number of consecutive regimens. Antibiotic consumption >3 months before EPE BSI was not associated with increased risk. Increasing age, malignancies and education ≤12 years (aORs >2) were associated with increased 30-day mortality.
CONCLUSIONS: Targeted interventions should be directed towards improving care for patients with immunosuppression, urological disorders and subjects with lower socio-economic status. Antibiotic stewardship should focus on reduction of fluoroquinolones.
PMID: 30986557 [PubMed - as supplied by publisher]