Artículo
Risk Factors and Prognosis of Nosocomial Bloodstream Infections Caused by Extended-Spectrum-B-Lactamase-Producing Escherichia coli
Autor/es | Rodríguez-Baño, Jesús
Picón, Encarnación Gijón, Paloma Hernández, José Ramón Cisneros, José Miguel Peña, Carmen Almela, Manuel Almirante, Benito Grill, Fabio Colomina, Javier Molinos, Sonia Oliver, Antonio Fernández-Mazarrasa, Carlos Navarro, Gemma Coloma, Ana López Cerero, Lorena Pascual Hernández, Álvaro |
Departamento | Universidad de Sevilla. Departamento de Medicina Universidad de Sevilla. Departamento de Microbiología |
Fecha de publicación | 2010-05 |
Fecha de depósito | 2016-05-05 |
Publicado en |
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Resumen | Extended-spectrum-B-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial
bloodstream ... Extended-spectrum-B-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.4 to 15.7), the previous use of oxyimino-B-lactams (OR = 6.0; 95% CI = 3.0 to 11.8), and unknown BSI source (protective; OR = 0.4; 95% CI = 0.2 to 0.9), and duration of hospital stay (OR = 1.02; 95% CI = 1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR = 3.9; 95% CI = 1.2 to 12.9), a high-risk source (OR = 5.5; 95% CI = 1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR = 6.5; 95% CI = 1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-B-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality. |
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