Antibiotic-resistant microorganisms in patients with bloodstream infection of intraabdominal origin: risk factors and impact on mortality.
Antibiotic resistance
Intra-abdominal infections
Mortality
Risk factors
Journal
Infection
ISSN: 1439-0973
Titre abrégé: Infection
Pays: Germany
ID NLM: 0365307
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
14
12
2020
accepted:
20
02
2021
pubmed:
18
3
2021
medline:
26
11
2021
entrez:
17
3
2021
Statut:
ppublish
Résumé
Knowledge of resistance patterns is essential to choose empirical treatment. We aimed to determine the risk factors for antibiotic-resistant microorganisms (ARM) in intraabdominal infections (IAI) and their impact on mortality. Retrospective cohort study of patients with bacteremia from IAI origin in a single hospital between January 2006 and July 2017. A total of 1485 episodes were recorded, including 381 (25.6%) due to ARM. Independent predictors of ARM were cirrhosis (OR 2; [95% CI 1.15-3.48]), immunosuppression (OR 1.49; 1.12-1.97), prior ceftazidime exposure (OR 3.7; 1.14-11.9), number of prior antibiotics (OR 2.33; 1.61-3.35 for 1 antibiotic), biliary manipulation (OR 1.53; 1.02-2.96), hospital-acquisition (OR 2.77; 1.89-4) and shock (OR 1.48; 1.07-2). Mortality rate of the whole cohort was 11.1%. Age (OR 1.03; 1.01-1.04), cirrhosis (OR 2.32; 1.07-4.38), urinary catheter (OR 1.99; 1.17-3.38), ultimately (OR 2.28; 1.47-3.51) or rapidly (OR 13.3; 7.12-24.9) fatal underlying disease, nosocomial infection (OR 2.76; 1.6-4.75), peritonitis (OR 1.95, 1.1-3.45), absence of fever (OR 2.17; 1.25-3.77), shock (OR 5.96; 3.89-9.13), and an ARM in non-biliary infections (OR 2.14; 1.19-3.83) were independent predictors of 30-day mortality. Source control (OR 0.24; 0.13-0.44) and 2015-2017 period (OR 0.29; 0.14-0.6) were protective. Biliary manipulation and septic shock are predictors of ARM. The presence of an ARM from a non-biliary focus is a poor-prognosis indicator. Source control continues to be of paramount importance.
Sections du résumé
BACKGROUND
BACKGROUND
Knowledge of resistance patterns is essential to choose empirical treatment. We aimed to determine the risk factors for antibiotic-resistant microorganisms (ARM) in intraabdominal infections (IAI) and their impact on mortality.
METHODS
METHODS
Retrospective cohort study of patients with bacteremia from IAI origin in a single hospital between January 2006 and July 2017.
RESULTS
RESULTS
A total of 1485 episodes were recorded, including 381 (25.6%) due to ARM. Independent predictors of ARM were cirrhosis (OR 2; [95% CI 1.15-3.48]), immunosuppression (OR 1.49; 1.12-1.97), prior ceftazidime exposure (OR 3.7; 1.14-11.9), number of prior antibiotics (OR 2.33; 1.61-3.35 for 1 antibiotic), biliary manipulation (OR 1.53; 1.02-2.96), hospital-acquisition (OR 2.77; 1.89-4) and shock (OR 1.48; 1.07-2). Mortality rate of the whole cohort was 11.1%. Age (OR 1.03; 1.01-1.04), cirrhosis (OR 2.32; 1.07-4.38), urinary catheter (OR 1.99; 1.17-3.38), ultimately (OR 2.28; 1.47-3.51) or rapidly (OR 13.3; 7.12-24.9) fatal underlying disease, nosocomial infection (OR 2.76; 1.6-4.75), peritonitis (OR 1.95, 1.1-3.45), absence of fever (OR 2.17; 1.25-3.77), shock (OR 5.96; 3.89-9.13), and an ARM in non-biliary infections (OR 2.14; 1.19-3.83) were independent predictors of 30-day mortality. Source control (OR 0.24; 0.13-0.44) and 2015-2017 period (OR 0.29; 0.14-0.6) were protective.
CONCLUSION
CONCLUSIONS
Biliary manipulation and septic shock are predictors of ARM. The presence of an ARM from a non-biliary focus is a poor-prognosis indicator. Source control continues to be of paramount importance.
Identifiants
pubmed: 33728587
doi: 10.1007/s15010-021-01592-y
pii: 10.1007/s15010-021-01592-y
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
693-702Informations de copyright
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Seguin P, Laviolle B, Chanavaz C, Donnio PY, Gautier-Lerestif AL, Campion JP, et al. Factors associated with multidrug-resistant bacteria in secondary peritonitis: impact on antibiotic therapy. Clin Microbiol Infect. 2006;12:980–5.
doi: 10.1111/j.1469-0691.2006.01507.x
Hawser SP, Bouchillon SK, Hoban DJ, Badal RE, Cantón R, Baquero F. Incidence and antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae with extended-spectrum beta-lactamases in community- and hospital-associated intra-abdominal infections in Europe: results of the 2008 Study for Monitoring Antimicrobial Resistance Trends (SMART). Antimicrob Agents Chemother. 2010;54:3043–6.
doi: 10.1128/AAC.00265-10
Krobot K, Yin D, Zhang Q, Sen S, Altendorf-Hofmann A, Scheele J, et al. Effect of inappropriate initial empiric antibiotic therapy on outcome of patients with community-acquired intra-abdominal infections requiring surgery. Eur J Clin Microbiol Infect Dis. 2004;23:682–7.
doi: 10.1007/s10096-004-1199-0
European Centre for Disease Prevention and Control. Surveillance of antimicrobial resistance in Europe - Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) (2018). Stockholm: ECDC. https://www.ecdc.europa.eu/sites/default/files/documents/surveillance-antimicrobial-resistance-Europe-2018.pdf . Accesed 14 July 2020.
McCabe WR, Jackson GG. Gram-negative bacteremia: II. clinical, laboratory, and therapeutic observations. Arch Intern Med. 1962;110:856–64.
doi: 10.1001/archinte.1962.03620240038007
Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137:791–7.
doi: 10.7326/0003-4819-137-10-200211190-00007
Levy MM, Mitchell PF, Marshall JC, Abraham E, Angus D, Cook A, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250–6.
doi: 10.1097/01.CCM.0000050454.01978.3B
Swenson BR, Metzger R, Hedrick TL, McElearney ST, Evans HL, Smith RL, et al. Choosing antibiotics for intra-abdominal infections: what do we mean by “high risk”? Surg Infect (Larchmt). 2009;10:29–39.
doi: 10.1089/sur.2007.041
Seguin P, Fédun Y, Laviolle B, Nesseler N, Donnio PY, Mallédant Y. Risk factors for multidrug-resistant bacteria in patients with post-operative peritonitis requiring intensive care. J Antimicrob Chemother. 2010;65:342–6.
doi: 10.1093/jac/dkp439
Ortega M, Marco F, Soriano A, Almela M, Martínez JA, López J, et al. Epidemiology and prognosis determinants of bacteraemic biliary tract infection. J Antimicrob Chemother. 2012;67:1508–13.
doi: 10.1093/jac/dks062
Reuken PA, Torres D, Baier M, Löffler B, Lübbert C, Lippmann N, et al. Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis. PLoS ONE. 2017;12:e0169900.
doi: 10.1371/journal.pone.0169900
Montravers P, Dufour G, Guglielminotti J, Desmard M, Muller C, Houissa H, et al. Dynamic changes of microbial flora and therapeutic consequences in persistent peritonitis. Crit Care. 2015;19:70.
doi: 10.1186/s13054-015-0789-9
Labricciosa FM, Sartelli M, Abbo LM, Barbadoro P, Ansaloni L, Coccolini F, et al. Epidemiology and risk factors for isolation of multi-drug-resistant organisms in patients with complicated intra-abdominal infections. Surg Infect (Larchmt). 2018;19:264–72.
doi: 10.1089/sur.2017.217
Cantón R, Loza E, Aznar J, Castillo FJ, Cercenado E, Fraile-Ribot PA, et al. Monitoring the antimicrobial susceptibility of Gram-negative organisms involved in intraabdominal and urinary tract infections recovered during the SMART study (Spain, 2016 and 2017). Rev Esp Quimioter. 2019;32:145–55.
pubmed: 30761824
pmcid: 6441989
Ben-Ami R, Rodríguez-Baño J, Arslan H, Pitout JD, Quentin C, Calbo E, et al. A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing enterobacteriaceae in nonhospitalized patients. Clin Infect Dis. 2009;49:682–90.
doi: 10.1086/604713
Trecarichi EM, Cauda R, Tumbarello M. Detecting risk and predicting patient mortality in patients with extended-spectrum β-lactamase-producing Enterobacteriaceae bloodstream infections. Future Microbiol. 2012;7:1173–89.
doi: 10.2217/fmb.12.100
Mohd Sazlly Lim S, Wong PL, Sulaiman H, Atiya N, Hisham Shunmugam R, Liew SM. Clinical prediction models for ESBL-Enterobacteriaceae colonization or infection: a systematic review. J Hosp Infect. 2019;102:8–16.
doi: 10.1016/j.jhin.2019.01.012
Detsis M, Karanika S, Mylonakis E. ICU acquisition rate, risk factors, and clinical significance of digestive tract colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae: a systematic review and meta-analysis. Crit Care Med. 2017;45:705–14.
doi: 10.1097/CCM.0000000000002253
Anesi JA, Lautenbach E, Tamma PD, Thom KA, Blumberg EA, Alby K et al. Risk factors for extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infection among solid organ transplant recipients. Clin Infect Dis 2020; 28: pii: ciaa190.
Biehl LM, Schmidt-Hieber M, Liss B, Cornely OA, Vehreschild MJ. Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients - Review of the literature from a clinical perspective. Crit Rev Microbiol. 2016;42:1–16.
doi: 10.3109/1040841X.2013.875515
Xiao T, Yang K, Zhou Y, Zhang S, Ji J, Risk Y, factors and outcomes in non-transplant patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia: a retrospective study from, , et al. to 2016. Antimicrob Resist Infect Control. 2013;2019(8):144.
Boix-Palop L, Xercavins M, Badía C, Obradors M, Riera M, Freixas N, et al. Emerging extended-spectrum β-lactamase-producing Klebsiella pneumoniae causing community-onset urinary tract infections: a case–control–control study. Int J Antimicrob Agents. 2017;50:197–202.
doi: 10.1016/j.ijantimicag.2017.03.009
Boontham P, Soontomrak R. Intra-Abdominal Infections: Prevalence and Risk Factors of ESBLs Infections. J Med Assoc Thai. 2015;98:1097–103.
pubmed: 26817180
Li G, Ren J, Wu Q, Hu D, Wang G, Wu X, et al. Bacteriology of Spontaneous Intra-Abdominal Abscess in Patients with Crohn Disease in China: Risk of Extended-Spectrum Beta-Lactamase-Producing Bacteria. Surg Infect (Larchmt). 2015;16:461–5.
doi: 10.1089/sur.2013.181
Maseda E, Ramírez S, Picatto P, Peláez-Peláez E, García-Bernedo C, Ojeda-Betancur N, et al. Critically ill patients with community-onset intraabdominal infections: Influence of healthcare exposure on resistance rates and mortality. PLoS ONE. 2019;14:e0223092.
doi: 10.1371/journal.pone.0223092
Coque TM, Baquero F, Canton R. (2008) Increasing prevalence of ESBL-producing Enterobacteriaceae in Europe. Euro Surveill 13: pii: 19044.
Cantón R, Novais A, Valverde A, Machado E, Peixe L, Baquero F, et al. Prevalence and spread of extended-spectrum b-lactamase producing enterobacteriaceae in Europe. Clin Microbiol Infect. 2008;14:144–53.
doi: 10.1111/j.1469-0691.2007.01850.x
Routsi C, Pratikaki M, Platsouka E, Sotiropoulou C, Papas V, Pitsiolis T, et al. Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients. Intensive Care Med. 2013;39:1253–61.
doi: 10.1007/s00134-013-2914-z
Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Argyropoulou A, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother. 2014;58:2322–8.
doi: 10.1128/AAC.02166-13
Bennion RS, Baron EJ, Thompson JE Jr, Downes J, Summanen P, Talan DA, et al. The bacteriology of gangrenous and perforated appendicitis–revisited. Ann Surg. 1990;211:165–71.
doi: 10.1097/00000658-199002000-00008
Montuori M, Santurro L, Gianotti L, Fattori L. Uselessness of microbiological samples in acute appendicitis with frank pus: to collect or not to collect? Eur J Trauma Emerg Surg. 2020;46:835–9.
doi: 10.1007/s00068-018-1031-7
Chen CY, Chen YC, Pu HN, Tsai CH, Chen WT, Lin CH. Bacteriology of acute appendicitis and its implication for the use of prophylactic antibiotics. Surg Infect (Larchmt). 2012;13:383–90.
doi: 10.1089/sur.2011.135
Reinisch A, Malkomes P, Habbe N, Bechstein WO, Liese J. Bad bacteria in acute appendicitis: rare but relevant. Int J Colorectal Dis. 2017;32:1303–11.
doi: 10.1007/s00384-017-2862-0
Andrey V, Crisinel PA, Prod’hom G, Croxatto A, Joseph JM. Impact of co-amoxicillin-resistant Escherichia coli and Pseudomonas aeruginosa on the rate of infectious complications in paediatric complicated appendicitis. Swiss Med Wkly. 2019;149:w20055.
pubmed: 31026042
Augustin P, Tran-Dinh A, Valin N, Desmard M, Crevecoeur MA, Muller-Serieys C, et al. Pseudomonas aeruginosa post-operative peritonitis: clinical features, risk factors, and prognosis. Surg Infect (Larchmt). 2013;14:297–303.
doi: 10.1089/sur.2012.084
Montravers P, Dupont H, Leone M, Constantin JM, Mertes PM; Société française d’anesthésie et de réanimation (Sfar) et al. Guidelines for management of intra-abdominal infections. Anaesth Crit Care Pain Med 2015; 34: 117–30.
Fortún J, Coque TM, Martín-Dávila P, Moreno L, Cantón R, Loza E, et al. Risk factors associated with ampicillin resistance in patients with bacteraemia caused by Enterococcus faecium. J Antimicrob Chemother. 2002;50:1003–9.
doi: 10.1093/jac/dkf216
Tedim AP, Ruiz-Garbajosa P, Corander J, Rodríguez CM, Cantón R, Willems RJ, et al. Population biology of intestinal enterococcus isolates from hospitalized and nonhospitalized individuals in different age groups. Appl Environ Microbiol. 2015;81:1820–31.
doi: 10.1128/AEM.03661-14
Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61–111.
doi: 10.1093/cid/ciw353
Torres A, Chalmers JD, Dela Cruz CS, Dominedò C, Kollef M, Martin-Loeches I, et al. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Med. 2019;45:159–71.
doi: 10.1007/s00134-019-05519-y
Masadeh M, Chandra S, Livorsi D, Johlin F, Silverman W. Evaluation of Biliary Bacterial Resistance in Patients with Frequent Biliary Instrumentation, One Size Does Not Fit All. Dig Dis Sci. 2018;63:3474–9.
doi: 10.1007/s10620-018-5263-5
Serra-Burriel M, Keys M, Campillo-Artero C, Agodi A, Barchitta M, Gikas A, et al. Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PLoS ONE. 2020;15:e0227139.
doi: 10.1371/journal.pone.0227139