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Clinical Impact of Sequence Type 131 in Adults with Community-Onset Monomicrobial Escherichia Coli Bacteremia

Background: The clinical impact of ST (sequence type) 131 in adults with community-onset Escherichia coli bacteremia remains controversial. Methods: Clinical data of 843 adults presenting with community-onset monomicrobial E. coli bacteremia at a medical center between 2008 and 2013 were collected....

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Detalles Bibliográficos
Autores principales: Wang, Jiun-Ling, Lee, Ching-Chi, Lee, Chung-Hsun, Lee, Nan-Yao, Hsieh, Chih-Chia, Hung, Yuan-Pin, Tang, Hung-Jen, Ko, Wen-Chien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306926/
https://www.ncbi.nlm.nih.gov/pubmed/30513864
http://dx.doi.org/10.3390/jcm7120508
Descripción
Sumario:Background: The clinical impact of ST (sequence type) 131 in adults with community-onset Escherichia coli bacteremia remains controversial. Methods: Clinical data of 843 adults presenting with community-onset monomicrobial E. coli bacteremia at a medical center between 2008 and 2013 were collected. E. coli isolates were genotyped by a multiplex polymerase chain reaction to detect ST131 and non-ST131 clones. Results: Of 843 isolates from 843 patients with a mean age of 69 years, there were 102 (12.1%) isolates of ST131. The ST131 clone was more likely to be found in the elderly (76.5% vs. 64.0%; p = 0.01) and in nursing-home residents (12.7% vs. 3.8%; p < 0.001) than non-ST131 clones. Furthermore, the ST131 clone was associated with a longer time to appropriate antibiotic therapy (2.6 vs. 0.8 days; p = 0.004) and a higher 28-day mortality rate (14.7% vs. 6.5%, p = 0.003). In the Cox regression analysis with an adjustment of independent predictors, the ST131 clone exhibited a significant adverse impact on 28-day mortality (adjusted odds ratio (aOR), 2.18; p = 0.02). The different impact of the ST131 clone on 28-day mortality was disclosed in the non-ESBL (aOR 1.27; p = 0.70) and ESBL (aOR 10.19; p = 0.048) subgroups. Conclusions: Among adults with community-onset E. coli bacteremia, the ST131 clone was associated with higher 28-day mortality, particularly in those infected by ESBL producers.