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Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections
OBJECTIVES: Healthcare-associated bacteraemia is defined as bacteraemia diagnosed ≤48 h after hospital admission in patients recently exposed to healthcare procedures or settings. It differs from hospital-acquired bacteraemia, which is diagnosed >48 h after hospital admission. Healthcare-associat...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9995923/ https://www.ncbi.nlm.nih.gov/pubmed/36910842 http://dx.doi.org/10.1016/j.ijregi.2023.01.005 |
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author | Peri, Anna Maria Calabretta, Davide Bozzi, Giorgio Migliorino, Guglielmo Marco Bramati, Simone Gori, Andrea Bandera, Alessandra |
author_facet | Peri, Anna Maria Calabretta, Davide Bozzi, Giorgio Migliorino, Guglielmo Marco Bramati, Simone Gori, Andrea Bandera, Alessandra |
author_sort | Peri, Anna Maria |
collection | PubMed |
description | OBJECTIVES: Healthcare-associated bacteraemia is defined as bacteraemia diagnosed ≤48 h after hospital admission in patients recently exposed to healthcare procedures or settings. It differs from hospital-acquired bacteraemia, which is diagnosed >48 h after hospital admission. Healthcare-associated bacteraemia is reported increasingly, often due to resistant pathogens including extended-spectrum beta-lactamase (ESBL) producers, representing a challenge to empirical treatment. This study aimed to assess the appropriateness of empirical treatment for ESBL bacteraemia at the authors’ centre, to perform a descriptive analysis according to the mode of infection acquisition (community-acquired, healthcare-associated, hospital-acquired), and to assess the risk factors for mortality. METHODS: A retrospective study on patients with ESBL bacteraemia was undertaken. RESULTS: In total, 129 consecutive cases of bacteraemia due to ESBL producers were included in this study. Compared with community- and hospital-acquired bacteraemia, healthcare-associated bacteraemia affected older patients (P=0.001) and patients with higher Charlson Comorbidity Index scores (P=0.007), and was more frequently associated with piperacillin-tazobactam resistance (P=0.025) and multi-drug resistance (P=0.026). Overall, ineffective empirical treatment was common (42%). Factors associated with 30-day mortality were septic shock [odds ratio (OR) 7.096, 95% confidence interval (CI) 2.58–24.58], high Pitt score (OR 6.636, 95% CI 1.71–23.62) and unknown source of bacteraemia (OR 19.28, 95% CI 2.80–30.70). CONCLUSIONS: Antimicrobial stewardship interventions focusing on both in-hospital and community settings are advocated to better manage healthcare-associated infections due to ESBL producers. |
format | Online Article Text |
id | pubmed-9995923 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-99959232023-03-10 Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections Peri, Anna Maria Calabretta, Davide Bozzi, Giorgio Migliorino, Guglielmo Marco Bramati, Simone Gori, Andrea Bandera, Alessandra IJID Reg Short Communication OBJECTIVES: Healthcare-associated bacteraemia is defined as bacteraemia diagnosed ≤48 h after hospital admission in patients recently exposed to healthcare procedures or settings. It differs from hospital-acquired bacteraemia, which is diagnosed >48 h after hospital admission. Healthcare-associated bacteraemia is reported increasingly, often due to resistant pathogens including extended-spectrum beta-lactamase (ESBL) producers, representing a challenge to empirical treatment. This study aimed to assess the appropriateness of empirical treatment for ESBL bacteraemia at the authors’ centre, to perform a descriptive analysis according to the mode of infection acquisition (community-acquired, healthcare-associated, hospital-acquired), and to assess the risk factors for mortality. METHODS: A retrospective study on patients with ESBL bacteraemia was undertaken. RESULTS: In total, 129 consecutive cases of bacteraemia due to ESBL producers were included in this study. Compared with community- and hospital-acquired bacteraemia, healthcare-associated bacteraemia affected older patients (P=0.001) and patients with higher Charlson Comorbidity Index scores (P=0.007), and was more frequently associated with piperacillin-tazobactam resistance (P=0.025) and multi-drug resistance (P=0.026). Overall, ineffective empirical treatment was common (42%). Factors associated with 30-day mortality were septic shock [odds ratio (OR) 7.096, 95% confidence interval (CI) 2.58–24.58], high Pitt score (OR 6.636, 95% CI 1.71–23.62) and unknown source of bacteraemia (OR 19.28, 95% CI 2.80–30.70). CONCLUSIONS: Antimicrobial stewardship interventions focusing on both in-hospital and community settings are advocated to better manage healthcare-associated infections due to ESBL producers. Elsevier 2023-02-12 /pmc/articles/PMC9995923/ /pubmed/36910842 http://dx.doi.org/10.1016/j.ijregi.2023.01.005 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Short Communication Peri, Anna Maria Calabretta, Davide Bozzi, Giorgio Migliorino, Guglielmo Marco Bramati, Simone Gori, Andrea Bandera, Alessandra Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections |
title | Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections |
title_full | Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections |
title_fullStr | Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections |
title_full_unstemmed | Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections |
title_short | Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections |
title_sort | retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing enterobacterales: the challenge of healthcare-associated infections |
topic | Short Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9995923/ https://www.ncbi.nlm.nih.gov/pubmed/36910842 http://dx.doi.org/10.1016/j.ijregi.2023.01.005 |
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