Role of place of acquisition and inappropriate empirical antibiotic therapy on the outcome of extended-spectrum β-lactamase-producing Enterobacteriaceae infections

Roberto Cauda, Evelina Tacconelli, Maria Adriana Cataldo, Nico T Mutters, Elena Carrara, Alessandro Bartoloni, Annibale Raglio, Elisabetta Mantengoli, Francesco Luzzaro, Angelo Pan, Lia A Beccara, Patrizia Pecile, Marco Tinelli, Gian Maria Rossolini

Risultato della ricerca: Contributo in rivistaArticolo in rivista

9 Citazioni (Scopus)

Abstract

Abstract The impact of inappropriate empirical antibiotic therapy (IEAT) on the outcome of severe infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-Ent) remains unclear. Current evidence is limited by study design and lack of confounder control. The main objective of this study was to define the outcome of severe infections due to ESBL-Ent according to clinical parameters and place of infection acquisition. Adult hospitalised patients with ESBL-Ent infections were included in a 3-year multicentre prospective study. Primary outcomes were IEAT rates and crude mortality of severe infections, adjusted by place of acquisition [community-acquired infection (CAI), healthcare-associated infection (HCAI) and hospital-acquired infection (HAI)]. Among 729 patients, 519 (71.2%) were diagnosed with HAI, 176 (24.1%) with HCAI and 34 (4.7%) with CAI. Moreover, 32.9% of patients received IEAT; higher rates of IEAT were observed in pneumonia (23%) and deep surgical site infections (19%). HCAIs were more frequently associated with IEAT than HAIs (48.3% vs. 27.9%; OR = 1.7, 95% CI 1.2-2.4). The overall mortality rate for severe infections (n = 264) was 12.1% and was significantly higher in HCAIs (20%) than HAIs (10%) (RR = 2.3, 95% CI 1.01-5.3). IEAT significantly increased the risk of mortality in bloodstream infections (RR = 8.3, 95% CI 2-46.3). Rates of IEAT and overall mortality of ESBL-Ent severe infections were higher in HCAIs than HAIs. Prompt diagnosis of patients with severe HCAIs due to ESBL-Ent is essential since these infections receive high rates of IEAT and significantly higher mortality than HAIs
Lingua originaleEnglish
pagine (da-a)49-54
Numero di pagine6
RivistaInternational Journal of Antimicrobial Agents
Volume54
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents
  • Community-acquired infection
  • Drug Therapy
  • ESBL
  • Enterobacteriaceae
  • Enterobacteriaceae Infections
  • Extended-spectrum β-lactamase
  • Female
  • Humans
  • Inappropriate antibiotic therapy
  • Male
  • Middle Aged
  • Prospective Studies
  • Survival Analysis
  • Treatment Outcome
  • Young Adult
  • beta-Lactam Resistance
  • beta-Lactamases

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