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Risk factors, outcome and impact of empirical antimicrobial treatment in extended-spectrum β-lactamase-producing Escherichia coli bacteraemia.

Van Aken, Stefanie; Lund, Nathalie LU ; Ahl, Jonas LU ; Odenholt, Inga LU and Tham, Johan LU (2014) In Scandinavian Journal of Infectious Diseases 46(11). p.753-762
Abstract
Background: To investigate patient characteristics and empirical antimicrobial treatment of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) bacteraemia, to determine risk factors, outcome and impact of empirical antimicrobial treatment. Methods: We performed a retrospective case-control study of all patients diagnosed with ESBL-EC from January 2011 to September 2012. The control group consisted of patients with non-ESBL E. coli bacteraemia. The groups were compared with respect to empirical treatment, risk factors and outcome, using univariate and multivariate analysis. Results: The study consisted of 70 consecutive cases of ESBL-producing and 140 controls of non-ESBL-producing E. coli bacteraemia. ESBL-EC prevalence of... (More)
Background: To investigate patient characteristics and empirical antimicrobial treatment of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) bacteraemia, to determine risk factors, outcome and impact of empirical antimicrobial treatment. Methods: We performed a retrospective case-control study of all patients diagnosed with ESBL-EC from January 2011 to September 2012. The control group consisted of patients with non-ESBL E. coli bacteraemia. The groups were compared with respect to empirical treatment, risk factors and outcome, using univariate and multivariate analysis. Results: The study consisted of 70 consecutive cases of ESBL-producing and 140 controls of non-ESBL-producing E. coli bacteraemia. ESBL-EC prevalence of bloodstream invasive E. coli isolates was 6.1%. The independent risk factor found for ESBL-EC bacteraemia was a prior culture with ESBL production (p < 0.001). A higher frequency of inappropriate empirical antibiotic treatment (p < 0.001) and a trend towards worse outcome was observed in patients infected with ESBL-EC and empirical guidelines were more often not followed (p = 0.013). If the guidelines were followed this was associated with adequate initial antibiotic treatment (p < 0.001). Conclusions: Patients with ESBL-EC frequently received inappropriate empirical treatment and guidelines were more often not followed. A prior culture of ESBL-producing bacteria was an independent predictor and risk factor for ESBL-EC bacteraemia. Since the prevalence of ESBL-producing E. coli is increasing the importance of adequate guidelines must be emphasized. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Infectious Diseases
volume
46
issue
11
pages
753 - 762
publisher
Informa Healthcare
external identifiers
  • pmid:25195648
  • wos:000343977500003
  • scopus:84912011262
ISSN
1651-1980
DOI
10.3109/00365548.2014.937454
language
English
LU publication?
yes
id
1d82f129-7070-417f-b9c5-405a3550b051 (old id 4692131)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25195648?dopt=Abstract
date added to LUP
2014-10-03 23:54:02
date last changed
2017-11-12 03:15:41
@article{1d82f129-7070-417f-b9c5-405a3550b051,
  abstract     = {Background: To investigate patient characteristics and empirical antimicrobial treatment of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) bacteraemia, to determine risk factors, outcome and impact of empirical antimicrobial treatment. Methods: We performed a retrospective case-control study of all patients diagnosed with ESBL-EC from January 2011 to September 2012. The control group consisted of patients with non-ESBL E. coli bacteraemia. The groups were compared with respect to empirical treatment, risk factors and outcome, using univariate and multivariate analysis. Results: The study consisted of 70 consecutive cases of ESBL-producing and 140 controls of non-ESBL-producing E. coli bacteraemia. ESBL-EC prevalence of bloodstream invasive E. coli isolates was 6.1%. The independent risk factor found for ESBL-EC bacteraemia was a prior culture with ESBL production (p &lt; 0.001). A higher frequency of inappropriate empirical antibiotic treatment (p &lt; 0.001) and a trend towards worse outcome was observed in patients infected with ESBL-EC and empirical guidelines were more often not followed (p = 0.013). If the guidelines were followed this was associated with adequate initial antibiotic treatment (p &lt; 0.001). Conclusions: Patients with ESBL-EC frequently received inappropriate empirical treatment and guidelines were more often not followed. A prior culture of ESBL-producing bacteria was an independent predictor and risk factor for ESBL-EC bacteraemia. Since the prevalence of ESBL-producing E. coli is increasing the importance of adequate guidelines must be emphasized.},
  author       = {Van Aken, Stefanie and Lund, Nathalie and Ahl, Jonas and Odenholt, Inga and Tham, Johan},
  issn         = {1651-1980},
  language     = {eng},
  number       = {11},
  pages        = {753--762},
  publisher    = {Informa Healthcare},
  series       = {Scandinavian Journal of Infectious Diseases},
  title        = {Risk factors, outcome and impact of empirical antimicrobial treatment in extended-spectrum β-lactamase-producing Escherichia coli bacteraemia.},
  url          = {http://dx.doi.org/10.3109/00365548.2014.937454},
  volume       = {46},
  year         = {2014},
}