Publication: Bacteriemia por Escherichia coli: factores predictivos de presencia de bacterias productoras de betalactamasas de espectro extendido e influencia de la resistencia en la mortalidad de los pacientes
Authors
García-Hernández, Ana ; García-Vázquez, Elisa ; Gómez Gómez, Joaquín ; Canteras, Manuel ; Hernández-Torres, Alicia ; Ruiz Gómez, Joaquín
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Publisher
Elsevier Doyma
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DOI
https://doi.org/10.1016/j.medcli.2010.05.014
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info:eu-repo/semantics/article
Description
©2010 Elsevier España, S.L. All rights reserved. This document is the Published, version of a Published Work that appeared in final form in Medicina Clínica. To access the final edited and published work see https://doi.org/10.1016/j.medcli.2010.05.014
Abstract
RESUMEN: Fundamento y objetivo: Analizar los factores predictivos de bacteriemia por E. coli productor de betalactamasa de espectro extendido (BLEE) frente a E. coli no productor de BLEE y su repercusión en la mortalidad. Pacientes y método: Estudio observacional de una cohorte de pacientes adultos ingresados con bacteriemia por E. coli. Resultados: Se incluyeron 153 bacteriemia por E. coli (22% eran BLEE). Los factores de riesgo para BLEE fueron:
consumo previo de antibióticos (odds ratio [OR] 2,61; intervalo de confianza del 95% [IC 95%] 1,1–6,19), índice
de Winston <_2 (OR 9,83, IC 95% 3,42–28,26) y adquisición asociada a cuidados sanitarios (OR 5,35; IC 95%
1,57–18,27). La mortalidad relacionada fue del 21%, siendo factores de riesgo: neoplasia de base (OR 4,02; IC
95% 1,08–14,82), gravedad de enfermedad de base (según índice de McCabe) (OR 7,69; IC 95% 1,96–30,09) y
gravedad al diagnóstico (según índice de Winston) (OR 48,89; IC 95% 11,58–206,97). El tratamiento empírico
inadecuado era más frecuente en pacientes con bacteriemia por E. coli BLEE (67%, p<0,05). Conclusiones: El tratamiento antibiótico previo, el índice de Winston <_2 y la adquisición relacionada con cuidados sanitarios se asocian a bacteriemia por E. coli productor de BLEE comparado con no productor. Ni la producción de BLEE ni el tratamiento empírico inadecuado se asociaban a mayor mortalidad, pero sí la existencia de neoplasia de base y la gravedad clínica al diagnóstico
ABSTRACT: Background and objectives: To analyze predictor factors of extended-spectrum betalactamasa (ESBL)- producing E. coli and its repercussion in mortality. Patients and methods: Observational and comparative study of a cohort of non-paediatric admitted patients with E. coli bacteraemia (EB). Results: 153 EB (22% ESBL-producing strains). Risk factors associated with ESBLB: previous antibiotic treatment (OR 2.61; 95% CI 1.1–6.19), severity Winston score <_2 (OR 9.83, 95% CI 3.42–28.26) and health-related acquired infection (OR 5.35; 95% CI 1.57–18.27). Related mortality rate was 21%, being independent risk factors: cancer (OR 4.02; 95% CI 1.08–14.82), high severity of underlying disease (McCabe) (OR 7.69; 95% CI 1.96–30.09) and critical severity of illness at onset (Winston) (OR 48.89; 95% CI 11.58–206.97). Inappropriate empirical therapy was more frequent in EBSL-producing group (67%, p<0.05). Conclusions: Previous antibiotic treatment, severity Winston score <_2 and health-related acquisition are factors associated to ESBL EB. EBSL-producing strains or inadequate treatment were not associated to higher mortality. Factors statistically associated to mortality were cancer, severity of underlying diseases and critical severity of illness at onset.
ABSTRACT: Background and objectives: To analyze predictor factors of extended-spectrum betalactamasa (ESBL)- producing E. coli and its repercussion in mortality. Patients and methods: Observational and comparative study of a cohort of non-paediatric admitted patients with E. coli bacteraemia (EB). Results: 153 EB (22% ESBL-producing strains). Risk factors associated with ESBLB: previous antibiotic treatment (OR 2.61; 95% CI 1.1–6.19), severity Winston score <_2 (OR 9.83, 95% CI 3.42–28.26) and health-related acquired infection (OR 5.35; 95% CI 1.57–18.27). Related mortality rate was 21%, being independent risk factors: cancer (OR 4.02; 95% CI 1.08–14.82), high severity of underlying disease (McCabe) (OR 7.69; 95% CI 1.96–30.09) and critical severity of illness at onset (Winston) (OR 48.89; 95% CI 11.58–206.97). Inappropriate empirical therapy was more frequent in EBSL-producing group (67%, p<0.05). Conclusions: Previous antibiotic treatment, severity Winston score <_2 and health-related acquisition are factors associated to ESBL EB. EBSL-producing strains or inadequate treatment were not associated to higher mortality. Factors statistically associated to mortality were cancer, severity of underlying diseases and critical severity of illness at onset.
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Citation
Med Clin (Barc). 2011 136(2):56–60
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