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Eberhard A, Mellhammar L. Extended-spectrum beta-lactamase-producing Enterobacterales in patients with suspected sepsis in an acute care setting in Skåne, Sweden: a cohort study. Infect Dis (Lond) 2024; 56:285-292. [PMID: 38163931 DOI: 10.1080/23744235.2023.2299676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Epidemiological data on extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales are most often based on microbiological laboratory isolates and do not consider important clinical data such as infection or colonisation, treatment, and outcome. This study aimed to assess prevalence of ESBL-producing Enterobacterales as the cause of infection in patients with suspected sepsis in the emergency department based on clinical data. It also examined the number of patients with suspected sepsis who had ESBL-producing pathogens, comparing estimates that were based on laboratory data versus a combination of laboratory and clinical data. METHODS Patients with suspected sepsis in the emergency department at Skåne University Hospital, Lund, Sweden were included consecutively. Data were collected retrospectively from medical records. RESULTS Of the 764 included patients, 223 patients had growth of Enterobacterales in any specimen (i.e. colonisation or infection according to laboratory data), while 191 patients had Enterobacterales detected in the blood or in the suspected focus of infection (i.e. an infection according to clinical and laboratory data). Eighteen patients had ESBL-producing Enterobacterales in any clinical specimen, 11 of whom had an infection with ESBL-producing Enterobacterales, resulting in a prevalence of infections with ESBL-producing Enterobacterales in infected patients with suspected sepsis of 1.8%. The number of patients with ESBL-producing Enterobacterales was not significantly different when infection was defined using laboratory data alone versus a combination of laboratory and clinical data [18/223 (8.1%) vs 11/191 (5.8%), p = 0.36]. CONCLUSIONS The prevalence of ESBL-producing Enterobacterales infections among patients with suspected sepsis is low in an acute care setting in Sweden.
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Affiliation(s)
- Arvid Eberhard
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Lisa Mellhammar
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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Prevalence and patient related factors associated with Extended-Spectrum Beta-Lactamase producing Escherichia coli and Klebsiella pneumoniae carriage and infection among pediatric patients in Tanzania. Sci Rep 2021; 11:22759. [PMID: 34815472 PMCID: PMC8611091 DOI: 10.1038/s41598-021-02186-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/03/2021] [Indexed: 12/26/2022] Open
Abstract
Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (EPE) is increasing worldwide, though less documented in low-income settings. Here we determined the prevalence of EPE infection and carriage, and patient factors associated with EPE-carriage among pediatric patients in three health care levels in Tanzania. Between January and April 2016, 350 febrile children (median age 21 months) seeking care at a university or a regional referral hospital, or a health centre in Moshi municipality, Tanzania, were included. Socio-demographic characteristics were collected using a questionnaire. Rectal swabs and blood cultures were collected from all children (n = 350) and urinary samples from 259 children at admission. ESBL-phenotype and antimicrobial susceptibility were determined for Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) isolates. Only one EPE case (E. coli) in blood and four in urine (one E. coli and three K. pneumoniae) were found, whereas (n = 90, 26%) of the children were colonized in feces (ESBL-E. coli; n = 76, ESBL-K. pneumoniae, n = 14). High resistance rates were seen in fecal ESBL-E. coli (n = 76) against trimethoprim-sulfamethoxazole (n = 69, 91%), gentamicin (n = 51, 67%), ciprofloxacin (n = 39, 51%) and chloramphenicol (n = 27, 35%) whereas most isolates were sensitive to amikacin (n = 71, 93%). Similar rates were seen for fecal ESBL-K. pneumoniae. Resistance to first line antibiotics were also very high in fecal E. coli not producing ESBL. No sociodemographic factor was associated with EPE-carriage. Children colonized with EPE were younger than 12 months (n = 43, 48%) and often treated with antibiotics (n = 40, 44%) in the previous two months. After adjustment for age children admitted to the intensive care unit had higher odds of EPE fecal carriage compared with those in the general wards (OR = 3.9, 95%CI = 1.4–10.4). Despite comparatively high rates of fecal EPE-carriage and previous antibiotic treatment, clinical EPE cases were rare in the febrile children. The very high resistant rates for the EPE and the non-ESBL producing E. coli to commonly used antibiotics are worrying and demand implementation of antibiotic stewardship programs in all levels of health care in Tanzania.
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Edlund C, Ternhag A, Skoog Ståhlgren G, Edquist P, Östholm Balkhed Å, Athlin S, Månsson E, Tempé M, Bergström J, Giske CG, Hanberger H. The clinical and microbiological efficacy of temocillin versus cefotaxime in adults with febrile urinary tract infection, and its effects on the intestinal microbiota: a randomised multicentre clinical trial in Sweden. THE LANCET. INFECTIOUS DISEASES 2021; 22:390-400. [PMID: 34756180 DOI: 10.1016/s1473-3099(21)00407-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/17/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Use of third-generation cephalosporins, such as cefotaxime, is associated with an increased risk of selection for antimicrobial resistance, so alternative antibiotics need to be considered. The aim of the present study was to evaluate intestinal colonisation with third-generation cephalosporin-resistant pathogens following use of temocillin-an alternative antibiotic to cefotaxime that is potentially less prone to disturbing the intestinal microbiota-in empirical treatment of febrile urinary tract infection (UTI). METHODS We did a randomised, multicentre, superiority, open-label phase 4 trial in patients who had been admitted to inpatient care in 12 Swedish hospitals with suspected or diagnosed febrile UTI (complicated or uncomplicated). To meet inclusion criteria, a patient was required to have at least one sign or symptom of pyelonephritis (ie, flank pain; costovertebral angle tenderness; and changes to urinary frequency or urgency or dysuria), a fever of 38·0°C or higher, and a positive urine dipstick (for nitrites, white blood cells, or both). Participants were also required to have an indication for intravenous antibiotic treatment. Participants were randomly assigned (1:1) to receive either 2 g temocillin or 1-2 g cefotaxime, by local investigators opening consecutive sealed randomisation envelopes that were generated centrally in advance. Both drugs were administered intravenously every 8 h. The trial was open label for investigators and patients, but those doing the microbiological analyses were masked to the groups. Participants were treated with antibiotics for 7-10 days (or up to 14 days if they had bacteraemia), at least 3 days of which were on the study drug; at day 4 and later, participants who were showing improvement could be given an oral antibiotic (ciprofloxacin, ceftibuten, cefixime, or co-trimoxazole). Patients not showing improvement were regarded as having treatment failures. Rectal swabs were collected at three timepoints: at baseline (before the first dose), after the last dose of study drug, and 7-10 days after treatment stopped. The composite primary outcome was colonisation with Enterobacterales with reduced susceptibility to third-generation cephalosporins, or colonisation with toxin-producing Clostridioides difficile, or both, to evaluate disturbance of the intestinal microbiota. The study is registered in the EU Clinical Trials Register (EudraCT 2015-003898-15). FINDINGS Between May 20, 2016, and July 31, 2019, 207 patients were screened for eligibility, of whom 55 patients were excluded. 152 participants were randomly assigned to groups: 77 (51%) patients received temocillin, 75 (49%) patients received cefotaxime. The composite primary endpoint was met by 18 (26%) of 68 participants receiving temocillin versus 30 (48%) of 62 patients receiving cefotaxime (risk difference -22% [95% CI -42% to -3%]), showing superiority of temocillin versus cefotaxime (ie, less disturbance of the intestinal microbiota). 43 adverse events were reported in 40 (52%) of 77 patients in the temocillin group, versus 46 adverse events in 34 (45%) of 75 patients in the cefotaxime group. Most events were of mild to moderate severity. 21 (27%) patients in the temocillin and 17 (23%) patients in the cefotaxime group had an adverse event that was considered to be associated with the study drug. INTERPRETATION Temocillin was found to be less selective than cefotaxime of Enterobacterales with reduced susceptibility to third-generation cephalosporins, and it could therefore be a favourable alternative in the empirical treatment of febrile UTI. Use of this antibiotic could reduce hospital transmission and health-care-associated infections by these pathogens. FUNDING Public Health Agency of Sweden.
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Affiliation(s)
| | - Anders Ternhag
- The Public Health Agency of Sweden, Solna, Sweden; Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | | | | | - Åse Östholm Balkhed
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Simon Athlin
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Emeli Månsson
- Department of Infectious Diseases and Centre of Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Maria Tempé
- Sundsvall Härnösand Regional Hospital, Sundsvall, Sweden
| | | | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Solna, Sweden; Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Håkan Hanberger
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.
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Nijsingh N, Munthe C, Lindblom A, Åhrén C. Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable? Monash Bioeth Rev 2021; 38:72-90. [PMID: 32356217 PMCID: PMC7749868 DOI: 10.1007/s40592-020-00113-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.
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Affiliation(s)
- Niels Nijsingh
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden. .,Department of Philosophy, Linguistics and Theory of Science (FLoV), University of Gothenburg, Gothenburg, Sweden. .,Institute for Ethics, History and Theory of Medicine, Ludwig-Maximilians University, Lessingstr. 2, 80336, Munich, Germany.
| | - Christian Munthe
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Philosophy, Linguistics and Theory of Science (FLoV), University of Gothenburg, Gothenburg, Sweden
| | - Anna Lindblom
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Åhrén
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden.,Swedish Strategic Program Against Antimicrobial Resistance (Strama), Region Västra Götaland, Gothenburg, Sweden
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Zhou Y, Zhang S. Early prediction models for extended-spectrum β-lactamase-producing Escherichia coli infection in emergency department: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e25504. [PMID: 33847667 PMCID: PMC8052042 DOI: 10.1097/md.0000000000025504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Resistance in gram-negative bacteria has gained great importance in recent decades and one reason is the rapid increase of extended spectrum β-lactamase (ESBL)-producing bacteria as a growing problem worldwide. The increasing proportion of ESBL-producing Enterobacteriaceae (ESBL-E) infections acquired in the emergency community is a new feature of ESBLs epidemiology. Early recognition of patients with extended-spectrum β-lactamase-producing Escherichia coli infection is important in the emergency department. To mitigate the burden on the healthcare system, while also providing the best possible care for patients, early recognition of the infection is needed. METHODS For the acquisition of required data of eligible prospective/retrospective cohort study or randomized controlled trials (RCTs), we will search for publications from PubMed, Web of science, EMBASE, Cochrane Library, Google scholar. Two independent reviewers will read the full English text of the articles, screened and selected carefully, removing duplication. Then we evaluate the quality and analyses data by Review Manager (V.5.4). Results data will be pooled and meta-analysis will be conducted if there's 2 eligible studies considered. RESULTS This systematic review and meta-analysis will evaluate the value of the early prediction models for Extended-spectrum β-lactamase-producing E coli infection in emergency department. CONCLUSIONS This systematic review and meta-analysis will provide clinical evidence for predicting Extended-spectrum β-lactamase-producing E coli infection in emergency department, inform our understanding of the value of the predictive model in predicting Extended-spectrum β-lactamase-producing E coli infection in emergency department in the early stage. The conclusions drawn from this study may be beneficial to patients, clinicians, and health-related policy makers. STUDY REGISTRATION NUMBER INPLASY202130049.
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Richelsen R, Smit J, Laxsen Anru P, Schønheyder HC, Nielsen H. Risk factors of community-onset extended-spectrum β-lactamase Escherichia coli and Klebsiella pneumoniae bacteraemia: an 11-year population-based case-control-control study in Denmark. Clin Microbiol Infect 2020; 27:871-877. [PMID: 32781243 DOI: 10.1016/j.cmi.2020.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate and explore temporal changes in risk factors of community-onset extended-spectrum β-lactamase (ESBL) Escherichia coli and Klebsiella pneumoniae bacteraemia in a region with low antibiotic resistance. METHODS Population-based case-control study including 223 cases hospitalized with a first-time community-onset ESBL-producing E. coli and K. pneumoniae bacteraemia, 2214 non-ESBL E. coli and K. pneumoniae bacteraemia controls, and 2228 population controls in the North Denmark Region between 2007 and 2017. We used a conditional logistic regression to compute crude and adjusted (age, gender and co-morbidity) odds ratios (aORs) and 95% CIs of risk factors and compared selected risk factors between 2007-2011 and 2016-2017. RESULTS Several conventional risk factors of ESBL E. coli or K. pneumoniae were identified compared with the population controls. Compared with the non-ESBL controls, use of fluoroquinolones (aOR 3.56, 95% CI 2.52-5.05), three or more admissions within the recent year (aOR 2.18, 95% CI 1.45-3.28), three or more antibiotic prescriptions within 15-365 days before the admission (aOR 2.18, 95% CI 1.53-3.10), male sex (aOR 2.01, 95% CI 1.50-2.69), admission within 1-91 days (aOR 1.84, 95% CI 1.37-2.48) and antibiotic within 15-91 days (aOR 1.82, 95% CI 1.37-2.42) inferred the highest risk. Assessment of temporal dynamics between 2007-2011 and 2016-2017 revealed a slight reduction in risk factors associated with direct health-care contact (e.g. hospital admission). CONCLUSIONS Recent and frequent hospitalization, and exposure to antibiotics, especially use of fluoroquinolones, appeared to be associated specifically with ESBL production, and focus and interventions should be directed towards these areas. Our results indicated a dissemination of ESBLs into the community.
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Affiliation(s)
- Rasmus Richelsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Jesper Smit
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Henrik Carl Schønheyder
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Extended-Spectrum-β-Lactamase- and Plasmid AmpC-Producing Escherichia coli Causing Community-Onset Bloodstream Infection: Association of Bacterial Clones and Virulence Genes with Septic Shock, Source of Infection, and Recurrence. Antimicrob Agents Chemother 2020; 64:AAC.02351-19. [PMID: 32423949 DOI: 10.1128/aac.02351-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/06/2020] [Indexed: 11/20/2022] Open
Abstract
Invasive infections due to extended-spectrum-β-lactamase- and pAmpC-producing Escherichia coli (ESBL/pAmpC-EC) are an important cause of morbidity, often caused by the high-risk clone sequence type (ST131) and isolates classified as extraintestinal pathogenic E. coli (ExPEC). The relative influence of host immunocompetence versus microbiological virulence factors in the acquisition and outcome of bloodstream infections (BSI) is poorly understood. Herein, we used whole-genome sequencing on 278 blood culture isolates of ESBL/pAmpC-EC from 260 patients with community-onset BSI collected from 2012 to 2015 in Stockholm to study the association of virulence genes, sequence types, and antimicrobial resistance with severity of disease, infection source, ESBL/pAmpC-EC BSI low-risk patients, and patients with repeated episodes. ST131 subclade C2 comprised 29% of all patients. Factors associated with septic shock in multivariable analysis were patient host factors (hematologic cancer or transplantation and reduced daily living activity), presence of the E. coli virulence factor iss (increased serum survival), absence of phenotypic multidrug resistance, and absence of the genes pap and hsp Adhesins, particularly pap, were associated with urinary tract infection (UTI) source, while isolates from post-prostate biopsy sepsis had a low overall number of virulence operons, including adhesins, and commonly belonged to ST131 clades A, B, and subclade C1, ST1193, and ST648. ST131 was associated with recurrent episodes. In conclusion, the most interesting finding is the association of iss with septic shock. Adhesins are important for UTI pathogenesis, while otherwise low-pathogenic isolates from the microbiota can cause post-prostate biopsy sepsis.
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Deelen JWT, Rottier WC, Giron Ortega JA, Rodriguez-Baño J, Harbarth S, Tacconelli E, Jacobsson G, Zahar JR, van Werkhoven CH, Bonten MJM. An international prospective cohort study to validate two prediction rules for infections caused by 3rd-generation cephalosporin-resistant Enterobacterales. Clin Infect Dis 2020; 73:e4475-e4483. [PMID: 32640024 PMCID: PMC8849131 DOI: 10.1093/cid/ciaa950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background The possibility of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacterales (3GC-R-BSI) leads to a trade-off between empiric inappropriate treatment (IAT) and unnecessary carbapenem use (UCU). Accurately predicting 3GC-R-BSI could reduce IAT and UCU. We externally validate 2 previously derived prediction rules for community-onset (CO) and hospital-onset (HO) suspected bloodstream infections. Methods In 33 hospitals in 13 countries we prospectively enrolled 200 patients per hospital in whom blood cultures were obtained and intravenous antibiotics with coverage for Enterobacterales were empirically started. Cases were defined as 3GC-R-BSI or 3GC-R gram-negative infection (3GC-R-GNI) (analysis 2); all other outcomes served as a comparator. Model discrimination and calibration were assessed. Impact on carbapenem use was assessed at several cutoff points. Results 4650 CO infection episodes were included and the prevalence of 3GC-R-BSI was 2.1% (n = 97). IAT occurred in 69 of 97 (71.1%) 3GC-R-BSI and UCU in 398 of 4553 non–3GC-R-BSI patients (8.7%). Model calibration was good, and the AUC was .79 (95% CI, .75–.83) for 3GC-R-BSI. The prediction rule potentially reduced IAT to 62% (60/97) while keeping UCU comparable at 8.4% or could reduce UCU to 6.3% (287/4553) while keeping IAT equal. IAT and UCU in all 3GC-R-GNIs (analysis 2) improved at similar percentages. 1683 HO infection episodes were included and the prevalence of 3GC-R-BSI was 4.9% (n = 83). Here model calibration was insufficient. Conclusions A prediction rule for CO 3GC-R infection was validated in an international cohort and could improve empirical antibiotic use. Validation of the HO rule yielded suboptimal performance.
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Affiliation(s)
- J W Timotëus Deelen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter C Rottier
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - José A Giron Ortega
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Jesús Rodriguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Gunnar Jacobsson
- Region Västra Götaland, Skaraborg Hospital, Department of Infectious Diseases, Skövde, Sweden
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Rue de Stalingrad, Bobigny, France
| | - Cornelis H van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Holmgren A, Ljung A, Bremell D. An easy-to-use scoring system for predicting bacteraemia with third-generation cephalosporin-resistant Enterobacterales in a low-resistance setting. Infect Dis (Lond) 2019; 52:242-248. [PMID: 31868053 DOI: 10.1080/23744235.2019.1705389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: The incidence of third-generation cephalosporin-resistant Enterobacterales (3GCR-E) is increasing and a growing number of patients risk receiving inappropriate initial antibiotic treatment. Published scoring systems for predicting 3GCR-E bacteraemia are mostly based on studies from countries with a high incidence. In this study, we aimed to create an easy-to-use scoring system for predicting bacteraemia with these bacteria in a low-resistance setting.Materials and methods: Factors associated with 3GCR-E were studied retrospectively in a cohort of patients with Enterobacterales bacteraemia using uni- and multivariate analysis. A scoring system was constructed and was validated in a separate cohort of patients with Enterobacterales bacteraemia.Results: The derivation cohort comprised 625 cases of Enterobacterales bacteraemia. Three variables (previous hospital care abroad, 3GCR-E in a previous blood or urine culture and 3GCR-E in a previous rectal swab culture) were significantly associated with 3GCR-E bacteraemia. A scoring system, where at least one positive parameter equalled a positive score, was studied in the validation cohort, which comprised 675 cases of Enterobacterales bacteraemia. The sensitivity and specificity of the score were 53% and 95%, respectively. Positive and negative predictive values were 38% and 97%, respectively.Conclusions: This study presents an easy-to-use scoring system for predicting bacteraemia with 3GCR-E. The performance of the score is similar to that of several other, more complicated, scoring systems, developed in countries with higher rates of resistance. The minimal extra effort required to use this new score could facilitate its introduction into clinical routine.
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Affiliation(s)
- Annika Holmgren
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Ljung
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Bremell
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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