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Clinical and microbiological determinants of severe and fatal outcomes in patients infected with Enterobacteriaceae producing extended-spectrum β-lactamase

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Abstract

Although extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have become a worldwide public health concern, little is known regarding the clinical course of colonized or infected individuals. Our objective was to characterize the determinants of fatal outcomes related to ESBL-producing microorganisms at a large hospital in Paris, France. In 2012–2013, all consecutive patients with clinical samples testing positive for ESBL-producing Enterobacteriaceae at Saint-Antoine Hospital were identified. Patient clinical data were obtained at hospital entry, while information on intensive care unit (ICU) admissions and death were prospectively collected. Risk-factors for fatal 1-year outcomes were assessed using logistic regression. In total, 643/4684 (13%) ESBL-positive samples were observed, corresponding to 516 episodes (n = 206, 40% treated) among 330 patients. Most episodes were nosocomial-related (n = 347/516, 67%) involving Escherichia coli (n = 232/516, 45%) or Klebsiella pneumoniae (n = 164/516, 32%). Empirical antibiotic therapy was adequate in 89/206 (43%) infections, while the median length of hospital stay was 30 days [interquartile range (IQR) = 11–55] and 39/201 (19%) were admitted to the ICU. Overall, 104/241 patients (43%) with available data died within 1 year. In the multivariable analysis, 1-year death was associated with age >80 years (p = 0.01), concomitant comorbidity (p = 0.001), nosocomial-acquired infection (p = 0.002), and being infected rather than colonized (p < 0.001). In this series of patients with identified samples of ESBL-producing Enterobacteriaceae, hospital burden was large and 1-year mortality rates high. Understanding which patients in this setting would benefit from broad-spectrum empirical antibiotic therapy should be further examined.

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References

  1. Pitout JD, Laupland KB (2008) Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 8(3):159–66

    Article  CAS  PubMed  Google Scholar 

  2. Talan DA, Takhar SS, Krishnadasan A, Abrahamian FM, Mower WR, Moran GJ; EMERGEncy ID Net Study Group (2016) Fluoroquinolone-resistant and extended-spectrum β-lactamase-producing Escherichia coli infections in patients with pyelonephritis, United States(1). Emerg Infect Dis 22(9)

  3. Lepeule R, Leflon-Guibout V, Vanjak D, Zahar JR, Lafaurie M, Besson C et al; Groupe des Référents en Infectiologie d’Île-de-France (GRIF) (2014) Clinical spectrum of urine cultures positive for ESBL-producing Escherichia coli in hospitalized patients and impact on antibiotic use. Med Mal Infect 44(11–12):530–534

    Article  CAS  PubMed  Google Scholar 

  4. Denis B, Lafaurie M, Donay JL, Fontaine JP, Oksenhendler E, Raffoux E et al (2015) Prevalence, risk factors, and impact on clinical outcome of extended-spectrum beta-lactamase-producing Escherichia coli bacteraemia: a five-year study. Int J Infect Dis 39:1–6

    Article  CAS  PubMed  Google Scholar 

  5. Birgy A, Levy C, Bidet P, Thollot F, Derkx V, Béchet S et al (2016) ESBL-producing Escherichia coli ST131 versus non-ST131: evolution and risk factors of carriage among French children in the community between 2010 and 2015. J Antimicrob Chemother 71(10):2949–2956

    Article  CAS  PubMed  Google Scholar 

  6. Barbier F, Pommier C, Essaied W, Garrouste-Orgeas M, Schwebel C, Ruckly S et al; OUTCOMEREA Study Group (2016) Colonization and infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure? J Antimicrob Chemother 71(4):1088–1097

    Article  CAS  PubMed  Google Scholar 

  7. Dallenne C, Da Costa A, Decré D, Favier C, Arlet G (2010) Development of a set of multiplex PCR assays for the detection of genes encoding important beta-lactamases in Enterobacteriaceae. J Antimicrob Chemother 65(3):490–495. doi:10.1093/jac/dkp498

    Article  CAS  PubMed  Google Scholar 

  8. de La Blanchardière A, Dargère S, Guérin F, Daurel C, Saint-Lorant G, Verdon R et al (2015) Non-carbapenem therapy of urinary tract infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae. Med Mal Infect 45(5):169–172

    Article  Google Scholar 

  9. Arpin C, Quentin C, Grobost F, Cambau E, Robert J, Dubois V et al; Scientific Committee of ONERBA (2009) Nationwide survey of extended-spectrum {beta}-lactamase-producing Enterobacteriaceae in the French community setting. J Antimicrob Chemother 63(6):1205–1214

    Article  CAS  PubMed  Google Scholar 

  10. Nicolas-Chanoine M-H, Gruson C, Bialek-Davenet S, Bertrand X, Thomas-Jean F, Bert F et al (2013) 10-Fold increase (2006–11) in the rate of healthy subjects with extended-spectrum β-lactamase-producing Escherichia coli faecal carriage in a Parisian check-up centre. J Antimicrob Chemother 68(3):562–568

    Article  CAS  PubMed  Google Scholar 

  11. Schwaber MJ, Navon-Venezia S, Kaye KS, Ben-Ami R, Schwartz D, Carmeli Y (2006) Clinical and economic impact of bacteremia with extended- spectrum-beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 50(4):1257–1262

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Tumbarello M, Sanguinetti M, Montuori E, Trecarichi EM, Posteraro B, Fiori B et al (2007) Predictors of mortality in patients with bloodstream infections caused by extended-spectrum-beta-lactamase-producing Enterobacteriaceae: importance of inadequate initial antimicrobial treatment. Antimicrob Agents Chemother 51(6):1987–1994

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Saltoglu N, Karali R, Yemisen M, Ozaras R, Balkan II, Mete B et al (2015) Comparison of community-onset healthcare-associated and hospital-acquired urinary infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and antimicrobial activities. Int J Clin Pract 69(7):766–770

    Article  CAS  PubMed  Google Scholar 

  14. Golan Y (2015) Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract infections: a systematic literature review of current and emerging treatment options. BMC Infect Dis 15:313

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tumbarello M, Trecarichi EM, Bassetti M, De Rosa FG, Spanu T, Di Meco E et al (2011) Identifying patients harboring extended-spectrum-beta-lactamase-producing Enterobacteriaceae on hospital admission: derivation and validation of a scoring system. Antimicrob Agents Chemother 55(7):3485–3490

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Goodman KE, Lessler J, Cosgrove SE, Harris AD, Lautenbach E, Han JH et al (2016) Antibacterial Resistance Leadership Group. A clinical decision tree to predict whether a bacteremic patient is infected with an extended-spectrum β-lactamase-producing organism. Clin Infect Dis 63(7):896–903

    Article  PubMed  Google Scholar 

  17. Woerther P-L, Burdet C, Chachaty E, Andremont A (2013) Trends in human fecal carriage of extended-spectrum β-lactamases in the community: toward the globalization of CTX-M. Clin Microbiol Rev 26(4):744–758

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This work has been presented in Journées Nationales d’Infectiologie in 2014 and in Congrès National de la Société Française de Microbiologie in 2015.

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Authors and Affiliations

  1. Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France

    L. Surgers, P.-A. Jolivot, P.-M. Girard, C. Cambier & J.-L. Meynard

  2. Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France

    L. Surgers, G. Arlet & D. Decre

  3. INSERM U1135, CIMI, Team E13, Paris, France

    L. Surgers, G. Arlet & D. Decre

  4. Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France

    A. Boyd, P.-Y. Boelle & P.-M. Girard

  5. INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, 75013, Paris, France

    A. Boyd, P.-Y. Boelle & P.-M. Girard

  6. Département de Santé Publique, Hôpital Saint Antoine, APHP, Paris, France

    P.-Y. Boelle

  7. Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France

    V. Lalande, G. Arlet, A. Homor & D. Decre

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  1. L. Surgers
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  2. A. Boyd
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  3. P.-Y. Boelle
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  4. V. Lalande
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  5. P.-A. Jolivot
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  6. P.-M. Girard
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  7. G. Arlet
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  8. C. Cambier
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  9. A. Homor
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  10. D. Decre
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  11. J.-L. Meynard
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Correspondence to L. Surgers.

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Funding

Laure Surgers received a grant from the “Fondation pour la Recherche Médicale” (DEA20140630021). Anders Boyd received post-doctoral funding from SIDACTION.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All patients have been informed of this observational study.

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Surgers, L., Boyd, A., Boelle, PY. et al. Clinical and microbiological determinants of severe and fatal outcomes in patients infected with Enterobacteriaceae producing extended-spectrum β-lactamase. Eur J Clin Microbiol Infect Dis 36, 1261–1268 (2017). https://doi.org/10.1007/s10096-017-2932-9

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  • DOI: https://doi.org/10.1007/s10096-017-2932-9

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