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

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

Research output: Contribution to journalArticle

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 [ClinicalTrials.gov Identifier: NCT00404625].

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalInternational Journal of Antimicrobial Agents
DOIs
Publication statusE-pub ahead of print - Apr 12 2019

Keywords

  • Community-acquired infection
  • ESBL
  • Extended-spectrum β-lactamase
  • Inappropriate antibiotic therapy

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

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