Scheuerman O1, Schechner V1, Carmeli Y1, Gutiérrez-Gutiérrez B2, Calbo E3, Almirante B4, Viale PL5, Oliver A6, Ruiz-Garbajosa P7, Gasch O8Gozalo M9, Pitout J10, Akova M11, Peña C12, Molina J13, Hernández-Torres A14, Venditti M15, Prim N16, Origüen J17, Bou G18, Tacconelli E19, Tumbarello M20, Hamprecht A21, Karaiskos I22, de la Calle C23, Pérez F24, Schwaber MJ1, Bermejo J25, Lowman W26, Hsueh PR27, Navarro-San Francisco C28, Bonomo RA24, Paterson DL29, Pascual A2, Rodríguez-Baño J2; REIPI/ESGBIS/INCREMENT investigators.
1Division of Epidemiology and Preventive Medicine,Tel Aviv Sourasky Medical Center,Tel Aviv,Israel.
2Unidad Clínica de Enfermedades Infecciosas y Microbiología,Hospital Universitario Virgen Macarena,Seville,Spain.
3Hospital Universitari Mútua de Terrassa,Barcelona,Spain.
4Hospital Universitari Vall d’Hebrón,Barcelona,Spain.
5Hospital Policlinico S. Orsola Malpighi,Bologna,Italy.
6Hospital Universitario Son Espases,Palma de Mallorca,Spain.
7Hospital Ramón y Cajal,Madrid,Spain.
8Corporacio Sanitaria Parc Taulí,Sabadell,Barcelona,Spain.
9Hospital Universitario Marqués de Valdecilla-IDIVAL,Santander,Spain.
10Department of Pathology and Laboratory Medicine,University of Calgary,Calgary,Alberta,Canada.
11Hacettepe University School of Medicine,Ankara,Turkey.
12Hospital Universitari de Bellvitge,Barcelona,Spain.
13Infectious Diseases,Microbiology and Preventive Medicine,Institute of Biomedicine of Seville (IBiS),University Hospital Virgen del Rocio,CSIC,University of Seville,Seville,Spain.
14Hospital Universitario Virgen de la Arrixaca,Murcia,Spain.
15Policlinico Umberto I,University of Rome La Sapienza,Rome,Italy.
16Hospital de la Santa Creu i Sant Pau,Barcelona,Spain.
17Hospital Universitario 12 de Octubre,Madrid,Spain.
18Complejo Hospitalario Universitario A Coruña,A Coruña,Spain.
20Catholic University of the Sacred Heart,Rome,Italy.
21Institut für Mikrobiologie,Immunologie und Hygiene Universitätsklinikum Köln,Cologne,Germany.
22Hygeia General Hospital,Athens,Greece.
24Research Service,Louis Stokes Cleveland Department of Veterans Affairs Medical Center,Cleveland,Ohio,United States.
26Wits Donald Gordon Medical Centre,Johannesburg,South Africa.
27National Taiwan University Hospital,National Taiwan University Hospital College of Medicine,Taipei,Taiwan.
28Hospital Universitario La Paz,Madrid,Spain.
29University of Queensland Centre for Clinical Research,The University of Queensland,Herston,Brisbane,Australia.
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes. As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression. The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non-CTX-M ESBLs were detected. Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
CLINICAL TRIALS IDENTIFIER: ClinicalTrials.gov. Identifier: NCT01764490.
Infection Control & Hospital Epidemiology 20108. DOI: 10.1017/ice.2018.63
Link to Pubmed