EE Microbiotas, Hosts, Antibiotics and bacterial Resistances (MiHAR) Institut de Recherche en Santé 2 (IRS2), Université de Nantes, 22 Boulevard Bénoni-Goullin, 44200, Nantes, France.
Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, 44000, Nantes, France.
Eur J Clin Microbiol Infect Dis. 2017 Dec;36(12):2417-2422. doi: 10.1007/s10096-017-3077-6. Epub 2017 Aug 12.
Previous studies have shown controversial results of factors associated with short-term mortality in patients with extended-spectrum beta-lactamase (ESBL)-producing E. coli bacteremia and no research has investigated the impact of the geriatric assessment criteria on short-term mortality. Our objective was to determine whether dementia and walking ability are associated with 30-day mortality in patients with ESBL-producing E. coli bacteremia. All blood bottle cultures, analyzed from January 2008 to April 2015, in the Bacteriology Department of a 2,600-bed, university-affiliated center, Nantes, France, were retrospectively extracted. Factors associated with short-term mortality in patients with ESBL-producing E. coli bacteremia: 140 patients with an ESBL-producing E. coli bloodstream infection were included; 22 (15.7%) patients died within 30 days following the first positive blood bottle culture of ESBL-producing E.coli. In multivariate analysis, a reduced ability to walk (OR = 0.30; p = 0.021), presence of dementia (OR = 54.51; p = 0.040), a high Sepsis-related Organ Failure Assessment (SOFA) score (OR = 1.69; p < 0.001), presence of neutropenia (OR = 12.94; p = 0.049), and presence of a urinary tract infection (OR = 0.07; p = 0.036), were associated with 30-day mortality. Our findings provide new data showing an independent association between 30-day mortality with dementia and reduced walking ability, in patients with ESBL-producing E. coli bacteremia. These criteria should be considered in the therapeutic management of patients with ESBL-producing E. coli bacteremia.
先前的研究表明，产超广谱β-内酰胺酶（ESBL）的大肠埃希菌菌血症患者短期死亡率的相关因素存在争议，且尚无研究调查老年评估标准对短期死亡率的影响。我们的目的是确定痴呆和行走能力是否与产 ESBL 的大肠埃希菌菌血症患者的 30 天死亡率相关。从 2008 年 1 月至 2015 年 4 月，法国南特市一家拥有 2600 张床位的大学附属医院的细菌学系回顾性提取了所有血瓶培养物。产 ESBL 的大肠埃希菌菌血症患者短期死亡率的相关因素：共纳入 140 例产 ESBL 的大肠埃希菌血流感染患者；在首次从 ESBL 阳性血培养瓶中分离出产 ESBL 的大肠埃希菌后 30 天内，有 22 例（15.7%）患者死亡。在多变量分析中，行走能力降低（OR=0.30；p=0.021）、存在痴呆（OR=54.51；p=0.040）、高脓毒症相关器官衰竭评估（SOFA）评分（OR=1.69；p<0.001）、中性粒细胞减少症（OR=12.94；p=0.049）和存在尿路感染（OR=0.07；p=0.036）与 30 天死亡率相关。我们的研究结果提供了新的数据，表明在产 ESBL 的大肠埃希菌菌血症患者中，痴呆和行走能力降低与 30 天死亡率独立相关。这些标准应在产 ESBL 的大肠埃希菌菌血症患者的治疗管理中加以考虑。
