Silva Ana Sheila Duarte Nunes, da Silva Natalia Chilinque Zambão, do Valle Fernanda Moreth, da Rocha Jaqueline Abel, Ehrlich Shelley, Martins Ianick Souto
Infection Disease Division, Department of Clinical Medicine, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil.
Hospital Universitário Antonio Pedro, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil.
Infect Drug Resist. 2024 Sep 18;17:4023-4035. doi: 10.2147/IDR.S473789. eCollection 2024.
ESCPM bacteria include spp, spp, spp, and spp. These Gram-negative bacilli harbor chromosomally encoded AmpC-type β-lactamases that cause resistance to β-lactam antibiotics, such as penicillins, β-lactam/β-lactamase inhibitors, and first-, second-, and third-generation cephalosporins. Bloodstream infections caused by ESCPM group bacteria (BSI-ESCPM) are difficult to treat.
To describe 30-day mortality and analyze potential risk factors for death in patients with BSI-ESCPM.
A cohort study of patients aged ≥ 18 years with BSI-ESCPM was conducted at a University Hospital in Brazil, from January 2013 and December 2018. Potential risk factors for death within 30 days of bloodstream infection BSI diagnosis were analyzed using multivariable logistic regression.
Among 138 patients with BSI-ESCPM, 63.0% were males, with a median age of 61 years. Of 155 BSI-ESCPM episodes, 61.3% were hospital-acquired. Primary BSI-ESCPM associated with short-term central venous catheter (37.4%) and BSI-ESCPM secondary to respiratory infection (19.4%) occurred mainly. Mostly, r spp. (49.7%) and spp. (29.0%) were isolated. Multidrug-resistance occurred in 27.7% of BSI-ESCPM episodes, involving spp. (16.1%) and spp. (7.7%) mainly. The mortality was 24.5%. Developing septic shock within 72 h of BSI-ESCPM diagnosis (OR: 70.26; 95% CI: 16.69-295.77; <0.01) was risk factor for death. Conversely, combined antibiotic therapy (OR: 0.23; 95% CI: 0.05-0.94; :0.04), BSI-ESCPM secondary to urinary infection (OR: 0.11; 95% CI: 0.01-0.99; :0.05), and spp. BSI (OR: 0.16; 95% CI: 0.05-0.56; 0<0.01) was protective factor against death. Tendency of association between inadequate antibiotic therapy and death (OR: 2.19; 95% CI: 0.51-9.42; :0.29) was observed.
BSI-ESCPM is severe and has serious outcomes such as sepsis-associated deaths. Combined antibiotic therapy was a protective factor against death in patients with BSI-ESCPM. There is a suggestive association between inadequate antibiotic therapy and mortality. The ESCPM group bacteria that are considered to be at moderate to high risk of clinically significant AmpC production were not associated with death.
ESCPM细菌包括 spp、 spp、 spp和 spp。这些革兰氏阴性杆菌携带染色体编码的AmpC型β-内酰胺酶，可导致对β-内酰胺类抗生素耐药，如青霉素、β-内酰胺/β-内酰胺酶抑制剂以及第一代、第二代和第三代头孢菌素。由ESCPM组细菌引起的血流感染（BSI-ESCPM）难以治疗。
描述BSI-ESCPM患者的30天死亡率，并分析死亡的潜在危险因素。
2013年1月至2018年12月，在巴西一家大学医院对年龄≥18岁的BSI-ESCPM患者进行了一项队列研究。采用多变量逻辑回归分析血流感染BSI诊断后30天内死亡的潜在危险因素。
138例BSI-ESCPM患者中，63.0%为男性，中位年龄61岁。在155次BSI-ESCPM发作中，61.3%为医院获得性感染。主要发生与短期中心静脉导管相关的原发性BSI-ESCPM（37.4%）和继发于呼吸道感染的BSI-ESCPM（19.4%）。大多数情况下，分离出r spp.（49.7%）和 spp.（29.0%）。27.7%的BSI-ESCPM发作出现多重耐药，主要涉及 spp.（16.1%）和 spp.（7.7%）。死亡率为24.5%。在BSI-ESCPM诊断后72小时内发生感染性休克（OR：70.26；95%CI：16.69-295.77；<0.01）是死亡的危险因素。相反，联合抗生素治疗（OR：0.23；95%CI：0.05-0.94；：0.04）、继发于泌尿系统感染的BSI-ESCPM（OR：0.11；95%CI：0.01-0.99；：0.05）和 spp. BSI（OR：0.16；95%CI：
