Clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing Enterobacterales
Bacteremia caused by antibiotic-resistant Enterobacterales, in particular those due to extended-spectrum-beta-lactamase-producing (ESBL-B) and carbapenemase-producing Enterobacterales (CPE-B), are a frequent complication in hospitalized patients due to high morbidity-mortality rates and scarce thera...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2022
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/39099 |
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I10-R327-article-39099 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
| institution_str |
I-10 |
| repository_str |
R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| format |
Artículo revista |
| topic |
bacteremia carbapenemases extended-spectrum-beta-lactamases enterobacterales bacteriemia carbapenemasas beta-lactamasas de espectro extendido enterobacterales |
| spellingShingle |
bacteremia carbapenemases extended-spectrum-beta-lactamases enterobacterales bacteriemia carbapenemasas beta-lactamasas de espectro extendido enterobacterales LIPARI, FG MORANDINI, FN Anna, AN Ruiz, SE Irrazabal, G Cometto, A Hernandez, D Saka, HA Clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing Enterobacterales |
| topic_facet |
bacteremia carbapenemases extended-spectrum-beta-lactamases enterobacterales bacteriemia carbapenemasas beta-lactamasas de espectro extendido enterobacterales |
| author |
LIPARI, FG MORANDINI, FN Anna, AN Ruiz, SE Irrazabal, G Cometto, A Hernandez, D Saka, HA |
| author_facet |
LIPARI, FG MORANDINI, FN Anna, AN Ruiz, SE Irrazabal, G Cometto, A Hernandez, D Saka, HA |
| author_sort |
LIPARI, FG |
| title |
Clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing Enterobacterales |
| title_short |
Clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing Enterobacterales |
| title_full |
Clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing Enterobacterales |
| title_fullStr |
Clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing Enterobacterales |
| title_full_unstemmed |
Clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing Enterobacterales |
| title_sort |
clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing enterobacterales |
| description |
Bacteremia caused by antibiotic-resistant Enterobacterales, in particular those due to extended-spectrum-beta-lactamase-producing (ESBL-B) and carbapenemase-producing Enterobacterales (CPE-B), are a frequent complication in hospitalized patients due to high morbidity-mortality rates and scarce therapeutic options. There are few studies comparing bacteremia caused by these microorganisms in our region. The aim of this work was to analyze and compare the clinical and microbiological characteristics of CPE-B and ESBL-B.
An observational, retrospective, descriptive study was carried out analyzing CPE-B and ESBL-B between 11/2019 and 03/2022. Demographic data, comorbidities and mortality of patients were evaluated, among other variables. Bacterial typing was assessed by MALDI-TOF. Antimicrobial susceptibility testing was determined using VITEK-2. Carbapenemase types were confirmed by PCR (KPC, NDM, VIM, IMP, OXA-48/163). Statistical analysis was performed using MedCalc 14.8.1.
A total of 92 CPE-B and 77 ESBL-B cases were studied. The predominant species in CPE-B was Klebsiella pneumoniae (72%), while Escherichia coli (46%) was the main species in ESBL-B (p<0.05). Carbapenemase types identified were KPC-71% (p<0.05), NDM-25%, KPC+NDM-3% and OXA-48/163-1%. A larger proportion of male patients (62%, p<0.05) was found in CPE-B. Median age (CPE-B/ESBL-B) was 59/64 years (p>0.05). Antibiotic use prior to bacteremia was 97%/74% (p<0.05), with a greater proportion in CPE-B for carbapenems (36%/10%) and aminoglycosides (24%/9%) (p<0.05). Proportions of appropriate empirical antibiotic treatment were 39%/57% (p<0.05). Stay at critical care unit (CCU) at the time of bacteremia was 54%/19% (p<0.05). Likely sources of infection were pulmonary in 23%/4% and urinary in 22%/43% (p<0.05). The only comorbidity showing differences between the groups was COVID-19 (4%/21%, p<0.01). 14-day mortality was 14%/27% (OR 2.2; p<0,05) and 30-day mortality was 17%/39% (OR 3.2; p<0.01).
We observed clear microbiological and clinical differences between ESBL-E and CPE-B, standing out a greater proportion of K. pneumoniae, male sex, COVID-19 comorbidity and prior antibiotic use, longer stay at CCU, decreased appropriate empirical antibiotic treatment and increased mortality in CPE-B patients. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2022 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/39099 |
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2024-09-03T21:04:12Z |
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I10-R327-article-390992024-04-15T16:14:45Z Clinical and microbiological characterization of bacteremia caused by carbapenemase- and extended-spectrum- beta-lactamase-producing Enterobacterales Comparación clínica y microbiológica de bacteriemias por Enterobacterales productoras de carbapenemasas y de beta-lactamasas de espectro extendido LIPARI, FG MORANDINI, FN Anna, AN Ruiz, SE Irrazabal, G Cometto, A Hernandez, D Saka, HA bacteremia carbapenemases extended-spectrum-beta-lactamases enterobacterales bacteriemia carbapenemasas beta-lactamasas de espectro extendido enterobacterales Bacteremia caused by antibiotic-resistant Enterobacterales, in particular those due to extended-spectrum-beta-lactamase-producing (ESBL-B) and carbapenemase-producing Enterobacterales (CPE-B), are a frequent complication in hospitalized patients due to high morbidity-mortality rates and scarce therapeutic options. There are few studies comparing bacteremia caused by these microorganisms in our region. The aim of this work was to analyze and compare the clinical and microbiological characteristics of CPE-B and ESBL-B. An observational, retrospective, descriptive study was carried out analyzing CPE-B and ESBL-B between 11/2019 and 03/2022. Demographic data, comorbidities and mortality of patients were evaluated, among other variables. Bacterial typing was assessed by MALDI-TOF. Antimicrobial susceptibility testing was determined using VITEK-2. Carbapenemase types were confirmed by PCR (KPC, NDM, VIM, IMP, OXA-48/163). Statistical analysis was performed using MedCalc 14.8.1. A total of 92 CPE-B and 77 ESBL-B cases were studied. The predominant species in CPE-B was Klebsiella pneumoniae (72%), while Escherichia coli (46%) was the main species in ESBL-B (p<0.05). Carbapenemase types identified were KPC-71% (p<0.05), NDM-25%, KPC+NDM-3% and OXA-48/163-1%. A larger proportion of male patients (62%, p<0.05) was found in CPE-B. Median age (CPE-B/ESBL-B) was 59/64 years (p>0.05). Antibiotic use prior to bacteremia was 97%/74% (p<0.05), with a greater proportion in CPE-B for carbapenems (36%/10%) and aminoglycosides (24%/9%) (p<0.05). Proportions of appropriate empirical antibiotic treatment were 39%/57% (p<0.05). Stay at critical care unit (CCU) at the time of bacteremia was 54%/19% (p<0.05). Likely sources of infection were pulmonary in 23%/4% and urinary in 22%/43% (p<0.05). The only comorbidity showing differences between the groups was COVID-19 (4%/21%, p<0.01). 14-day mortality was 14%/27% (OR 2.2; p<0,05) and 30-day mortality was 17%/39% (OR 3.2; p<0.01). We observed clear microbiological and clinical differences between ESBL-E and CPE-B, standing out a greater proportion of K. pneumoniae, male sex, COVID-19 comorbidity and prior antibiotic use, longer stay at CCU, decreased appropriate empirical antibiotic treatment and increased mortality in CPE-B patients. Las bacteriemias por Enterobacterales resistentes a antibióticos, en particular las causadas por productores de beta-lactamasas de espectro extendido (B-BLEE) y de carbapenemasas (B-EPC), son frecuentes y constituyen una grave complicación en pacientes hospitalizados por su elevada morbi-mortalidad y las escasas opciones terapéuticas. Existen pocos análisis comparativos entre las bacteriemias causadas por estos microorganismos en nuestro medio. El objetivo de este trabajo es: analizar y comparar las características clínicas y microbiológicas de las B-EPC y las B-BLEE. Se realizó un estudio observacional, retrospectivo y descriptivo analizando las B-EPC y B-BLEE desde 11/2019 a 03/2022. Se evaluaron las características demográficas, comorbilidades y mortalidad de los pacientes entre otras variables. La tipificación bacteriana se realizó por MALDI-TOF. La sensibilidad antimicrobiana se determinó por Vitek2. El tipo de carbapenemasa se confirmó mediante PCR (KPC, NDM, VIM, IMP, OXA-48/163). Para el análisis estadístico se usó MedCalc 14.8.1. Se estudiaron 92 casos de B-EPC y 77 de B-BLEE. La especie predominante en B-EPC fue Klebsiella pneumoniae (72%), mientras que en B-BLEE predominó Escherichia coli (46%) (p<0,05). Los tipos de carbapenemasa fueron: KPC 71% (p<0,05), NDM 25%, KPC+NDM 3%, OXA-48/163 1%. En B-EPC hubo una mayor proporción de pacientes masculinos (62%) (p<0,05). La edad mediana (B-EPC/B-BLEE) fue de 59/64 años (p>0,05). En cuanto al uso de antibióticos previo a la bacteriemia fue 97%/74% (p<0,05), siendo mayor en B-EPC el antecedente de carbapenems (36%/10%) y aminoglucósidos (24%/9%) (p<0,05). La comparación del tratamiento empírico apropiado fue 39%/57% (p<0,05). Cuando se analizó la estadía del paciente en unidad de terapia intensiva (UTI) al momento de la bacteriemia fue 54%/19% (p<0,05). El análisis del foco probable de la bacteriemia fue pulmonar en 23%/4% y urinario en 22%/43% (ambas p<0,05). En comorbilidades, la única con diferencia fue COVID-19: 4%/21% (p<0,01). La mortalidad a los 14 días fue 14%/27% (OR 2,2; p<0,05) y a los 30 días 17%/39% (OR 3,2; p<0,01). Observamos claras diferencias microbiológicas y clínicas entre B-BLEE y B-EPC. Se destaca predominio de K. pneumoniae, sexo masculino, mayor uso de antibióticos previos, menor acierto en el tratamiento empírico, mayor estadía en UTI, antecedente de COVID-19 y mayor mortalidad en B-EPC. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022-10-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion . https://revistas.unc.edu.ar/index.php/med/article/view/39099 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 79 No. Suplemento JIC XXIII (2022): Suplemento JIC XXIII Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 79 Núm. Suplemento JIC XXIII (2022): Suplemento JIC XXIII Revista da Faculdade de Ciências Médicas de Córdoba; v. 79 n. Suplemento JIC XXIII (2022): Suplemento JIC XXIII 1853-0605 0014-6722 http://creativecommons.org/licenses/by-nc/4.0 |