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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| Autores principales: | , , , , , , , |
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| Formato: | Artículo revista |
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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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| Sumario: | 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. |
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