Factors Affecting Mortality of Patients with Bloodstream Infection Caused by Ceftriaxone-resistant Enterobacterales at Chonburi Hospital
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Abstract
Objective: To determine factors affecting mortality of patients with bloodstream infection caused by Ceftriaxone-resistant (CRO-R) Enterobacterales at Chonburi Hospital. Methods: A retrospective cohort study was conducted by collecting relevant information from medical records. Eligible patients were adults aged ≥ 18 years with bloodstream infection caused by CRO-R Enterobacterales and hospitalized at Chonburi Hospital from April 1, 2023 to March 30, 2024. The study employed binary logistic regression to determine factors affecting mortality. Results: There were 86 participants. The majority were female (n=38 or 57.58%), Mean age was 62.48 ± 15.16 years. Three most common sources of bloodstream infection were urinary tract infection, primary bacteremia with unknown source and gastrointestinal and intra-abdominal infection. Multivariate analysis revealed that two factors having significant association with mortality of patients with bloodstream infection caused by (CRO-R) Enterobacterales were primary bacteremia (aRR 11.88, 95%CI: 1.25, 113.13, P = 0.031) and septic shock (aRR 51.91, 95%CI: 4.19, 643.03, P = 0.002). Conclusion: Primary bacteremia and septic shock were factors affecting mortality of bloodstream infection patients caused by CRO-R Enterobacterales. However, the limitations of this study include small sample size and study setting focused only on internal medicine ward. Therefore, further studies should explore additional factors to enhance the accuracy of mortality predictions.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Antimicrobial Resistance C. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022; 399: 629-55.
Collaborators GBDAR. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022; 400: 2221-48.
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020; 395: 200-11.
Choosri P, Panya I, Parnkerd P. Developing nursing care guidelines for patients with septicemia at female medical ward 1, Buddhachinaraj Phitsanulok Hospital. Nursing, Health, and Public Health Journal 2022; 1: 12-27.
Collaborators GBDAR. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024; 404: 1199-226.
Phumart P, Phodha T, Thamlikitkul V, Riewpaiboon A, Prakongsai P, Limwattananon S. Health and economic impacts of antimicrobial resistant infections in Thailand: A preliminary study. J Health Serv Res Policy 2012; 6: 352-60.
Tamma PD, Heil EL, Justo JA, Mathers AJ, Satlin MJ, Bonomo RA. Infectious Diseases Society of America 2024 Guidance on the treatment of antimicrobial-resistant gram-negative infections. Clin Infect Dis. 2024; 7: ciae403. doi: 10.1093/cid/ciae 40 3 .
Thamlikitkul V, Rattanaumpawan P, Sirijatuphat R, Wangchinda W. Integrated one-day surveillance of antimicrobial use, antimicrobial consumption, antimicrobial resistance, healthcare-associated infection, and antimicrobial resistance burden among hospitalized patients in Thailand. J Infect 2020; 81: 98-106.
Trecarichi EM, Giuliano G, Cattaneo C, Ballanti S, Criscuolo M, Candoni A, et al. Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey. PLoS One. 2019; 14: e0224465.
Guo Q, Wang XW, Chen XY, Zhao J, He SL, Tian WW, et al. Analysis of pathogenic bacterial spectrum, drug resistance and risk factors for mortality of bloodstream infection in patients with hematologic diseases. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2023; 31: 1556-62.
Lim CL, Spelman D. Mortality impact of empirical antimicrobial therapy in ESBL- and AmpC-producing Enterobacteriaceae bacteremia in an Australian tertiary hospital. Infect Dis Health 2019; 24: 124-33.
Shi N, Kang J, Wang S, Song Y, Yin D, Li X, et al. Bacteriological profile and antimicrobial susceptibility patterns of gram-negative bloodstream infection and risk factors associated with mortality and drug resistance: A retrospective study from Shanxi, China. Infect Drug Resist 2022; 15: 3561-78.
Xiao T, Yang K, Zhou Y, Zhang S, Ji J, Ying C, et al. Risk factors and outcomes in non-transplant patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia: a retrospective study from 2013 to 2016. Antimicrob Resist Infect Control 2019; 8: 144.
Peri AM, Calabretta D, Bozzi G, Migliorino GM, Bramati S, Gori A, et al. Retrospective analysis of bacteraemia due to extended-spectrum beta-lacta- mase-producing Enterobacterales: the challenge of healthcare-associated infections. IJID Reg. 2023; 6: 167-70.
Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Oh MD, et al. Bloodstream infections caused by Enterobacter species: predictors of 30-day mortality rate and impact of broad-spectrum cephalosporin resistance on outcome. Clin Infect Dis 2004; 39: 812-8.
Xiao Y, Hang Y, Chen Y, Fang X, Cao X, Hu X, et al. A retrospective analysis of risk factors and patient outcomes of bloodstream infection with extended-spectrum beta-lactamase-producing Escherichia coli in a chinese tertiary hospital. Infect Drug Resist 2020; 13: 4289-96.
Laxminarayan R, Van Boeckel T, Frost I, Kariuki S, Khan EA, Limmathurotsakul D, et al. The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later. Lancet Infect Dis 2020; 20: e51-e60.
Elixhauser A FB, Stranges E. Septicemia in U.S. Hospitals, 2009 [online]. 2006 [cited Oct 18, 2024]. Available from: www.ncbi.nlm.nih.gov/books/NBK65 391/.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315: 801-10.
Centers for Disease Control and Prevention. About ESBL-producing Enterobacterales [onine]. 2024 [Oct 18, 2024]. Available from: www.cdc.gov/esbl-producing-enterobacterales/about/index.html.
Pospisil M, Car H, Elvedi-Gasparovic V, Beader N, Herljevic Z, Bedenic B. Bloodstream Infections by AmpC-producing Enterobacterales: Risk factors and therapeutic outcome. Pathogens. 2023; 12: 1125. doi: 10.3390/pathogens12091125.
Livermore DM. Mechanisms of resistance to cephalo sporin antibiotics. Drugs 1987; 34 Suppl 2: 64-88.
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011; 52: e56-93.
van Smeden M, Moons KG, de Groot JA, Collins GS, Altman DG, Eijkemans MJ, et al. Sample size for binary logistic prediction models: Beyond events per variable criteria. Stat Methods Med Res 2019; 28: 2455-74.
Chen L, Han X, Li Y, Li M. Assessment of mortality-related risk factors and effective antimicrobial regimens for treatment of bloodstream infections caused by carbapenem-resistant Enterobacterales. Antimicrob Agents Chemother 2021; 65: e0069821.
Palacios-Baena ZR, Gutierrez-Gutierrez B, De Cueto M, Viale P, Venditti M, Hernandez-Torres A, et al. Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended -spectrum-beta-lactamase-producing Enterobacteria ceae. J Antimicrob Chemother. 2017; 72: 906-13.
Frescas BE, McCoy C, Kirby J, Bowden R, Mercuro NJ. 1228. Outcomes associated with empiric cefe- pime or meropenem for bloodstream infections caused by ceftriaxone-resistant, cefepime-suscep- tible Escherichia coli and Klebsiella pneumoniae. Open Forum Infect Dis 2021; 8(Supplement_1): S703-S.
Harris PNA, Tambyah PA, Lye DC, Mo Y, Lee TH, Yilmaz M, et al. Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with E coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: A randomized clinical trial. JAMA. 2018; 320: 984-94.
Mitsuboshi S, Tsuruma N, Watanabe K, Takahashi S, Ito A, Nakashita M, et al. Advanced age is not a risk factor for mortality in patients with bacteremia caused by extended-spectrum beta-lactamase-producing organisms: A multicenter cohort study. Jpn J Infect Dis. 2020; 73: 288-92.
Capsoni N, Bellone P, Aliberti S, Sotgiu G, Pavanello D, Visintin B, et al. Prevalence, risk factors and outcomes of patients coming from the community with sepsis due to multidrug resistant bacteria. Multidiscip Respir Med. 2019; 14: 23.
Isendahl J, Giske CG, Hammar U, Sparen P, Tegmark Wisell K, Ternhag A, et al. Temporal dynamics and risk factors for bloodstream infection with extended-spectrum beta-lactamase-producing bacteria in previously-colonized individuals: National population-based cohort study. Clin Infect Dis 2019; 68: 641-9.
Tamma PD, Komarow L, Ge L, Garcia-Diaz J, Herc ES, Doi Y, et al. Clinical impact of ceftriaxone resistance in escherichia coli bloodstream infections: A multicenter prospective cohort study. Open Forum Infect Dis 2022; 9: ofac572.
Tocut M, Zohar I, Schwartz O, Yossepowitch O, Maor Y. Short- and long-term mortality in patients with urosepsis caused by Escherichia coli susceptible and resistant to 3rd generation cephalosporins. BMC Infect Dis. 2022; 22: 571.
