Predicting resistance to third generation cephalosporins in

Abstract

Introduction: Some Enterobacteriaceae can produce enzymes (extended spectrum betalactamases or ESBLs) which make them resistant to certain antibiotics. In Sweden, the number of ESBL-septicemias are increasing and Escherichia coli (E. coli) is the dominant bacteria. There are difficulties to initially identify which septic patients are to be suspected of infection with multi-resistant Enterobacteriaceae, sometimes resulting in delayed effective treatment. There are several potential risk factors to consider when assessing whether a septic patient might be infected with ESBL-producing bacteria. Therefore, it would be valuable to have indicating factors to facilitate the identification of patients at risk in order to choose effective empiric treatment. Methods: The patients were selected based on the occurrence of E. coli-positive blood cultures between 1 Jan - 31 Dec 2016. Analyzed factors were age, sex, previous hospitalization, recent surgery, use of urinary catheter, living in nursing home, previous antibiotic treatment, immunosuppression, hospital care abroad, hospital vs. community acquired infection, previous faeces culture with ESBL-E. coli and previous urine and/or blood culture with ESBL-E. coli. A multivariate analysis was performed for variables with a univariate p-value <0.2 and statistical significance was established at £0.05. Results: A total of 470 patients were evaluated, with 485 cases of septicemia. Three parameters gained statistical significance: hospital care abroad (OR=3.4, 95%CI=1.1-10.4, p=0.037), previously ESBL-positive in faeces (OR=8.1, 95%CI=1.0-65.4, p=0.050) and previously ESBL-positive in blood and/or urine (OR=54.5, 95%CI=11.2-256.5, p<0.001). Conclusion: In this retrospectively conducted survey of patients with E. coli bacteremia, we found that previously detected ESBL-E. coli in blood, urine or faeces and previous hospital care abroad were predicting factor for bacteremia with ESBL-producing E. coli. KEY WORDS: ESBL; E. coli; bacteremia; risk factors