Sa1425 - Risk Factors and Hospital Mortality of Patients with Acute Cholangitis Caused by Third-Generation Cephalosporin Resistant Organisms

2018 ◽  
Vol 154 (6) ◽  
pp. S-301
Author(s):  
Manus Rugivarodom ◽  
Nonthalee Pausawasdi ◽  
Phunchai Charatcharoenwitthaya
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Acute Cholangitis ◽  
Generation Cephalosporin ◽  
Third Generation

scholarly journals Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae: A Multicenter Study in China

2020 ◽  
Vol 17 (24) ◽  
pp. 9285
Author(s):  
Xuemei Zhen ◽  
Cecilia Stålsby Lundborg ◽  
Xueshan Sun ◽  
Xiaoqian Hu ◽  
Hengjin Dong
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Hospital Mortality ◽  
Multicenter Study ◽  
Generation Cephalosporin ◽  
Total Hospital Cost ◽  
Third Generation ◽  
E Coli ◽  
Significant Difference ◽  
The Impact

Quantifying economic and clinical outcomes for interventions could help to reduce third-generation cephalosporin resistance and Escherichia coli or Klebsiella pneumoniae. We aimed to compare the differences in clinical and economic burden between third-generation cephalosporin-resistant E. coli (3GCREC) and third-generation cephalosporin-susceptible E. coli (3GCSEC) cases, and between third-generation cephalosporin-resistant K. pneumoniae (3GCRKP) and third-generation cephalosporin-susceptible K. pneumoniae (3GCSKP) cases. A retrospective and multicenter study was conducted. We collected data from electronic medical records for patients who had clinical samples positive for E. coli or K. pneumoniae isolates during 2013 and 2015. Propensity score matching (PSM) was conducted to minimize the impact of potential confounding variables, including age, sex, insurance, number of diagnoses, Charlson comorbidity index, admission to intensive care unit, surgery, and comorbidities. We also repeated the PSM including length of stay (LOS) before culture. The main indicators included economic costs, LOS and hospital mortality. The proportions of 3GCREC and 3GCRKP in the sampled hospitals were 44.3% and 32.5%, respectively. In the two PSM methods, 1804 pairs and 1521 pairs were generated, and 1815 pairs and 1617 pairs were obtained, respectively. Compared with susceptible cases, those with 3GCREC and 3GCRKP were associated with significantly increased total hospital cost and excess LOS. Inpatients with 3GCRKP were significantly associated with higher hospital mortality compared with 3GCSKP cases, however, there was no significant difference between 3GCREC and 3GCSEC cases. Cost reduction and outcome improvement could be achieved through a preventative approach in terms of both antimicrobial stewardship and preventing the transmission of organisms.

scholarly journals Characterization of AmpC-hyperproducing Escherichia coli from humans and dairy farms collected in parallel in the same geographical region

2020 ◽  
Vol 75 (9) ◽  
pp. 2471-2479 ◽  
Author(s):  
Maryam Alzayn ◽  
Jacqueline Findlay ◽  
Hannah Schubert ◽  
Oliver Mounsey ◽  
Virginia C Gould ◽  
...  
Keyword(s):  
Risk Factors ◽  
Phylogenetic Analysis ◽  
Human Population ◽  
Dairy Farms ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
E Coli ◽  
Increased Risk ◽  
Amoxicillin Clavulanate ◽  
Cephalosporin Resistance

Abstract Objectives To characterize putative AmpC-hyperproducing third-generation cephalosporin-resistant E. coli from dairy farms and their phylogenetic relationships; to identify risk factors for their presence; and to assess evidence for their zoonotic transmission into the local human population. Methods Proteomics was used to explain differences in antimicrobial susceptibility. WGS allowed phylogenetic analysis. Multilevel, multivariable logistic regression modelling was used to identify risk factors. Results Increased use of amoxicillin/clavulanate was associated with an increased risk of finding AmpC hyperproducers on farms. Expansion of cephalosporin resistance in AmpC hyperproducers was seen in farm isolates with marR mutations (conferring cefoperazone resistance) or when AmpC was mutated (conferring fourth-generation cephalosporin and cefoperazone resistance). Phylogenetic analysis confirmed the dominance of ST88 amongst farm AmpC hyperproducers but there was no evidence for acquisition of farm isolates by members of the local human population. Conclusions Clear evidence was found for recent farm-to-farm transmission of AmpC-hyperproducing E. coli and of adaptive mutations to expand resistance. Whilst there was no evidence of isolates entering the local human population, efforts to reduce third-generation cephalosporin resistance on dairy farms must address the high prevalence of AmpC hyperproducers. The finding that amoxicillin/clavulanate use was associated with an increased risk of finding AmpC hyperproducers is important because this is not currently categorized as a highest-priority critically important antimicrobial and so is not currently targeted for specific usage restrictions in the UK.

scholarly journals Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors

2016 ◽  
Vol 71 (10) ◽  
pp. 2957-2963 ◽  
Author(s):  
A. Hamprecht ◽  
A. M. Rohde ◽  
M. Behnke ◽  
S. Feihl ◽  
P. Gastmeier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Admission Prevalence

scholarly journals Risk Factors for Emergence of Resistance to Broad-Spectrum Cephalosporins among Enterobacterspp

2001 ◽  
Vol 45 (9) ◽  
pp. 2628-2630 ◽  
Author(s):  
Keith S. Kaye ◽  
Sara Cosgrove ◽  
Anthony Harris ◽  
George M. Eliopoulos ◽  
Yehuda Carmeli
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Broad Spectrum ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Independent Risk Factors ◽  
Emergence Of Resistance

ABSTRACT Among 477 patients with susceptible Enterobacter spp., 49 subsequently harbored third-generation cephalosporin-resistantEnterobacter spp. Broad-spectrum cephalosporins were independent risk factors for resistance (relative risk [OR] = 2.3, P = 0.01); quinolone therapy was protective (OR = 0.4, P = 0.03). There were trends toward decreased risk for resistance among patients receiving broad-spectrum cephalosporins and either aminoglycosides or imipenem. Of the patients receiving broad-spectrum cephalosporins, 19% developed resistance.

scholarly journals Clinical Impact and Risk Factors of Nonsusceptibility to Third-Generation Cephalosporins Among Hospitalized Adults With Monomicrobial Enterobacteriaceae Bacteremia in Southern Taiwan: A Multicenter Study

2020 ◽  
Author(s):  
Tsao-Chin Lin ◽  
Yuan-Pin Hung ◽  
Ching-Chi Lee ◽  
Wei-Tang Lin ◽  
Li-Chen Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Generation Cephalosporin ◽  
Rapid Identification ◽  
First Episode ◽  
Prognostic Impact ◽  
Third Generation ◽  
Crude Mortality ◽  
District Hospitals ◽  
Southern Taiwan

Abstract Background: Reducing effectiveness of broad-spectrum cephalosporins against Enterobacteriaceae infections has been recognized. This study aimed to investigate risk factors and clinical significance of third-generation cephalosporin nonsusceptibility (3GC-NS) among the cases of monomicrobial Enterobacteriaceae bacteremia (mEB) at regional or district hospitals.Methods: The study was conducted at three hospitals at southern Taiwan between Jan. 2017 and Oct. 2019. Only the first episode of mEB from each adult (aged ≥20 years) was included. The primary outcome was in-hospital crude mortality.Results: Overall there were 499 episodes of adults with mEB included, and their mean age was 74.5 years. Female predominated, accounting for 53% of all patients. Escherichia coli (62%) and Klebsiella pneumoniae (21%) were two major causative species. The overall mortality rate was 15% (73/499), and patients infected by 3GC-NS isolates (34%, 172/499) had a higher mortality rate than those by 3GC-susceptible isolates (66%, 327/499) (21% vs. 11%, P=0.005). By the multivariate analysis, 3GC-NS was the only independent prognostic determinant (adjusted odds ratio [AOR], 1.78; P=0.04). Of note, male (AOR 2.02, P=0.001), nosocomial-acquired bacteremia (AOR 2.77, P<0.001), and usage of nasogastric tube (AOR 2.01, P=0.002) were positively associated with 3GC-NS, but P. mirabilis bacteremia (AOR 0.28, P=0.01) and age (AOR 0.98, P=0.04) negatively with 3GC-NS.Conclusion: For adults with Enterobacteriaceae bacteremia, 3GC-NS signifies a significant prognostic impact. Efforts to rapid identification of such antimicrobial resistance profiles should be incorporated into antimicrobial stewardship programs to achieve favorable outcomes.

Prevalence of third-generation cephalosporin-resistant Enterobacterales colonization on hospital admission and ESBL genotype-specific risk factors: a cross-sectional study in six German university hospitals

2020 ◽  
Vol 75 (6) ◽  
pp. 1631-1638
Author(s):  
Anna M Rohde ◽  
Janine Zweigner ◽  
Miriam Wiese-Posselt ◽  
Frank Schwab ◽  
Michael Behnke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hospital Stay ◽  
Generation Cephalosporin ◽  
Resistant Bacteria ◽  
Third Generation ◽  
University Hospitals ◽  
Term Care ◽  
Specific Risk ◽  
M 14

Abstract Objectives To assess the admission prevalence of third-generation cephalosporin-resistant Enterobacterales (3GCREB) and to assess whether risk factors vary by β-lactamase genotype. Methods Adult patients were recruited within 72 h of admission to general wards of six university hospitals in 2014 and 2015. Rectal swabs were screened for 3GCREB and isolates were analysed phenotypically and genotypically. Patients were questioned on potential risk factors. Multivariable analyses were performed to identify risk factors for 3GCREB colonization and for specific β-lactamases. Results Of 8753 patients screened, 828 were 3GCREB positive (9.5%). Eight hundred and thirteen isolates were available for genotyping. CTX-M-15 was the most common ESBL (38.0%), followed by CTX-M-1 (22.5%), CTX-M-14 (8.7%), CTX-M-27 (7.5%) and SHV-ESBL (4.4%). AmpC was found in 11.9%. Interestingly, 18 Escherichia coli isolates were AmpC positive, 12 of which (67%) contained AmpC on a gene of plasmid origin [CMY (n = 10), DHA (n = 2)]. Risk factors for 3GCREB colonization varied by genotype. Recent antibiotic exposure and prior colonization by antibiotic-resistant bacteria were risk factors for all β-lactamases except CTX-M-14 and CTX-M-27. Travel outside Europe was a risk factor for CTX-M-15 and CTX-M-27 [adjusted OR (aOR) 3.49, 95% CI 2.88–4.24 and aOR 2.73, 95% CI 1.68–4.43]. A previous stay in a long-term care facility was associated with CTX-M-14 (aOR 3.01, 95% CI 1.98–4.59). A preceding hospital stay in Germany increased the risk of CTX-M-15 (aOR 1.27, 95% CI 1.14–1.41), while a prior hospital stay in other European countries increased the risk of SHV-ESBL colonization (aOR 3.85, 95% CI 1.67–8.92). Conclusions The detection of different ESBL types is associated with specific risk factor sets that might represent distinct sources of colonization and ESBL-specific dissemination routes.

Risk factors for the isolation of a third generation cephalosporin resistant strain in patients with community-acquired Enterobacteriaceae bacteraemia

2016 ◽  
Vol 72 (2) ◽  
pp. 268-271 ◽  
Author(s):  
M. Ortega ◽  
A. Soriano ◽  
F. Marco ◽  
M. Almela ◽  
J.A. Martínez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Resistant Strain ◽  
Generation Cephalosporin ◽  
Third Generation

scholarly journals Third-generation cephalosporin-resistant urinary tract infections in children presenting to the paediatric emergency department

2019 ◽  
Vol 25 (3) ◽  
pp. 166-172
Author(s):  
Kristopher T Kang ◽  
Karen Ng ◽  
Jennifer Kendrick ◽  
Peter Tilley ◽  
Joseph Ting ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Urinary Tract Infections ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Tract Infections

Abstract Background The incidence of antibiotic-resistant urinary tract infections (UTIs) in children is increasing. The purpose of this study was to describe the incidence, clinical characteristics, and risk factors for third-generation cephalosporin-resistant UTIs presenting to the paediatric emergency department (ED). Methods This was a retrospective cohort study conducted at British Columbia Children’s Hospital. Children aged 0 to 18 years old presenting to the ED between July 1, 2013 and June 30, 2014 and were found to have UTI due to Enterobacteriaceae and Pseudomonas species were included. Patient demographics, clinical features, laboratory findings, and outcomes were compared using standard statistical analyses. Risk factors for resistant UTIs were analyzed using multiple logistic regression analysis. Results There were 294 eligible patients. The median age was 27.4 months. A third-generation cephalosporin-resistant organism was identified in 36 patients (12%). Patients with resistant UTI had lower rates of appropriate empiric antibiotic therapy (25% versus 95.3%, P&lt;0.05), higher rates of hospitalization (38.9% versus 21.3%, P&lt;0.05), higher rates of undergoing a voiding cystourethrogram (19.4% versus 5.0%, P&lt;0.05), and higher rates of UTI recurrence within 30 days (13.9% versus 4.7%, P&lt;0.05). In multivariate analysis, recent hospitalization (odds ratio [OR] 4.3, confidence interval [CI] 1.2 to 16) and antibiotic therapy (OR 3.5, CI 1.5 to 8.5) within the previous 30 days were risk factors for resistant UTI. Conclusions Third-generation cephalosporin-resistant organisms account for a significant proportion of community-acquired paediatric UTIs. Recent hospitalization and antibiotic use are associated with increased risk of resistant UTI.

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