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. 2018 Nov;52(5):577-585.
doi: 10.1016/j.ijantimicag.2018.06.018. Epub 2018 Jun 30.

Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae

A Russo  1 , M Falcone  1 , B Gutiérrez-Gutiérrez  2 , E Calbo  3 , B Almirante  4 , P L Viale  5 , A Oliver  6 , P Ruiz-Garbajosa  7 , O Gasch  8 , M Gozalo  9 , J Pitout  10 , M Akova  11 , C Peña  12 , J M Cisneros  13 , A Hernández-Torres  14 , A Farcomeni  1 , N Prim  15 , J Origüen  16 , G Bou  17 , E Tacconelli  18 , M Tumbarello  19 , A Hamprecht  20 , I Karaiskos  21 , C de la Calle  22 , F Pérez  23 , M J Schwaber  24 , J Bermejo  25 , W Lowman  26 , P-R Hsueh  27 , M Mora-Rillo  28 , J Rodriguez-Gomez  29 , M Souli  30 , R A Bonomo  31 , D L Paterson  32 , Y Carmeli  24 , A Pascual  2 , J Rodríguez-Baño  2 , M Venditti  33 ; REIPI/ESGBIS/INCREMENT investigators
Affiliations
Free article

Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae

A Russo et al. Int J Antimicrob Agents. 2018 Nov.
Free article

Abstract

Purpose: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E.

Methods: Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts.

Results: 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. β-lactam/β-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy.

Conclusions: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.

Keywords: carbapenems; extended-spectrum ß-lactamases; sepsis; septic shock; ß-lactam/ß-lactamase inhibitors.

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