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. 2022 Dec 14:14:1547-1560.
doi: 10.2147/CLEP.S385555. eCollection 2022.

Antimicrobial Resistance and Mortality in Hospitalized Patients with Bacteremia in the Greater Paris Area from 2016 to 2019

Salam Abbara  1   2 , Didier Guillemot  1   2   3 , Salma El Oualydy  4 , Maeva Kos  4 , Cécile Poret  5 , Stéphane Breant  5 , Christian Brun-Buisson  1   2 , Laurence Watier  1   2
Affiliations

Antimicrobial Resistance and Mortality in Hospitalized Patients with Bacteremia in the Greater Paris Area from 2016 to 2019

Salam Abbara et al. Clin Epidemiol. .

Abstract

Purpose: Antibiotic-resistant bacteremia is a leading global cause of infectious disease morbidity and mortality. Clinical data warehouses (CDWs) allow for the secure, real-time coupling of diverse data sources from real-world clinical settings, including care-based medical-administrative data and laboratory-based microbiological data. The main purpose of this study was to assess the contribution of CDWs in the epidemiological study of antibiotic resistance by constructing a database of bacteremia patients, BactHub, and describing their main clinico-microbiological features and outcomes.

Patients and methods: Adult patients with bacteremia hospitalized between January 1, 2016 and December 31, 2019 in 14 acute care university hospitals from the Greater Paris area were identified; their first bacteremia episode was included. Data describing patients, episodes of bacteremia, bacterial isolates, and antimicrobial resistance were structured.

Results: Among 29,228 patients with bacteremia, 41% of episodes were community-onset (CO) and 59% were hospital-acquired (HA). Thirty-day and ninety-day mortality rates were 15% and 20% in CO episodes, and 18% and 36% in HA episodes. Overall resistance rates were high, including third-generation cephalosporin resistance among Klebsiella pneumoniae (CO 21%, HA 37%) and Escherichia coli (CO 13%, HA 17%), and methicillin resistance among Staphylococcus aureus (CO 11%, HA 14%). Annual incidence rates increased significantly from 2017 to 2019, from 20.0 to 20.9 to 22.1 stays with bacteremia per 1000 stays (p < 0.0001).

Conclusion: The Bacthub database provides accurate clinico-microbiological data describing bacteremia across France's largest hospital group. Data from Bacthub may inform surveillance and the clinical decision-making process for bacteremia patients, including choice of antimicrobial therapy. The database also offers opportunities for research, including analysis of hospital care pathways and significant patient outcomes such as mortality and recurrence of infection.

Keywords: anti-bacterial agents; bacteremia; data warehousing; drug resistance; incidence; microbial; mortality.

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Conflict of interest statement

Funding received by SA had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. LW received consulting fees from Pfizer, HEVA, IQVIA for unrelated projects. Other authors report no competing interests. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of the selection process for the Bacthub database, Greater Paris university hospitals, 2016–2019.
Figure 2
Figure 2
Rates of resistance of bacterial isolates in the blood to major antimicrobials, per primary infection site. (A) Third generation cephalosporins resistance rate of E. coli and K. pneumoniae isolates. (B) Methicillin resistance rate of S. aureus isolates.
See this image and copyright information in PMC

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