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Emerging antimicrobial resistance among Escherichia coli strains in bloodstream infections in Toronto, 2006-2016: a retrospective cohort study.

ABSTRACT: Enterobacteriaceae that produce extended-spectrum ?-lactamase (ESBL) have emerged as a serious threat, with variable rates depending on geographic region. We determined the prevalence of ESBL-producing Escherichia coli, Klebsiella pneumoniae, K. oxytoca and Proteus mirabilis in bloodstream infections in Toronto from 2006 through 2016. All patients with E. coli, K. pneumoniae, K. oxytoca and P. mirabilis isolated from blood in a tertiary care microbiology laboratory in Toronto between 2006 and 2016 (1 isolate per species per patient per year) were included in this retrospective cohort study. Organisms were identified by conventional methods, and susceptibility testing was performed according to Clinical and Laboratory Standards Institute standards. Screening for ESBL and phenotypic confirmatory testing were done with a modified Clinical and Laboratory Standards Institute method. ST131 clonal type was determined by means of an established protocol. The proportion of ESBL-producing E. coli isolates increased significantly between 2006 and 2016, from 6.4% (19/296) to 17.3% (89/513) (p < 0.001). This trend was seen in both intensive care units and emergency departments. Concurrently, the proportion of ST131 among ESBL-producing E. coli also increased significantly, from 31.6% (6/19) in 2006 to 73.0% (65/89) in 2016 (p = 0.03). Among ESBL-producing E. coli, significant resistance was noted to multiple antimicrobial classes. Comparable increases in the proportion of ESBL-producing K. pneumoniae, K. oxytoca and P. mirabilis were not noted. We observed a significant increase in the proportion of ESBL-producing E. coli in bloodstream infections in Toronto temporally correlated with an increase in the ST131 clonal type. Recognition of this dramatic rise is important to inform empiric antibiotic treatment.

SUBMITTER: Mineau S

PROVIDER: S-EPMC6277254 | biostudies-other | 2018 Oct-Dec

REPOSITORIES: biostudies-other

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Emerging antimicrobial resistance among <i>Escherichia coli</i> strains in bloodstream infections in Toronto, 2006-2016: a retrospective cohort study.

Mineau Sophie S Kozak Robert R Kissoon Melissa M Paterson Aimee A Oppedisano Anthony A Douri Firas F Gogan Kate K Willey Barbara M BM McGeer Allison A Poutanen Susan M SM

CMAJ open 20181001 4

<h4>Background</h4>Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL) have emerged as a serious threat, with variable rates depending on geographic region. We determined the prevalence of ESBL-producing <i>Escherichia coli</i>, <i>Klebsiella pneumoniae</i>, <i>K. oxytoca</i> and <i>Proteus mirabilis</i> in bloodstream infections in Toronto from 2006 through 2016.<h4>Methods</h4>All patients with <i>E. coli</i>, <i>K. pneumoniae</i>, <i>K. oxytoca</i> and <i>P. mirabilis</i> iso ...[more]

PMID: 30510041

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Project description:UnlabelledAlthough some studies have examined the epidemiology of bloodstream infections after liver transplantation, they were based in single centers and did not identify bloodstream infections treated in other hospitals.MethodsWe retrospectively examined a cohort of 7912 adult liver transplant recipients from 24 transplant centers using 2004 to 2012 International Classification of Diseases, Ninth Revision, Clinical Modification billing data from 3 State Inpatient Databases, and identified bloodstream infections, inpatient death, and cumulative 1-year hospital costs. Multilevel Cox regression analyses were used to determine factors associated with bloodstream infections and death.ResultsBloodstream infections were identified in 29% (n = 2326) of liver transplant recipients, with a range of 19% to 40% across transplant centers. Only 63% of bloodstream infections occurring more than 100 days posttransplant were identified at the original transplant center. Bloodstream infections were associated with posttransplant laparotomy (adjusted hazard ratio [aHR], 1.52), prior liver transplant (aHR, 1.42), increasing age (aHR, 1.07/decade), and some comorbidities. Death was associated with bloodstream infections with and without septic shock (aHR, 10.96 and 3.71, respectively), transplant failure or rejection (aHR, 1.41), posttransplant laparotomy (aHR, 1.40), prior solid-organ transplant (aHR, 1.48), increasing age (aHR, 1.15/decade), and hepatitis C cirrhosis (aHR, 1.20). The risk of bloodstream infections and death varied across transplant centers. Median 1-year cumulative hospital costs were higher for patients who developed bloodstream infections within 1 year of transplant compared with patients who were bloodstream infection-free (US $229 806 vs US $111 313; P < 0.001).ConclusionsBloodstream infections are common and costly complications after liver transplantation that are associated with a markedly increased risk of death. The incidence and risk of developing bloodstream infections may vary across transplant centers.

Project description:Introduction: Bloodstream infections (BSI) are a major cause of mortality all over the world. Inappropriate empirical antimicrobial treatment (i-EAT) impact on mortality has been largely reported. However, information on related factors for the election of i-EAT in the treatment of BSI in adults is lacking. The aim of the study was the identification of risk-factors associated with the use of i-EAT in BSI. Methods: A retrospective, observational cohort study, from a prospective database was conducted in a 400-bed acute-care teaching hospital including all BSI episodes in adult patients between January and December 2018. The main outcome variable was EAT appropriation. Multivariate analysis using logistic regression was performed. Results: 599 BSI episodes were included, 146 (24%) received i-EAT. Male gender, nosocomial and healthcare-associated acquisition of infection, a high Charlson Comorbidity Index (CCI) score and the isolation of multidrug resistant (MDR) microorganisms were more frequent in the i-EAT group. Adequation to local guidelines' recommendations on EAT resulted in 91% of appropriate empirical antimicrobial treatment (a-EAT). Patients receiving i-EAT presented higher mortality rates at day 14 and 30 when compared to patients with a-EAT (14% vs. 6%, p = 0.002 and 22% vs. 9%, p < 0.001 respectively). In the multivariate analysis, a CCI score ≥3 (OR 1.90 (95% CI 1.16-3.12) p = 0.01) and the isolation of a multidrug resistant (MDR) microorganism (OR 3.79 (95% CI 2.28-6.30), p < 0.001) were found as independent risk factors for i-EAT. In contrast, female gender (OR 0.59 (95% CI 0.35-0.98), p = 0.04), a correct identification of clinical syndrome prior to antibiotics administration (OR 0.26 (95% CI 0.16-0.44), p < 0.001) and adherence to local guidelines (OR 0.22 (95% CI 0.13-0.38), p < 0.001) were identified as protective factors against i-EAT. Conclusion: One quarter of BSI episodes received i-EAT. Some of the i-EAT related factors were unmodifiable (male gender, CCI score ≥3 and isolation of a MDR microorganism) but others (incorrect identification of clinical syndrome before starting EAT or the use of local guidelines for EAT) could be addressed to optimize the use of antimicrobials.

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Dataset Information

Emerging antimicrobial resistance among Escherichia coli strains in bloodstream infections in Toronto, 2006-2016: a retrospective cohort study.

Publications

Emerging antimicrobial resistance among <i>Escherichia coli</i> strains in bloodstream infections in Toronto, 2006-2016: a retrospective cohort study.

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