Objectives: Healthcare-associated bacteraemia is defined as bacteraemia diagnosed ≤48 h after hospital admission in patients recently exposed to healthcare procedures or settings. It differs from hospital-acquired bacteraemia, which is diagnosed >48 h after hospital admission. Healthcare-associated bacteraemia is reported increasingly, often due to resistant pathogens including extended-spectrum beta-lactamase (ESBL) producers, representing a challenge to empirical treatment. This study aimed to assess the appropriateness of empirical treatment for ESBL bacteraemia at the authors' centre, to perform a descriptive analysis according to the mode of infection acquisition (community-acquired, healthcare-associated, hospital-acquired), and to assess the risk factors for mortality. Methods: A retrospective study on patients with ESBL bacteraemia was undertaken. Results: In total, 129 consecutive cases of bacteraemia due to ESBL producers were included in this study. Compared with community- and hospital-acquired bacteraemia, healthcare-associated bacteraemia affected older patients (P=0.001) and patients with higher Charlson Comorbidity Index scores (P=0.007), and was more frequently associated with piperacillin-tazobactam resistance (P=0.025) and multi-drug resistance (P=0.026). Overall, ineffective empirical treatment was common (42%). Factors associated with 30-day mortality were septic shock [odds ratio (OR) 7.096, 95% confidence interval (CI) 2.58-24.58], high Pitt score (OR 6.636, 95% CI 1.71-23.62) and unknown source of bacteraemia (OR 19.28, 95% CI 2.80-30.70). Conclusions: Antimicrobial stewardship interventions focusing on both in-hospital and community settings are advocated to better manage healthcare-associated infections due to ESBL producers.

Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections / A.M. Peri, D. Calabretta, G. Bozzi, G.M. Migliorino, S. Bramati, A. Gori, A. Bandera. - In: IJID REGIONS. - ISSN 2772-7076. - 6:(2023 Mar), pp. 167-170. [10.1016/j.ijregi.2023.01.005]

Retrospective analysis of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacterales: the challenge of healthcare-associated infections

A.M. Peri
Primo
;
D. Calabretta
Secondo
;
G. Bozzi;A. Gori
Penultimo
;
A. Bandera
Ultimo
2023

Abstract

Objectives: Healthcare-associated bacteraemia is defined as bacteraemia diagnosed ≤48 h after hospital admission in patients recently exposed to healthcare procedures or settings. It differs from hospital-acquired bacteraemia, which is diagnosed >48 h after hospital admission. Healthcare-associated bacteraemia is reported increasingly, often due to resistant pathogens including extended-spectrum beta-lactamase (ESBL) producers, representing a challenge to empirical treatment. This study aimed to assess the appropriateness of empirical treatment for ESBL bacteraemia at the authors' centre, to perform a descriptive analysis according to the mode of infection acquisition (community-acquired, healthcare-associated, hospital-acquired), and to assess the risk factors for mortality. Methods: A retrospective study on patients with ESBL bacteraemia was undertaken. Results: In total, 129 consecutive cases of bacteraemia due to ESBL producers were included in this study. Compared with community- and hospital-acquired bacteraemia, healthcare-associated bacteraemia affected older patients (P=0.001) and patients with higher Charlson Comorbidity Index scores (P=0.007), and was more frequently associated with piperacillin-tazobactam resistance (P=0.025) and multi-drug resistance (P=0.026). Overall, ineffective empirical treatment was common (42%). Factors associated with 30-day mortality were septic shock [odds ratio (OR) 7.096, 95% confidence interval (CI) 2.58-24.58], high Pitt score (OR 6.636, 95% CI 1.71-23.62) and unknown source of bacteraemia (OR 19.28, 95% CI 2.80-30.70). Conclusions: Antimicrobial stewardship interventions focusing on both in-hospital and community settings are advocated to better manage healthcare-associated infections due to ESBL producers.
Antimicrobial resistance; Bacteraemia; Extended-spectrum beta-lactamases; Healthcare-associated infections; Sepsis
Settore MED/17 - Malattie Infettive
mar-2023
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1020243
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