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Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and

Marco Mussa1,2,3, Pedro María Martínez Pérez-Crespo4,5, Luis Eduardo Lopez-Cortes2,4

  • 1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy.

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|June 30, 2022
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Summary

Enterococcus bloodstream infections in the biliary tract are linked to specific risk factors like cholangiocarcinoma and hospital acquisition. Identifying these factors can help guide appropriate empirical treatment for better patient outcomes.

Keywords:
Enterococcus spp.biliary tract infectionbloodstream infection

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Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Epidemiology

Background:

  • Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus species are associated with poorer outcomes.
  • Inappropriate empirical treatment is a significant concern in managing these infections.
  • Enterococcal BT-BSI may require different empirical antimicrobial strategies compared to other pathogens.

Purpose of the Study:

  • To identify independent risk factors for enterococcal BT-BSI.
  • To develop a predictive score for enterococcal BT-BSI.
  • To aid in optimizing empirical treatment decisions for biliary tract infections.

Main Methods:

  • Retrospective cohort study of patients with BT-BSI from the PROBAC cohort.
  • Multivariate logistic regression analysis to identify predictors of enterococcal BT-BSI.
  • Development and evaluation of a predictive score based on identified risk factors.

Main Results:

  • Enterococcus species accounted for 8.5% of BT-BSI episodes.
  • Independent predictors for enterococcal BT-BSI included cholangiocarcinoma, hospital acquisition, prior carbapenem use, biliary prosthesis, and chronic kidney disease.
  • A predictive score demonstrated moderate predictive ability (AUC 0.74) for enterococcal BT-BSI.

Conclusions:

  • Cholangiocarcinoma, hospital acquisition, prior carbapenems, biliary prosthesis, and CKD are key predictors of enterococcal BT-BSI.
  • The developed predictive score may assist clinicians in empirical therapy selection.
  • Further validation of the predictive score is warranted for clinical application.