Related Experiment Video
Updated: Jun 12, 2025
Methods for Detecting Cytotoxic Amyloids Following Infection of Pulmonary Endothelial Cells by Pseudomonas aeruginosa
Published on: July 12, 2018
Mortality and Risk Factors of Death in Patients with AmpC β-Lactamase Producing Enterobacterales Bloodstream
Ana Sheila Duarte Nunes Silva1, Natalia Chilinque Zambão da Silva1, Fernanda Moreth do Valle2
1Infection Disease Division, Department of Clinical Medicine, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil.
Aim:
ESCPM bacteria include Enterobacter spp, Serratia, Citrobacter spp, Providencia spp, and Morganella spp. These Gram-negative bacilli harbor chromosomally encoded AmpC-type β-lactamases that cause resistance to β-lactam antibiotics, such as penicillins, β-lactam/β-lactamase inhibitors, and first-, second-, and third-generation cephalosporins. Bloodstream infections caused by ESCPM group bacteria (BSI-ESCPM) are difficult to treat.
Purpose:
To describe 30-day mortality and analyze potential risk factors for death in patients with BSI-ESCPM.
Patients And Methods:
A cohort study of patients aged ≥ 18 years with BSI-ESCPM was conducted at a University Hospital in Brazil, from January 2013 and December 2018. Potential risk factors for death within 30 days of bloodstream infection BSI diagnosis were analyzed using multivariable logistic regression.
Results:
Among 138 patients with BSI-ESCPM, 63.0% were males, with a median age of 61 years. Of 155 BSI-ESCPM episodes, 61.3% were hospital-acquired. Primary BSI-ESCPM associated with short-term central venous catheter (37.4%) and BSI-ESCPM secondary to respiratory infection (19.4%) occurred mainly. Mostly, Enterobacter spp. (49.7%) and Serratia spp. (29.0%) were isolated. Multidrug-resistance occurred in 27.7% of BSI-ESCPM episodes, involving Enterobacter spp. (16.1%) and Serratia spp. (7.7%) mainly. The mortality was 24.5%. Developing septic shock within 72 h of BSI-ESCPM diagnosis (OR: 70.26; 95% CI: 16.69-295.77; P<0.01) was risk factor for death. Conversely, combined antibiotic therapy (OR: 0.23; 95% CI: 0.05-0.94; P:0.04), BSI-ESCPM secondary to urinary infection (OR: 0.11; 95% CI: 0.01-0.99; P:0.05), and Enterobacter spp. BSI (OR: 0.16; 95% CI: 0.05-0.56; P0<0.01) was protective factor against death. Tendency of association between inadequate antibiotic therapy and death (OR: 2.19; 95% CI: 0.51-9.42; P:0.29) was observed.
Conclusion:
BSI-ESCPM is severe and has serious outcomes such as sepsis-associated deaths. Combined antibiotic therapy was a protective factor against death in patients with BSI-ESCPM. There is a suggestive association between inadequate antibiotic therapy and mortality. The ESCPM group bacteria that are considered to be at moderate to high risk of clinically significant AmpC production were not associated with death.
Insights
Bloodstream infections caused by ESCPM bacteria are serious, with a 24.5% mortality rate. Combined antibiotic therapy significantly reduced deaths, while septic shock increased mortality risk in these difficult-to-treat infections.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- The ESCPM group (Enterobacter, Serratia, Citrobacter, Providencia, Morganella) comprises Gram-negative bacilli known for AmpC-type β-lactamase production.
- These bacteria confer resistance to various β-lactam antibiotics, complicating the treatment of bloodstream infections (BSI-ESCPM).
- BSI-ESCPM are associated with significant morbidity and mortality, necessitating a deeper understanding of risk factors.
Purpose of the Study:
- To determine the 30-day mortality rate in patients diagnosed with BSI-ESCPM.
- To identify and analyze potential risk factors associated with increased mortality in this patient cohort.
Main Methods:
- A retrospective cohort study was conducted at a Brazilian University Hospital between January 2013 and December 2018.
- The study included 138 adult patients diagnosed with BSI-ESCPM.
- Multivariable logistic regression analysis was employed to identify risk factors for 30-day mortality.
Main Results:
- The overall 30-day mortality rate for BSI-ESCPM was 24.5%.
- Development of septic shock within 72 hours of diagnosis was a significant risk factor for death (OR: 70.26).
- Combined antibiotic therapy (OR: 0.23), BSI-ESCPM secondary to urinary infection (OR: 0.11), and Enterobacter spp. BSI (OR: 0.16) were identified as protective factors against mortality.
Conclusions:
- BSI-ESCPM represents a severe clinical challenge with substantial mortality.
- Combined antibiotic therapy emerged as a crucial protective factor, highlighting the importance of appropriate treatment strategies.
- While not directly associated with death in this study, the moderate-to-high risk of AmpC production in ESCPM bacteria warrants continued vigilance.
More Related Videos
11:17Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
09:07Author Spotlight: Accelerating Diagnostic Accuracy with Direct Identification of Gram-Negatives from Blood Culture Bottles
Published on: May 24, 2024
Related Concept Videos
01:23Antimicrobial Proteins
Interferons
Interferons (IFNs) are proteins produced by lymphocytes, macrophages, and fibroblasts infected with viruses. While IFNs cannot prevent viruses from entering and...
01:31Defense Against Bacterial Pathogens
Phagocytes
Phagocytes are the frontline soldiers of the immune system. They include neutrophils and macrophages. Neutrophils are the most abundant type of white blood cell and are quickly mobilized to the site of infection. Macrophages are larger cells that patrol...