Association of high mortality with extended–spectrum β-lactamase (ESBL) positive cultures in community acquired infections

Infections due to multidrug resistant organisms have become a serious health concern worldwide. The present study was conducted to investigate the spectrum of microbial resistance pattern in the community and their effects on mortality. A retrospective review and analysis of prospectively collected...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of critical care Vol. 44; pp. 255 - 260
Main Authors:	Ray, Sumit, Anand, Dimple, Purwar, Sankalp, Samanta, Arijit, Upadhye, Kaustubh V., Gupta, Prasoon, Dhar, Debashis
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2018 Elsevier Limited
Subjects:	Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotics Bacteria beta-Lactamases - metabolism BL + BLI Community-acquired infections Community-Acquired Infections - drug therapy Community-Acquired Infections - microbiology Community-Acquired Infections - mortality Drug Administration Schedule Drug resistance Drug Resistance, Multiple, Bacterial ESBL ESBL positive Escherichia coli - drug effects Escherichia coli - enzymology Escherichia coli - isolation & purification Escherichia coli Infections - drug therapy Escherichia coli Infections - microbiology Escherichia coli Infections - mortality Female Hospital Mortality Hospitals Humans India Intensive care Intensive Care Units Klebsiella - drug effects Klebsiella - enzymology Klebsiella - isolation & purification Klebsiella Infections - drug therapy Klebsiella Infections - microbiology Klebsiella Infections - mortality Laboratories Male Microbial Sensitivity Tests Middle Aged Mortality Nosocomial infections Organisms Patients Pneumonia Prospective Studies Retrospective Studies Sepsis - drug therapy Sepsis - microbiology Sepsis - mortality Statistical analysis Systematic review Urinary tract diseases Urinary tract infections Urine Urogenital system India ESBL ESBL positive Community-acquired infections BL+BLI Mortality
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Infections due to multidrug resistant organisms have become a serious health concern worldwide. The present study was conducted to investigate the spectrum of microbial resistance pattern in the community and their effects on mortality. A retrospective review and analysis of prospectively collected data was done of all patients admitted with diagnosis of sepsis in two tertiary care ICU's for a period of two years. Demographics, culture positivity, microbial spectrum, resistance pattern and outcome data were collected. Out of 5309 patients enrolled; 3822 had suspected clinical infection on admission with 1452 patients growing positive microbial cultures. Among these, 201 bacterial strains were isolated from patients who had community acquired infections. 73% were Gram negative bacilli, commonest being E. coli (63%). 63.4% E. coli and 60.7% Klebsiella isolates were ESBL producers. The mortality in ESBL positive infections was significantly higher as compared to ESBL negative infections (Odds ratio 2.756). Moreover, ESBL positive patients empirically treated with Beta Lactams+Beta Lactamase inhibitors (BL+BLI) had significantly higher mortality as compared to patients treated with carbapenems. More data from multiple centres need to be gathered to formulate appropriate antibiotic policy for critically ill patients admitted from the community. •High incidence of ESBL producing gram negative infections from the community is worrying.•ESBL positive organisms found to cause higher mortality as compared to ESBL negatives.•BL+BLI combination is not appropriate for ESBL.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0883-9441 1557-8615
DOI:	10.1016/j.jcrc.2017.10.036