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Antimicrobial resistance patterns, clinical features, and risk factors for septic shock and death of nosocomial E coli bacteremia in adult patients with hematological disease: A monocenter retrospective study in China.

Abstract The aim of this retrospective analysis was to evaluate the antimicrobial resistance, clinical features, and risk factors for septic shock and death of nosocomial E coli bacteremia in adult patients in a single hematological center in China. A retrospective case-control study of 157 adult hematological patients with 168 episodes of E coli bacteremia was initiated from April 2012 to July 2015. Antimicrobial susceptibility as well as antimicrobial co-resistance rates were analyzed. Clinical features and outcomes were also studied. In addition, risk factors for septic shock and death were investigated. Among the 553 positive blood isolates during the study period, the prevalence of E coli was 33.3% and ESBL production strains represented 61.9% of those examined. In all the E coli strains isolated, 85.6% were multidrug-resistance (MDR), 2.4% were extensive drug resistance (XDR), and 6.0% were resistant to carbapenems. More MDR phenotype was noted in ESBL-EC strains (98.6% vs 62.8%, P<.001) and isolates from neutropenic patients (98.6% vs 62.8%, P < .001). In the antimicrobial susceptibility test, carbapenems and amikacin exhibited not only higher in vitro activity against E coli (94.0% and 92.0%, respectively), but lower co-resistance rates to other antibiotics. Carbapenem resistant strains retained full sensitivity to tigecycline and 60% to amikacin. Piperacillin/tazobatam was the third sensitive drug to both ESBL-EC (77.1%) and non-ESBL-EC (86.0%). In our series, 81.6% episodes received appropriate initial antibiotic treatment and no significant decrease in it was found in bacteremia due to ESBL E coli and patients with neutropenia, septic shock. Septic shock was noted in 15.5% patients and the overall 30-day mortality rate was 21.7%. Multivariate analysis revealed that induction chemotherapy (OR 2.126; 95% CI 1.624-11.332; P = .003) and polymicrobial infection (OR 3.628; 95% CI 1.065-21.219; P = .041) were risk factors for septic shock, whereas male (OR 2.223; 95% CI 1.132-12.022; P < .01) and septic shock (OR 52.359; 95% CI 19.951-292.690; P = .030) were risk factors for death.In the hematology department, ESBL-producing and MDR are widely prevalent in E coli bacteremia which is still a major life-threatening problem, especially for patients with septic shock. For empirical antimicrobial therapy, combination based on aminoglycoside, especially amikacin, will be helpful to increase the antimicrobial coverage against ESBL-EC while combining tigecycline with aminoglycoside should be considered for seriously carbapenem-resistant infectious patients.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28538389
OWN - NLM
STAT- In-Process
DA  - 20170524
LR  - 20170524
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 21
DP  - 2017 May
TI  - Antimicrobial resistance patterns, clinical features, and risk factors for septic
      shock and death of nosocomial E coli bacteremia in adult patients with
      hematological disease: A monocenter retrospective study in China.
PG  - e6959
LID - 10.1097/MD.0000000000006959 [doi]
AB  - The aim of this retrospective analysis was to evaluate the antimicrobial
      resistance, clinical features, and risk factors for septic shock and death of
      nosocomial E coli bacteremia in adult patients in a single hematological center
      in China. A retrospective case-control study of 157 adult hematological patients 
      with 168 episodes of E coli bacteremia was initiated from April 2012 to July
      2015. Antimicrobial susceptibility as well as antimicrobial co-resistance rates
      were analyzed. Clinical features and outcomes were also studied. In addition,
      risk factors for septic shock and death were investigated. Among the 553 positive
      blood isolates during the study period, the prevalence of E coli was 33.3% and
      ESBL production strains represented 61.9% of those examined. In all the E coli
      strains isolated, 85.6% were multidrug-resistance (MDR), 2.4% were extensive drug
      resistance (XDR), and 6.0% were resistant to carbapenems. More MDR phenotype was 
      noted in ESBL-EC strains (98.6% vs 62.8%, P&lt;.001) and isolates from neutropenic
      patients (98.6% vs 62.8%, P &lt; .001). In the antimicrobial susceptibility test,
      carbapenems and amikacin exhibited not only higher in vitro activity against E
      coli (94.0% and 92.0%, respectively), but lower co-resistance rates to other
      antibiotics. Carbapenem resistant strains retained full sensitivity to
      tigecycline and 60% to amikacin. Piperacillin/tazobatam was the third sensitive
      drug to both ESBL-EC (77.1%) and non-ESBL-EC (86.0%). In our series, 81.6%
      episodes received appropriate initial antibiotic treatment and no significant
      decrease in it was found in bacteremia due to ESBL E coli and patients with
      neutropenia, septic shock. Septic shock was noted in 15.5% patients and the
      overall 30-day mortality rate was 21.7%. Multivariate analysis revealed that
      induction chemotherapy (OR 2.126; 95% CI 1.624-11.332; P = .003) and
      polymicrobial infection (OR 3.628; 95% CI 1.065-21.219; P = .041) were risk
      factors for septic shock, whereas male (OR 2.223; 95% CI 1.132-12.022; P &lt; .01)
      and septic shock (OR 52.359; 95% CI 19.951-292.690; P = .030) were risk factors
      for death.In the hematology department, ESBL-producing and MDR are widely
      prevalent in E coli bacteremia which is still a major life-threatening problem,
      especially for patients with septic shock. For empirical antimicrobial therapy,
      combination based on aminoglycoside, especially amikacin, will be helpful to
      increase the antimicrobial coverage against ESBL-EC while combining tigecycline
      with aminoglycoside should be considered for seriously carbapenem-resistant
      infectious patients.
FAU - Ma, Jie
AU  - Ma J
AD  - Department of Hematology, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Li, Ning
AU  - Li N
FAU - Liu, Yajie
AU  - Liu Y
FAU - Wang, Chong
AU  - Wang C
FAU - Liu, Xiaoyan
AU  - Liu X
FAU - Chen, Shengmei
AU  - Chen S
FAU - Xie, Xinsheng
AU  - Xie X
FAU - Gan, Silin
AU  - Gan S
FAU - Wang, Meng
AU  - Wang M
FAU - Cao, Weijie
AU  - Cao W
FAU - Wang, Fang
AU  - Wang F
FAU - Liu, Yanfan
AU  - Liu Y
FAU - Wan, Dingming
AU  - Wan D
FAU - Sun, Ling
AU  - Sun L
FAU - Sun, Hui
AU  - Sun H
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/05/26 06:00
MHDA- 2017/05/26 06:00
CRDT- 2017/05/25 06:00
AID - 10.1097/MD.0000000000006959 [doi]
AID - 00005792-201705260-00030 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 May;96(21):e6959. doi: 10.1097/MD.0000000000006959.

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