410
Table 1. Baseline Characteristics and Outcomes of 302 Patients Screened for ESBL-PE Carriage
Variable Age, y
Female
Hospitalization within <4 weeks
4–12 weeks 13 weeks to 1 y
Admission diagnosis Trauma
Post reanimation
Cardiovascular: myocardial infarction, peripheral artery occlusion, cardiac decomensation, aortic dissection
Sepsis/infection
Metabolic (eg, diabetes, hepatic insufficiency, etc) Respiratory (COPD, asthma, etc)
Neurologic: stroke, cerebral bleeding, delirium, seizures
Gastrointestinal bleeding
Hemodynamic monitoring after elective surgery Other
Charlson comorbidity index SAPS II
Immunosuppression Hematological disorder
Active (nonhematological) malignancy Solid organ transplant Bone marrow transplant
Known colonization with multidrug-resistant bacteria
MRSA VRE
ESBL Other multidrug-resistant gram-negative bacteria
Exposure to antibiotics prior to ICU admission (since beginning of hospitalization)
Exposure to carbapenems prior ICU admission
Exposure to piperacillin-tazobactam prior ICU admission
Detection of ESBL-PE colonization on ICU admission Exposure to any antibiotics after screening result Exposure to carbapenems after ICU admission
Exposure to piperacillin-tazobactam after ICU admission
Infection after ICU admission Respiratory tract Urinary tract Abdominal
No. or Median
66 94
105 28 56
20 41 45
80 6
19 23
5
49 14 2
68 12 15 35 0 7
15
5 0
10 2
269 63 135 24
120 39 49
120 66 11 11
%or IQR
56–74 31.1
34.9 9.3
18.6 6.6
13.6 14.9
26.5 2.0 6.3 7.6
1.7
16.2 4.6 1-4
57–78 4.0 5.0
11.6 ::: 2.3 5.0
1.7 0
3.3 0.7
89.1
20.9 44.9
8.0
39.4 12.9 16.2
39.7 21.9 3.6 3.6
Table 1. (Continued ) Variable
Catheter related Other
Unknown focus
Infection after ICU admission caused by ESBL-PE
Length of ICU stay among survivors, d Length of hospital stay among survivors, d Death, overall
Death attributable to infection Death attributable to infection with ESBL-PE
Aurélien E. Martinez et al
No. or Median
3
13 16 4
7
23 90 26 2
%or IQR
1.0 4.3 5.3 1.3
5–13
15–35 29.8 8.6 0.7
Note. IQR, interquartile range; COPD, chronic obstructive pulmonary disease; SAPS II, simplified acute physiology score; MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococci;ESBL, extended-spectrum β-lactamase; ESBL- PE, ESBL-producing Enterobacteriaceae.
Duration of ICU and hospital stay in survivors did not differ
between patients colonized with ESBL-PE (median, 8 days [IQR, 2–16] vs median, 6 days [IQR, 4–12]; P=.849) and not colonized with ESBL-PE (median, 20 days [IQR, 9–32] vs median, 20 days [IQR, 11–34]; P=.537). Patients colonized with ESBL-PE were not at increased risk for death by any cause (HR, 1.00; 95% CI, 0.44–2.30; P=.993) or death attributable to infection (HR, 1.20; 95% CI, 0.28–5.11; P=.808) (Table 2). Among the 4 patients with ESBL-PE infection, 2 patients died.
Discussion
Colonization with ESBL-PE was a reliable predictor for infection with ESBL-PE. Colonization with ESBL-PE was not associated with comorbid conditions, disease severity or prior exposure to antibi- otics, but it was associated with an increased exposure to carbape- nems after ICU admission. In contrast to prior studies, ESBL-PE colonization was not associated with increased length of ICU stay, length of hospital stay, or mortality. Incidence of ESBL-PE colonization was 8% in our cohort. This
finding is in line with the findings of a recent Swiss study reporting a prevalence of ESBL-PE colonization of 7.1% in HIV-positive outpatients and 10% in healthy individuals.20 Recent studies on colonization in ICU patients show rates varying between 2%21 and up to 56%,22 and this large range can be explained by different settings and countries, such as the United States and India, as well as different time frames (2001–2005 and 2016). In our cohort, as in most published studies on ESBL-PE colonization,22–24 22 of 24 ESBL-PE isolates were E. coli. The only factor associated with ESBL-PE colonization in our
study is known colonization with multidrug-resistant bacteria, including ESBL-PE. However, the most common previous coloniz- ing multidrug-resistant bacteria were ESBL-PE. Previous coloniza- tion with multidrug-resistant bacteria might therefore not be an independent risk factor for a positive screening result but actually represents the same biologic event. In our study, colonization with ESBL-PE was not a risk factor
for development of any infection, septic shock, or death. In con- trast to our findings, a number of studies show that infection and even colonization with ESBL-PE are associated with worse outcomes than infections with non–ESBL-PE.25–28 A German
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122
