Infection Control & Hospital Epidemiology
Table 2. Comparisons Between Baseline Characteristics, Exposures and Outcomes Between Patients Colonized and Not Colonized With ESBL-PE
Patients Colonized With ESBL-PE on ICU Admission (n=24)
No. or Median % or IQR
Age, y Female
Hospitalization within
<4 weeks 4–12 weeks 13 weeks to 1 y
Charlson comorbidity index
SAPS II
Immunosuppression Hematological disorder Active
(nonhematological) malignancy
Bone marrow transplant
Solid organ transplant
Known colonization with multidrug- resistant bacteria
MRSA ESBL VRE
Other multidrug- resistant gram-negative bacteria
Exposure to antibiotics prior to ESBL screening (since beginning of hospitalization)
Exposure to carbapenems prior ICU admission
Exposure to piperacillin- tazobactam prior ICU admission
Exposure to antibiotics after ESBL screening result
Exposure to carbapenems
Infection after ESBL screening result
Respiratory tract Urinary tract
1
0 7
4.2 0.0 29.2 6
0 8
2.2 .443
0.0 NA 2.9
<0.001
1 6 0 1
4.2
25.0 0.0 4.2
4 4 0 1
1.4 1.4
0.341 <0.001
0.0 NA 0.4 NA
23 95.8 246 88.5 .492 6 11 25.0 45.8 57 124 20.5 44.8 .603 .920
study, however, did not find this association in ESBL-PE blood- stream infections.29 A recent French study showed an increase in ICU length of stay in ESBL-PE–colonized patients but only a very small difference in crude mortality rates.28 Although our study may be underpowered to show the latter, the former might be explained by the fact that we did not apply contact precautions in E. coli ESBL-PE–colonized patients. In the same study, the neg- ative effect on outcomes of ESBL-PE infection was mostly associ- ated with non–E. coli ESBL-PE. The small number of ESBL-PE other than E. coli in our cohort may therefore have lessened the effect. In addition, this French study analyzed from a period (1996–2013) when clinicians had less experience with ESBL- PE–colonized and –infected patients than they had during our study period (2014–2015). Most studies that found an association with negative outcomes also showed that the risk for receiving an ineffective empiric antibiotic treatment was higher for patients with ESBL-PE infections.30 We speculate that the high percentage of patients empirically treated by carbapenems may have influ- enced the outcome. Additionally, recent studies have indicated that β-lactam/
10 5 10
6 0
41.7 20.8 41.7
25.0 0.0
110 34 110
60 11
39.6 12.2 39.6
21.6 4.0
.831 .214 .840
β-lactamase inhibitor combination antibiotics might have a certain effectiveness in the treatment of ESBL infection.31,32 As in our cohort, β-lactam/β-lactamase inhibitor therapy was the most frequent choice of empirical therapy, which may have further influenced the outcome. In this study, of 4 patients that developed a documented
ESBL-PE infection, 3 had a positive screening result, making ESBL-PE colonization the strongest risk factor for ESBL-PE infection. This finding is consistent with several studies that also identified ESBL-PE colonization as risk factor for ESPL-PE infection.21,28,33–35 Carbapenem exposure after availability of the screening result differed between patients with a positive screening result and
7 2 5
29.2 8.3
20.8
65.5 56–76 2 2 3
8.3 8.3
12.5
98 26 51
68 10 13 32
35.4 9.4
18.4 21–421–4 .658
1.000 .785 .398
57–78 .797 3.6 4.7
11.5
.245 .338 .748
20.8 Patients Not
Colonized With ESBL-PE on ICU
Admission (n=278)
No. or Median % or IQR
89 32.0 P Value
60.3 56.9–74.0 66.6 56.5–74.4 .932 5
.359 Abdominal
Catheter related Other
Unknown focus
Infection caused by ESBL-PE
Length of ICU stay in survivors
Length of hospital stay in survivors
Death overall
Death attributable to infection
Table 2. (Continued )
Patients Colonized With ESBL-PE on ICU Admission (n=24)
No. or Median % or IQR
1 1 1 1 3
4.2 4.2 4.2 4.2
12.5 82–16 20
6 2
9–32
25.0 8.3
Patients Not
Colonized With ESBL-PE on ICU
Admission (n=278)
No. or Median % or IQR
10 2
12 15 1
6 20
85 24
3.6 0.7 4.3 5.4 0.4
P Value
411
.002 4–12 .849 11–34 .537
30.6 8.6
.649 1.000
Note. ESBL-PE, ESBL-producing Enterobacteriaceae; IQR, interquartile range; SAPS II, simplified acute physiology score; MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococci; ESBL, extended-spectrum β-lactamase; NA, not applicable.
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