|Topic:||30. Sepsis / Adult / Clinical Studies / Critical Care (CC)|
|Authors:||J.D. Price, R.Y.H. Kim, N. Maniar, T. Rahman, Y. Kothari, R. Pearce, R. Cavallazzi; Louisville, KY/US|
Extended Spectrum Beta-Lactamase (ESBL) infection is a major problem worldwide. ESBL organisms inactivate beta-lactam antibiotics by hydrolysis and lead to resistance to a number of broad spectrum cephalosporin and monobactam antibiotics. In this study, we aimed to evaluate risk factors for mortality in hospitalized patients with ESBL infection. By identifying risk factors for mortality, providers will be able to identify patients at risk for adverse outcomes in order to guide medical decision making.
This is an analysis of a cohort of inpatients with ESBL infection. The sample consisted of all inpatients who had a positive culture for an ESBL organism from 2010 to 2015. The primary outcome was in-hospital mortality. We assessed whether site of infection, isolated pathogen, time of culture obtainment, gender, and Charlson Comorbidity Index score (CCI) are associated with increased mortality.
Among 233 patients included, 29 (12.5%) died. On multivariate regression model, we observed an increased mortality in those with a positive blood culture (OR: 3.34; 95% CI: 1.29 to 8.66; P value = 0.013), positive respiratory tract culture (OR: 4.44; 95% CI: 1.62 to 12.1; P value = 0.004), and increasing comorbidity score (OR: 1.24; 95% CI: 1.07 to 1.44; P value = 0.004) whereas increasing age was at the threshold of significance (OR: 1.03; 95% CI: 1.01 to 1.06; P value = 0.052).
In patients with an ESBL infection, a positive blood culture was associated with a 3-fold increase in risk of death; a positive respiratory tract culture was associated with a 4-fold increase in risk. Gender, time of culture obtainment, and isolated pathogen were not associated with mortality in our cohort.