Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project
| Autor: | Mussa, Marco, Martínez Pérez-Crespo, Pedro María, Lopez-Cortes, Luis Eduardo, Retamar-Gentil, Pilar, Sousa-Dominguez, Adrián, Goikoetxea-Aguirre, Ane Josune, Reguera-Iglesias, José María, León Jiménez, Eva, Fernández-Natal, Isabel, Armiñanzas-Castillo, Carlos, Boix-Palop, Lucía, Cuquet-Pedragosa, Jordi, Morán Rodríguez, Miguel Ángel, Fernandez-Suarez, Jonathan, Del Arco-Jiménez, Alfonso, Jóver-Saenz, Alfredo, Bahamonde-Carrasco, Alberto, Galan-Sanchez, Fátima, Sánchez-Calvo, Juan Manuel, Smithson-Amat, Alejandro, Vinuesa-García, David, Sánchez-Porto, Antonio, López-Hernández, Inmaculada, Rodríguez-Baño, Jesús, PROBAC REIPI/GEIH-SEIMC/SAEI group |
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| Přispěvatelé: | [Mussa M] Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy. UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain. Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain. [Martínez Pérez-Crespo PM] Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain. Hospital Universitario de Valme, Sevilla, Spain. [Lopez-Cortes LE] UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain. Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain. [Retamar-Gentil P] UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain. Departamento de Medicina, Universidad de Sevilla/IBiS/CSIC, Sevilla, Spain. Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Sevilla, Spain. [Sousa-Dominguez A] Hospital Universitario de Vigo, Vigo, Spain. [Goikoetxea-Aguirre AJ] Hospital de Cruces, Bilbao, Spain. [Cuquet-Pedragosa J] Hospital General Granollers, Granollers, Spain, Hospital General de Granollers, Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), European Commission, Red Española de Investigación en Patología Infecciosa, Universidad de Cantabria |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Microbiology (medical)
Enterococs Physiology Cholangitis Enterococcus faecium bloodstream infection Bacteremia Bloodstream infection Cholangiocarcinoma Cohort Studies Bacterièmia Risk Factors Genetics Enterococcus faecalis Humans Renal Insufficiency Chronic Biliary Tract Gram-Positive Bacterial Infections Aged General Immunology and Microbiology Ecology Enterococcus spp Biliary tract infection Cell Biology Anti-Bacterial Agents Infectious Diseases Bacteria::Firmicutes::Lactobacillales::Enterococcaceae::Enterococcus [ORGANISMS] Carbapenems biliary tract infection Conductes biliars - Infeccions Bacteria::Firmicutes::Lactobacillales::Enterococcaceae::Enterococcus [ORGANISMOS] Enterococcus |
| Zdroj: | Scientia Microbiol Spectr . 2022 Aug 31;10(4):e0005122 |
| Popis: | Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus faecalis and E. faecium are associated with inappropriate empirical treatment and worse outcomes compared to other etiologies. The objective of this study was to investigate the risk factors for enterococcal BT-BSI. Patients with BT-BSI from the PROBAC cohort, including consecutive patients with BSI in 26 Spanish hospitals between October 2016 and March 2017, were selected; episodes caused by E. faecalis or E. faecium and other causes were compared. Independent predictors for enterococci were identified by logistic regression, and a predictive score was developed. Eight hundred fifty episodes of BT-BSI were included; 73 (8.5%) were due to target Enterococcus spp. (48 [66%] were E. faecium and 25 [34%] E. faecalis). By multivariate analysis, the variables independently associated with Enterococcus spp. were (OR; 95% confidence interval): cholangiocarcinoma (4.48;1.32 to 15.25), hospital acquisition (3.58;2.11 to 6.07), use of carbapenems in the previous month (3.35;1.45 to 7.78), biliary prosthesis (2.19;1.24 to 3.90), and moderate or severe chronic kidney disease (1.55;1.07 to 2.26). The AUC of the model was 0.74 [95% CI0.67 to 0.80]. A score was developed, with 7, 6, 5, 4, and 2 points for these variables, respectively, with a negative predictive value of 95% for a score ≤ 6. A model, including cholangiocarcinoma, biliary prosthesis, hospital acquisition, previous carbapenems, and chronic kidney disease showed moderate prediction ability for enterococcal BT-BSI. Although the score will need to be validated, this information may be useful for deciding empirical therapy in biliary tract infections when bacteremia is suspected. IMPORTANCE Biliary tract infections are frequent, and a significant cause of morbidity and mortality. Bacteremia is common in these infections, particularly in the elderly and patients with cancer. Inappropriate empirical treatment has been associated with increased risk of mortality in bacteremic cholangitis, and the probability of receiving inactive empirical treatment is higher in episodes caused by enterococci. This is because many of the antimicrobial agents recommended in guidelines for biliary tract infections lack activity against these organisms. To the best of our knowledge, this is the first study analyzing the predictive factors for enterococcal BT-BSI and deriving a predictive score. This work was financed by Plan Nacional de I+D+i 2013‐2016, Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades, through grants PI16/01432 and Spanish Network for Research in Infectious Diseases (REIPI) [RD16/0016/0001; RD16/0016/0007; and RD16/0016/0012]; co‐financed by European Development Regional Fund “A Way to Achieve Europe,” Operative program Intelligent Growth 2014–2020. |
| Databáze: | OpenAIRE |
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