TABLE 5.
Risk factors associated with 21-day mortality (by univariate and multivariate analyses) for 129 patients with bloodstream infections due to ESBL-producing Escherichia coli
| Variable | Resulta for patients who:
|
P | OR (95% CI) | |
|---|---|---|---|---|
| Died (n = 38) | Survived (n = 91) | |||
| Univariate analysis | ||||
| Demographics | ||||
| Male sex | 16 (42.1) | 48 (52.2) | 0.27 | 0.65 (0.28-1.49) |
| Mean age (yr) ± SD | 54 ± 20 | 51 ± 20 | 0.44 | |
| Comorbidity | ||||
| Chronic liver disease | 9 (23.6) | 7 (7.6) | 0.01 | 3.72 (1.10-12.78) |
| Chronic renal insufficiency | 8 (21) | 23 (25.2) | 0.60 | 0.78 (0.27-2.09) |
| Diabetes mellitus | 11 (28.9) | 22 (24.1) | 0.57 | 1.27 (0.48-3.20) |
| Hematological malignancy | 5 (13.1) | 26 (28.5) | 0.06 | 0.37 (0.10-1.13) |
| Solid tumor | 10 (26.3) | 32 (35.1) | 0.32 | 0.65 (0.25-1.62) |
| Immunosuppression | 13 (34.2) | 35 (38.4) | 0.64 | 0.83 (0.34-1.95) |
| Mean Charlson index ± SD | 2.9 ± 1.9 | 2.8 ± 1.8 | 0.76 | |
| History | ||||
| Invasive proceduresb | 19 (50) | 30 (32.9) | 0.06 | 2.03 (0.87-4.71) |
| Surgeryc | 9 (23.6) | 29 (31.8) | 0.35 | 0.66 (0.24-1.68) |
| Prior ESBL-producing E. coli infectiond | 9 (23.6) | 13 (14.2) | 0.19 | 1.86 (0.62-5.28) |
| Prior antimicrobialsd | 26 (68.4) | 47 (51.6) | 0.07 | 2.02 (10.85-4.95) |
| Aminoglycosides | 6 (15.7) | 7 (7.6) | 0.16 | 2.25 (0.57-8.44) |
| β-Lactam-β-lactamase inhibitor combinations | 5 (13.1) | 10 (10.9) | 0.72 | 1.22 (0.30-4.31) |
| Fluoroquinolones | 10 (26.3) | 21 (23.1) | 0.69 | 1.19 (0.44-3.05) |
| Oxyimino cephalosporins | 12 (31.5) | 22 (24.1) | 0.38 | 1.44 (0.56-3.57) |
| Prior hospital admissione | 24 (63.1) | 48 (52.7) | 0.27 | 1.53 (0.66-3.63) |
| Epidemiological category | ||||
| Nosocomial | 29 (76.3) | 80 (87.9) | 0.09 | 0.44 (0.55-1.35) |
| Health care associated | 8 (21.1) | 10 (10.9) | 0.13 | 2.16 (0.66-6.69) |
| Community acquired | 1 (2.6) | 1 (1.1) | 0.52 | 2.43 (0.03-19.3) |
| Ward at BSI onset | ||||
| Medicine | 14 (36.8) | 46 (50.5) | 0.15 | 0.57 (0.24-1.32) |
| Surgery | 21 (55.2) | 41 (45) | 0.29 | 1.50 (0.65-3.46) |
| Intensive care unit | 3 (7.8) | 4 (4.4) | 0.42 | 1.86 (0.25-11.58) |
| Clinical presentation | ||||
| Mean APACHE III score ± SD | 32 ± 15 | 29 ± 11 | 0.16 | |
| Presentation with septic shock | 5 (13.1) | 4 (4.3) | 0.07 | 3.29 (0.65-17.48) |
| Primary source of infection | ||||
| Pancreaticobiliary tract | 6 (15.7) | 16 (28.5) | 0.12 | 0.46 (0.14-1.32) |
| Central venous catheter | 0 | 4 (4.4) | 0.18 | |
| Lower respiratory tract | 1 (2.6) | 0 | 0.12 | |
| Surgical wound | 4 (10.5) | 13 (14.2) | 0.56 | 0.70 (0.15-2.51) |
| Urinary tract | 4 (10.5) | 36 (39.5) | 0.001 | 0.17 (0.04-0.57) |
| Unknown | 24 (63.1) | 19 (20.8) | <0.001 | 6.49 (2.62-16.25) |
| ESBL-producing E. coli bloodstream isolate | ||||
| CTX-M type ESBL production | 15 (39.4) | 38 (41.7) | 0.81 | 0.90 (0.38-2.10) |
| Coresistance to ≥3 antimicrobialsf | 14 (36.8) | 41 (45) | 0.38 | 0.71 (0.30-1.65) |
| Inadequate initial antimicrobial treatment | 29 (76.3) | 27 (29.6) | <0.001 | 7.63 (2.97-20.58) |
| Multivariate analysis | ||||
| Inadequate initial antimicrobial treatment | <0.001 | 6.22 (2.33-16.61) | ||
| Unknown source | 0.001 | 4.28 (1.71-10.69) | ||
| Presentation with septic shock | 0.02 | 5.88 (1.26-27.45) | ||
a
Results are numbers (percentages) of patients except where indicated otherwise.
b
During the 72 h before the index blood culture.
c
During the 30 days before the index blood culture.
d
During the 3 months before the index blood culture.
e
During the 12 months preceding the index hospitalization.
f
Coresistance to ≥3 of the following antimicrobials: amoxicillin clavulanic acid, piperacillin-tazobactam, gentamicin, ciprofloxacin, and trimethoprim-sulfamethoxazole.