Enterococcal bacteraemia: predictive and prognostic risk factors for ampicillin resistance
To identify the predictive and prognostic factors associated with ampicillin-resistant enterococcal bacteraemia, we retrospectively reviewed demographic, microbiological and clinical data of patients attending the Kyoto University Hospital, Japan, between 2009 and 2015. Logistic regression and Cox r...
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| Veröffentlicht in: | Epidemiology and infection 2018-12, Vol.146 (16), p.2028-2035 |
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| creator | Matsumura, T Nagao, M Nakano, S Yamamoto, M Matsumura, Y Ichiyama, S |
| description | To identify the predictive and prognostic factors associated with ampicillin-resistant enterococcal bacteraemia, we retrospectively reviewed demographic, microbiological and clinical data of patients attending the Kyoto University Hospital, Japan, between 2009 and 2015. Logistic regression and Cox regression analyses were performed to determine the predictive and prognostic factors, respectively. In total, 235 episodes of enterococcal bacteraemia were identified. As ampicillin susceptibility was uniform for Enterococcus faecalis isolates and almost all ampicillin-resistant isolates were E. faecium, bacteraemia due to these species was investigated separately. E. faecalis and E. faecium accounted for 41.7% (98/235) and 48.1% (113/235) of the isolates, respectively and 91.2% of all E. faecium were ampicillin resistant. Nosocomial E. faecium bacteraemia acquisition (odds ratio (OR), 13.6; 95% confidence intervals, 3.16-58.3) was associated with ampicillin-resistant isolates. Bacteraemia from an unknown source (hazard ratio (HR), 2.91; 95% CI 1.36-6.21) and an increased Pitt bacteraemia score (PBS) (HR, 1.36; 95% CI 1.21-1.52) were associated with 30-day mortality in E. faecium infections. Likewise, bacteraemia from an unknown source (HR, 4.17; 95% CI 1.25-13.9) and increased PBS (HR, 1.27; 95% CI 1.09-1.48) were associated with 30-day mortality in patients with E. faecalis bacteraemia. The empirical therapeutic administration of glycopeptides is recommended for patients with bacteraemia from an unknown source in whom severe E. faecium bacteraemia is suspected. |
| doi_str_mv | 10.1017/S0950268818002479 |
| format | Article |
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Logistic regression and Cox regression analyses were performed to determine the predictive and prognostic factors, respectively. In total, 235 episodes of enterococcal bacteraemia were identified. As ampicillin susceptibility was uniform for Enterococcus faecalis isolates and almost all ampicillin-resistant isolates were E. faecium, bacteraemia due to these species was investigated separately. E. faecalis and E. faecium accounted for 41.7% (98/235) and 48.1% (113/235) of the isolates, respectively and 91.2% of all E. faecium were ampicillin resistant. Nosocomial E. faecium bacteraemia acquisition (odds ratio (OR), 13.6; 95% confidence intervals, 3.16-58.3) was associated with ampicillin-resistant isolates. Bacteraemia from an unknown source (hazard ratio (HR), 2.91; 95% CI 1.36-6.21) and an increased Pitt bacteraemia score (PBS) (HR, 1.36; 95% CI 1.21-1.52) were associated with 30-day mortality in E. faecium infections. Likewise, bacteraemia from an unknown source (HR, 4.17; 95% CI 1.25-13.9) and increased PBS (HR, 1.27; 95% CI 1.09-1.48) were associated with 30-day mortality in patients with E. faecalis bacteraemia. The empirical therapeutic administration of glycopeptides is recommended for patients with bacteraemia from an unknown source in whom severe E. faecium bacteraemia is suspected.</description><identifier>ISSN: 0950-2688</identifier><identifier>EISSN: 1469-4409</identifier><identifier>DOI: 10.1017/S0950268818002479</identifier><identifier>PMID: 30165917</identifier><language>eng</language><publisher>England: Cambridge University Press</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ampicillin ; Ampicillin Resistance ; Antibacterial Resistance ; Antibiotics ; Antimicrobial agents ; Bacteremia ; Bacteremia - epidemiology ; Bacteremia - microbiology ; Bacteremia - mortality ; Comorbidity ; Confidence intervals ; Demographics ; Disease control ; Drug resistance ; Empirical analysis ; Enterococcus faecalis - drug effects ; Enterococcus faecalis - isolation & purification ; Enterococcus faecium - drug effects ; Enterococcus faecium - isolation & purification ; Epidemiology ; Female ; Glycopeptides ; Gram-Positive Bacterial Infections - epidemiology ; Gram-Positive Bacterial Infections - microbiology ; Gram-Positive Bacterial Infections - mortality ; Hospitals ; Hospitals, University ; Humans ; Infectious diseases ; Japan - epidemiology ; Laboratories ; Male ; Medical prognosis ; Microbiology ; Middle Aged ; Mortality ; Nosocomial infection ; Nosocomial infections ; Original Paper ; Patients ; Penicillin ; Prevalence ; Prognosis ; Regression analysis ; Resistance factors ; Retrospective Studies ; Risk analysis ; Risk Factors ; Staphylococcus infections ; Statistical analysis ; Survival Analysis ; Trends ; Variables ; Young Adult</subject><ispartof>Epidemiology and infection, 2018-12, Vol.146 (16), p.2028-2035</ispartof><rights>Copyright © Cambridge University Press 2018</rights><rights>Cambridge University Press 2018 2018 Cambridge University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-c2888701eda94f632abeaadd70224c7e359914628925549f7bdaa547846b7aa03</citedby><cites>FETCH-LOGICAL-c427t-c2888701eda94f632abeaadd70224c7e359914628925549f7bdaa547846b7aa03</cites><orcidid>0000-0002-2006-2298</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453014/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453014/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30165917$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Matsumura, T</creatorcontrib><creatorcontrib>Nagao, M</creatorcontrib><creatorcontrib>Nakano, S</creatorcontrib><creatorcontrib>Yamamoto, M</creatorcontrib><creatorcontrib>Matsumura, Y</creatorcontrib><creatorcontrib>Ichiyama, S</creatorcontrib><title>Enterococcal bacteraemia: predictive and prognostic risk factors for ampicillin resistance</title><title>Epidemiology and infection</title><addtitle>Epidemiol Infect</addtitle><description>To identify the predictive and prognostic factors associated with ampicillin-resistant enterococcal bacteraemia, we retrospectively reviewed demographic, microbiological and clinical data of patients attending the Kyoto University Hospital, Japan, between 2009 and 2015. Logistic regression and Cox regression analyses were performed to determine the predictive and prognostic factors, respectively. In total, 235 episodes of enterococcal bacteraemia were identified. As ampicillin susceptibility was uniform for Enterococcus faecalis isolates and almost all ampicillin-resistant isolates were E. faecium, bacteraemia due to these species was investigated separately. E. faecalis and E. faecium accounted for 41.7% (98/235) and 48.1% (113/235) of the isolates, respectively and 91.2% of all E. faecium were ampicillin resistant. Nosocomial E. faecium bacteraemia acquisition (odds ratio (OR), 13.6; 95% confidence intervals, 3.16-58.3) was associated with ampicillin-resistant isolates. Bacteraemia from an unknown source (hazard ratio (HR), 2.91; 95% CI 1.36-6.21) and an increased Pitt bacteraemia score (PBS) (HR, 1.36; 95% CI 1.21-1.52) were associated with 30-day mortality in E. faecium infections. Likewise, bacteraemia from an unknown source (HR, 4.17; 95% CI 1.25-13.9) and increased PBS (HR, 1.27; 95% CI 1.09-1.48) were associated with 30-day mortality in patients with E. faecalis bacteraemia. The empirical therapeutic administration of glycopeptides is recommended for patients with bacteraemia from an unknown source in whom severe E. faecium bacteraemia is suspected.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ampicillin</subject><subject>Ampicillin Resistance</subject><subject>Antibacterial Resistance</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Bacteremia</subject><subject>Bacteremia - epidemiology</subject><subject>Bacteremia - microbiology</subject><subject>Bacteremia - mortality</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Demographics</subject><subject>Disease control</subject><subject>Drug resistance</subject><subject>Empirical analysis</subject><subject>Enterococcus faecalis - drug effects</subject><subject>Enterococcus faecalis - isolation & purification</subject><subject>Enterococcus faecium - drug effects</subject><subject>Enterococcus faecium - isolation & purification</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Glycopeptides</subject><subject>Gram-Positive Bacterial Infections - epidemiology</subject><subject>Gram-Positive Bacterial Infections - microbiology</subject><subject>Gram-Positive Bacterial Infections - mortality</subject><subject>Hospitals</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Japan - epidemiology</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Microbiology</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nosocomial infection</subject><subject>Nosocomial infections</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Penicillin</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Regression analysis</subject><subject>Resistance factors</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Staphylococcus infections</subject><subject>Statistical analysis</subject><subject>Survival Analysis</subject><subject>Trends</subject><subject>Variables</subject><subject>Young Adult</subject><issn>0950-2688</issn><issn>1469-4409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNplkUFLHTEUhYNU9NX6A7qRgW66mXqTSSaJi4KI1YLgQrtxE-5kMs_YmeQ1mSf475uHr1J1FS7nu4ecewj5TOEbBSqPb0ALYK1SVAEwLvUOWVDe6ppz0B_IYiPXG32ffMz5AQA0U3KP7DdAW6GpXJC78zC7FG20FseqQ1smdJPHk2qVXO_t7B9dhaEvY1yGmGdvq-Tz72oobEy5GmKqcFp568fRhyq57POMwbpPZHfAMbvD7XtAfv04vz27rK-uL36enV7VljM515YppSRQ16PmQ9sw7Bxi30tgjFvpGqF1CcWUZkJwPciuRxRcKt52EhGaA_L92Xe17ibXWxfmhKNZJT9hejIRvXmtBH9vlvHRtFyUQ_Bi8HVrkOKftcuzmXy2bhwxuLjOhoFWUkKhC_rlDfoQ1ymUeIbRhgpQLYhC0WfKpphzcsPLZyiYTXPmXXNl5-j_FC8b_6pq_gJ6l5Tn</recordid><startdate>20181201</startdate><enddate>20181201</enddate><creator>Matsumura, T</creator><creator>Nagao, M</creator><creator>Nakano, S</creator><creator>Yamamoto, M</creator><creator>Matsumura, Y</creator><creator>Ichiyama, S</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7T2</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88E</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2006-2298</orcidid></search><sort><creationdate>20181201</creationdate><title>Enterococcal bacteraemia: predictive and prognostic risk factors for ampicillin resistance</title><author>Matsumura, T ; Nagao, M ; Nakano, S ; Yamamoto, M ; Matsumura, Y ; Ichiyama, S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-c2888701eda94f632abeaadd70224c7e359914628925549f7bdaa547846b7aa03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ampicillin</topic><topic>Ampicillin Resistance</topic><topic>Antibacterial Resistance</topic><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Bacteremia</topic><topic>Bacteremia - epidemiology</topic><topic>Bacteremia - microbiology</topic><topic>Bacteremia - mortality</topic><topic>Comorbidity</topic><topic>Confidence intervals</topic><topic>Demographics</topic><topic>Disease control</topic><topic>Drug resistance</topic><topic>Empirical analysis</topic><topic>Enterococcus faecalis - drug effects</topic><topic>Enterococcus faecalis - isolation & purification</topic><topic>Enterococcus faecium - drug effects</topic><topic>Enterococcus faecium - isolation & purification</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Glycopeptides</topic><topic>Gram-Positive Bacterial Infections - epidemiology</topic><topic>Gram-Positive Bacterial Infections - microbiology</topic><topic>Gram-Positive Bacterial Infections - mortality</topic><topic>Hospitals</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Japan - epidemiology</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Microbiology</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nosocomial infection</topic><topic>Nosocomial infections</topic><topic>Original Paper</topic><topic>Patients</topic><topic>Penicillin</topic><topic>Prevalence</topic><topic>Prognosis</topic><topic>Regression analysis</topic><topic>Resistance factors</topic><topic>Retrospective Studies</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Staphylococcus infections</topic><topic>Statistical analysis</topic><topic>Survival Analysis</topic><topic>Trends</topic><topic>Variables</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Matsumura, T</creatorcontrib><creatorcontrib>Nagao, M</creatorcontrib><creatorcontrib>Nakano, S</creatorcontrib><creatorcontrib>Yamamoto, M</creatorcontrib><creatorcontrib>Matsumura, Y</creatorcontrib><creatorcontrib>Ichiyama, S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Epidemiology and infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Matsumura, T</au><au>Nagao, M</au><au>Nakano, S</au><au>Yamamoto, M</au><au>Matsumura, Y</au><au>Ichiyama, S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Enterococcal bacteraemia: predictive and prognostic risk factors for ampicillin resistance</atitle><jtitle>Epidemiology and infection</jtitle><addtitle>Epidemiol Infect</addtitle><date>2018-12-01</date><risdate>2018</risdate><volume>146</volume><issue>16</issue><spage>2028</spage><epage>2035</epage><pages>2028-2035</pages><issn>0950-2688</issn><eissn>1469-4409</eissn><abstract>To identify the predictive and prognostic factors associated with ampicillin-resistant enterococcal bacteraemia, we retrospectively reviewed demographic, microbiological and clinical data of patients attending the Kyoto University Hospital, Japan, between 2009 and 2015. Logistic regression and Cox regression analyses were performed to determine the predictive and prognostic factors, respectively. In total, 235 episodes of enterococcal bacteraemia were identified. As ampicillin susceptibility was uniform for Enterococcus faecalis isolates and almost all ampicillin-resistant isolates were E. faecium, bacteraemia due to these species was investigated separately. E. faecalis and E. faecium accounted for 41.7% (98/235) and 48.1% (113/235) of the isolates, respectively and 91.2% of all E. faecium were ampicillin resistant. Nosocomial E. faecium bacteraemia acquisition (odds ratio (OR), 13.6; 95% confidence intervals, 3.16-58.3) was associated with ampicillin-resistant isolates. Bacteraemia from an unknown source (hazard ratio (HR), 2.91; 95% CI 1.36-6.21) and an increased Pitt bacteraemia score (PBS) (HR, 1.36; 95% CI 1.21-1.52) were associated with 30-day mortality in E. faecium infections. Likewise, bacteraemia from an unknown source (HR, 4.17; 95% CI 1.25-13.9) and increased PBS (HR, 1.27; 95% CI 1.09-1.48) were associated with 30-day mortality in patients with E. faecalis bacteraemia. The empirical therapeutic administration of glycopeptides is recommended for patients with bacteraemia from an unknown source in whom severe E. faecium bacteraemia is suspected.</abstract><cop>England</cop><pub>Cambridge University Press</pub><pmid>30165917</pmid><doi>10.1017/S0950268818002479</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2006-2298</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Ampicillin Ampicillin Resistance Antibacterial Resistance Antibiotics Antimicrobial agents Bacteremia Bacteremia - epidemiology Bacteremia - microbiology Bacteremia - mortality Comorbidity Confidence intervals Demographics Disease control Drug resistance Empirical analysis Enterococcus faecalis - drug effects Enterococcus faecalis - isolation & purification Enterococcus faecium - drug effects Enterococcus faecium - isolation & purification Epidemiology Female Glycopeptides Gram-Positive Bacterial Infections - epidemiology Gram-Positive Bacterial Infections - microbiology Gram-Positive Bacterial Infections - mortality Hospitals Hospitals, University Humans Infectious diseases Japan - epidemiology Laboratories Male Medical prognosis Microbiology Middle Aged Mortality Nosocomial infection Nosocomial infections Original Paper Patients Penicillin Prevalence Prognosis Regression analysis Resistance factors Retrospective Studies Risk analysis Risk Factors Staphylococcus infections Statistical analysis Survival Analysis Trends Variables Young Adult |
| title | Enterococcal bacteraemia: predictive and prognostic risk factors for ampicillin resistance |
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