The association of ESBL Escherichia coli with mortality in patients with Escherichia coli bacteremia at the emergency department

Pariwat Phungoen; Jessada Sarunyaparit; Korakot Apiratwarakul; Lumyai Wonglakorn; Atibordee Meesing; Kittisak Sawanyawisuth

doi:10.33393/dti.2022.2422

Authors

Pariwat Phungoen Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand https://orcid.org/0000-0003-3631-0679
Jessada Sarunyaparit Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand
Korakot Apiratwarakul Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand https://orcid.org/0000-0002-1984-0865
Lumyai Wonglakorn Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand
Atibordee Meesing Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand https://orcid.org/0000-0003-3184-9229
Kittisak Sawanyawisuth Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen - Thailand https://orcid.org/0000-0003-3570-8474

DOI:

https://doi.org/10.33393/dti.2022.2422

Keywords:

Extended-spectrum beta-lactamase-producing Escherichia coli, Glucose, Lactate

Abstract

Background: Escherichia coli is a common bloodstream infection pathogen in the emergency department (ED). Patients with extended-spectrum beta-lactamase (ESBL) E. coli have a higher risk of morbidity. However, there is still debate surrounding ESBL E. coli-associated mortality in community, intensive care unit, and tertiary care settings. In addition, there have been few studies regarding mortality in ESBL E. coli in ED settings, and results have been contradictory.

Methods: This was a retrospective cohort study conducted at the Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University in Thailand aimed at evaluating the possible association between ESBL E. coli bacteremia and mortality in the ED. The inclusion criteria were age 18 years or over, clinical presentation suspicious of infection, and positive blood culture for E. coli. Predictors for mortality were analyzed by logistic regression analysis.

Results: During the study period, 273 patients presented at the ED with hemoculture positive for E. coli. Of those, 27 (9.89%) died. Five factors remained in the final model, of which plasma glucose levels, serum lactate levels, and ESBL E. coliwere significantly associated with 28-day mortality in the ED with adjusted odds ratios of 0.970, 1.258, and 12.885, respectively. Plasma glucose of less than 113 mg/dL yielded a sensitivity of 80.95% and specificity of 64.29%, while serum lactate over 2.4 mmol/L had a sensitivity of 81.48% and specificity of 45.50%.

Conclusion: ESBL E. coli, plasma glucose, and serum lactate levels were associated with 28-day mortality in patients with E. coli bacteremia presenting at the ED.

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References

Chase M, Klasco RS, Joyce NR, Donnino MW, Wolfe RE, Shapiro NI. Predictors of bacteremia in emergency department patients with suspected infection. Am J Emerg Med. 2012;30(9):1691-1697. https://doi.org/10.1016/j.ajem.2012.01.018 PMID:22626814 DOI: https://doi.org/10.1016/j.ajem.2012.01.018

Zhu Q, Zhu M, Li C, et al. Epidemiology and microbiology of Gram-negative bloodstream infections in a tertiary-care hospital in Beijing, China: a 9-year retrospective study. Expert Rev Anti Infect Ther. 2021;19(6):769-776. https://doi.org/10.1080/14787210.2021.1848544PMID:33187451 DOI: https://doi.org/10.1080/14787210.2021.1848544

MacKinnon MC, McEwen SA, Pearl DL, et al. Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study. BMC Infect Dis. 2021;21(1):606. https://doi.org/10.1186/s12879-021-06326-x PMID:34172003 DOI: https://doi.org/10.1186/s12879-021-06326-x

Sianipar O, Asmara W, Dwiprahasto I, Mulyono B. Mortality risk of bloodstream infection caused by either Escherichia coli or Klebsiella pneumoniae producing extended-spectrum β-lactamase: a prospective cohort study. BMC Res Notes. 2019;12(1):719. https://doi.org/10.1186/s13104-019-4751-9 PMID:31675991 DOI: https://doi.org/10.1186/s13104-019-4751-9

Hawkey PM. Multidrug-resistant Gram-negative bacteria: a product of globalization. J Hosp Infect. 2015;89(4):241-247. https://doi.org/10.1016/j.jhin.2015.01.008 PMID:25737092 DOI: https://doi.org/10.1016/j.jhin.2015.01.008

Nagvekar V, Sawant S, Amey S. Prevalence of multidrug-resistant Gram-negative bacteria cases at admission in a multispeciality hospital. J Glob Antimicrob Resist. 2020;22:457-461. https://doi.org/10.1016/j.jgar.2020.02.030 PMID:32165287 DOI: https://doi.org/10.1016/j.jgar.2020.02.030

Morris S, Cerceo E. Trends, epidemiology, and management of multi-drug resistant Gram-negative bacterial infections in the hospitalized setting. Antibiotics (Basel). 2020;9(4):E196. https://doi.org/10.3390/antibiotics9040196 PMID:32326058 DOI: https://doi.org/10.3390/antibiotics9040196

Siwakoti S, Subedi A, Sharma A, Baral R, Bhattarai NR, Khanal B. Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal – a prospective cohort study. Antimicrob Resist Infect Control. 2018;7(1):114. https://doi.org/10.1186/s13756-018-0404-3 PMID:30275945 DOI: https://doi.org/10.1186/s13756-018-0404-3

Lee YC, Hsiao CY, Hung MC, et al. Bacteremic urinary tract infection caused by multidrug-resistant Enterobacteriaceae are associated with severe sepsis at admission: implication for empirical therapy. Medicine (Baltimore). 2016;95(20):e3694. https://doi.org/10.1097/MD.0000000000003694 PMID:27196480 DOI: https://doi.org/10.1097/MD.0000000000003694

Kang CI, Song JH, Chung DR, et al; Korean Network for Study of Infectious Diseases (KONSID). Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli. Int J Antimicrob Agents. 2010;36(3):284-287. https://doi.org/10.1016/j.ijantimicag.2010.05.009 PMID:20580534 DOI: https://doi.org/10.1016/j.ijantimicag.2010.05.009

Park SH, Choi SM, Lee DG, et al. Emergence of extended-spectrum β-lactamase-producing Escherichia coli as a cause of community-onset bacteremia in South Korea: risk factors and clinical outcomes. Microb Drug Resist. 2011;17(4):537-544. https://doi.org/10.1089/mdr.2011.0072 DOI: https://doi.org/10.1089/mdr.2011.0072

Namikawa H, Yamada K, Fujimoto H, et al. Clinical characteristics of bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli at a tertiary hospital. Intern Med. 2017;56(14):1807-1815. https://doi.org/10.2169/internalmedicine.56.7702 PMID:28717075 DOI: https://doi.org/10.2169/internalmedicine.56.7702

Xiao T, Wu Z, Shi Q, et al. A retrospective analysis of risk factors and outcomes in patients with extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections. J Glob Antimicrob Resist. 2019;17:147-156. https://doi.org/10.1016/j.jgar.2018.12.014 PMID:30634054 DOI: https://doi.org/10.1016/j.jgar.2018.12.014

Hattori H, Maeda M, Nagatomo Y, et al. Epidemiology and risk factors for mortality in bloodstream infections: a single-center retrospective study in Japan. Am J Infect Control. 2018;46(12):e75-e79. https://doi.org/10.1016/j.ajic.2018.06.019 PMID:30172607 DOI: https://doi.org/10.1016/j.ajic.2018.06.019

Haruki Y, Hagiya H, Haruki M, Sugiyama T. Clinical characteristics and outcome of critically ill patients with bacteremia caused by extended-spectrum β-lactamase-producing and non-producing Escherichia coli. J Infect Chemother. 2018;24(11):944-947. https://doi.org/10.1016/j.jiac.2018.04.016 PMID:29803763 DOI: https://doi.org/10.1016/j.jiac.2018.04.016

Rodríguez-Baño J, Picón E, Gijón P, et al; Spanish Network for Research in Infectious Diseases (REIPI). Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis. Clin Infect Dis. 2010;50(1):40-48. https://doi.org/10.1086/649537 PMID:19995215 DOI: https://doi.org/10.1086/649537

Yao RQ, Ren C, Wu GS, Zhu YB, Xia ZF, Yao YM. Is intensive glucose control bad for critically ill patients? A systematic review and meta-analysis. Int J Biol Sci. 2020;16(9):1658-1675. https://doi.org/10.7150/ijbs.43447 PMID:32226310 DOI: https://doi.org/10.7150/ijbs.43447

Wang J, Zhu CK, Yu JQ, Tan R, Yang PL. Hypoglycemia and mortality in sepsis patients: a systematic review and meta-analysis. Heart Lung. 2021;50(6):933-940. https://doi.org/10.1016/j.hrtlng.2021.07.017 PMID:34433111 DOI: https://doi.org/10.1016/j.hrtlng.2021.07.017

Park S, Kim DG, Suh GY, et al. Mild hypoglycemia is independently associated with increased risk of mortality in patients with sepsis: a 3-year retrospective observational study. Crit Care. 2012;16(5):R189. https://doi.org/10.1186/cc11674 PMID:23062226 DOI: https://doi.org/10.1186/cc11674

Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449-461. https://doi.org/10.1056/NEJMoa052521 PMID:16452557 DOI: https://doi.org/10.1056/NEJMoa052521

Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45(5):524-528. https://doi.org/10.1016/j.annemergmed.2004.12.006 PMID:15855951 DOI: https://doi.org/10.1016/j.annemergmed.2004.12.006

Vorwerk C, Loryman B, Coats TJ, et al. Prediction of mortality in adult emergency department patients with sepsis. Emerg Med J. 2009;26(4):254-258. https://doi.org/10.1136/emj.2007.053298PMID:19307384 DOI: https://doi.org/10.1136/emj.2007.053298

Puskarich MA, Illich BM, Jones AE. Prognosis of emergency department patients with suspected infection and intermediate lactate levels: a systematic review. J Crit Care. 2014;29(3):334-339. https://doi.org/10.1016/j.jcrc.2013.12.017 PMID:24559577 DOI: https://doi.org/10.1016/j.jcrc.2013.12.017

Bou Chebl R, El Khuri C, Shami A, et al. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study. Scand J Trauma Resusc Emerg Med. 2017;25(1):69. https://doi.org/10.1186/s13049-017-0415-8PMID:28705203 DOI: https://doi.org/10.1186/s13049-017-0415-8

Chang CP, Fann WC, Wu SR, Lin CN, Hsiao CT. Lactate on emergency department arrival as a predictor of in-hospital mortality in necrotizing fasciitis: a retrospective study. J Orthop Surg Res. 2019;14(1):73. https://doi.org/10.1186/s13018-019-1108-y PMID:30841912 DOI: https://doi.org/10.1186/s13018-019-1108-y

Rezoagli E, McNicholas BA, Madotto F, Pham T, Bellani G, Laffey JG; LUNG SAFE Investigators, the ESICM Trials Group. Presence of comorbidities alters management and worsens outcome of patients with acute respiratory distress syndrome: insights from the LUNG SAFE study. Ann Intensive Care. 2022;12(1):42. https://doi.org/10.1186/s13613-022-01015-7PMID:35596885 DOI: https://doi.org/10.1186/s13613-022-01015-7

Charoentanyarak S, Sawunyavisuth B, Deepai S, Sawanyawisuth K. A point-of-care serum lactate level and mortality in adult sepsis patients: a community hospital setting. J Prim Care Community Health. 2021;12:21501327211000233. https://doi.org/10.1177/21501327211000233 PMID:33733925 DOI: https://doi.org/10.1177/21501327211000233

Jeerasuwannakul B, Sawunyavisuth B, Khamsai S, Sawanyawisuth K. Prevalence and risk factors of proteinuria in patients with type 2 diabetes mellitus. Asia-Pac J Sci Technol. 2021 Jul 1;26(04):APST-26-04-02. Online https://so01.tci-thaijo.org/index.php/APST/article/view/248718 (Accessed May 2022).

Soontornrungsun B, Khamsai S, Sawunyavisuth B, et al. Obstructive sleep apnea in patients with diabetes less than 40 years of age. Diabetes Metab Syndr. 2020;14(6):1859-1863. https://doi.org/10.1016/j.dsx.2020.09.008 PMID:32992217 DOI: https://doi.org/10.1016/j.dsx.2020.09.008

Tongdee S, Sawunyavisuth B, Sukeepaisarnjaroen W, Boonsawat W, Khamsai S, Sawanyawisuth K. Clinical factors predictive of appropriate treatment in COPD: a community hospital setting. Drug Target Insights. 2021;15:21-25. https://doi.org/10.33393/dti.2021.2291PMID:34803374 DOI: https://doi.org/10.33393/dti.2021.2291

Namwaing P, Chaisuksant S, Sawadpanich R, et al. Oxygen saturation is associated with recurrent primary spontaneous pneumothorax treated by intercostal chest drainage. Asian J Surg. 2022;45(1):431-434. https://doi.org/10.1016/j.asjsur.2021.07.021 PMID:34312054 DOI: https://doi.org/10.1016/j.asjsur.2021.07.021

Namwaing P, Chaisuksant S, Sawadpanich R, et al. Factors associated with duration of intercostal chest drainage in patients with primary spontaneous pneumothorax and the role of pulmonary rehabilitation. Open Access Emerg Med. 2021;13:569-573. https://doi.org/10.2147/OAEM.S336637 PMID:34938130 DOI: https://doi.org/10.2147/OAEM.S336637

Boonwang T, Namwaing P, Srisaphonphusitti L, et al. Esports may improve cognitive skills in soccer players: a systematic review. Asia-Pac J Sci Technol. 2022;27(3). Online https://so01.tci-thaijo.org/index.php/APST/article/view/257467 (Accessed May 2022).

Ruangritkul P, Tiamkao S, Chainirun N, et al. The efficacy and safety profile of generic intravenous levetiracetam in a real-world setting. Curr Ther Res Clin Exp. 2021;95:100648. https://doi.org/10.1016/j.curtheres.2021.100648 PMID:34840633 DOI: https://doi.org/10.1016/j.curtheres.2021.100648

Sanlung T, Sawanyawisuth K, Silaruks S, et al. Clinical characteristics and complications of obstructive sleep apnea in Srinagarind Hospital. J Med Assoc Thai. 2020;103(1):36-39. Online http://www.jmatonline.com/index.php/jmat/article/view/10743 (Accessed May 2022).