TY - JOUR
T1 - Clinical Impact of Ceftriaxone Resistance in Escherichia coli Bloodstream Infections
T2 - A Multicenter Prospective Cohort Study
AU - for the Antibacterial Resistance Leadership Group
AU - Tamma, Pranita D.
AU - Komarow, Lauren
AU - Ge, Lizhao
AU - Garcia-Diaz, Julia
AU - Herc, Erica S.
AU - Doi, Yohei
AU - Arias, Cesar A.
AU - Albin, Owen
AU - Saade, Elie
AU - Miller, Loren G.
AU - Jacob, Jesse T.
AU - Satlin, Michael J.
AU - Krsak, Martin
AU - Huskins, W. Charles
AU - Dhar, Sorabh
AU - Shelburne, Samuel A.
AU - Hill, Carol
AU - Baum, Keri R.
AU - Bhojani, Minal
AU - Greenwood-Quaintance, Kerryl E.
AU - Schmidt-Malan, Suzannah M.
AU - Patel, Robin
AU - Evans, Scott R.
AU - Chambers, Henry F.
AU - Fowler, Vance G.
AU - Van Duin, David
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Background: Ceftriaxone-resistant (CRO-R) Escherichia coli bloodstream infections (BSIs) are common. Methods: This is a prospective cohort of patients with E coli BSI at 14 United States hospitals between November 2020 and April 2021. For each patient with a CRO-R E coli BSI enrolled, the next consecutive patient with a ceftriaxone-susceptible (CRO-S) E coli BSI was included. Primary outcome was desirability of outcome ranking (DOOR) at day 30, with 50% probability of worse outcomes in the CRO-R group as the null hypothesis. Inverse probability weighting (IPW) was used to reduce confounding. Results: Notable differences between patients infected with CRO-R and CRO-S E coli BSI included the proportion with Pitt bacteremia score ≥4 (23% vs 15%, P =. 079) and the median time to active antibiotic therapy (12 hours [interquartile range {IQR}, 1-35 hours] vs 1 hour [IQR, 0-6 hours]; P <. 001). Unadjusted DOOR analyses indicated a 58% probability (95% confidence interval [CI], 52%-63%) for a worse clinical outcome in CRO-R versus CRO-S BSI. In the IPW-adjusted cohort, no difference was observed (54% [95% CI, 47%-61%]). Secondary outcomes included unadjusted and adjusted differences in the proportion of 30-day mortality between CRO-R and CRO-S BSIs (-5.3% [95% CI, -10.3% to -.4%] and -1.8 [95% CI, -6.7% to 3.2%], respectively), postculture median length of stay (8 days [IQR, 5-13 days] vs 6 days [IQR, 4-9 days]; P <. 001), and incident admission to a long-term care facility (22% vs 12%, P =. 045). Conclusions: Patients with CRO-R E coli BSI generally have poorer outcomes compared to patients infected with CRO-S E coli BSI, even after adjusting for important confounders.
AB - Background: Ceftriaxone-resistant (CRO-R) Escherichia coli bloodstream infections (BSIs) are common. Methods: This is a prospective cohort of patients with E coli BSI at 14 United States hospitals between November 2020 and April 2021. For each patient with a CRO-R E coli BSI enrolled, the next consecutive patient with a ceftriaxone-susceptible (CRO-S) E coli BSI was included. Primary outcome was desirability of outcome ranking (DOOR) at day 30, with 50% probability of worse outcomes in the CRO-R group as the null hypothesis. Inverse probability weighting (IPW) was used to reduce confounding. Results: Notable differences between patients infected with CRO-R and CRO-S E coli BSI included the proportion with Pitt bacteremia score ≥4 (23% vs 15%, P =. 079) and the median time to active antibiotic therapy (12 hours [interquartile range {IQR}, 1-35 hours] vs 1 hour [IQR, 0-6 hours]; P <. 001). Unadjusted DOOR analyses indicated a 58% probability (95% confidence interval [CI], 52%-63%) for a worse clinical outcome in CRO-R versus CRO-S BSI. In the IPW-adjusted cohort, no difference was observed (54% [95% CI, 47%-61%]). Secondary outcomes included unadjusted and adjusted differences in the proportion of 30-day mortality between CRO-R and CRO-S BSIs (-5.3% [95% CI, -10.3% to -.4%] and -1.8 [95% CI, -6.7% to 3.2%], respectively), postculture median length of stay (8 days [IQR, 5-13 days] vs 6 days [IQR, 4-9 days]; P <. 001), and incident admission to a long-term care facility (22% vs 12%, P =. 045). Conclusions: Patients with CRO-R E coli BSI generally have poorer outcomes compared to patients infected with CRO-S E coli BSI, even after adjusting for important confounders.
KW - ESBL
KW - Escherichia coli
KW - bacteremia
KW - ceftriaxone
KW - mortality
KW - resistance
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U2 - 10.1093/ofid/ofac572
DO - 10.1093/ofid/ofac572
M3 - Article
AN - SCOPUS:85145051860
SN - 2328-8957
VL - 9
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 11
M1 - ofac572
ER -