Clinical Impact of Ceftriaxone Resistance in Escherichia coli Bloodstream Infections: A Multicenter Prospective Cohort Study
Year: 2022
Type: article
Study design: Observational Study
Abstract: 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.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofac572
Authors: Pranita D Tamma, Lauren Komarow, Lizhao Ge, Julia Garcia-Diaz, Erica S Herc, Yohei Doi, Cesar A Arias, Owen Albin, Elie Saade, Loren G Miller, Jesse T Jacob, Michael J Satlin, Martin Krsak, W Charles Huskins, Sorabh Dhar, Samuel A Shelburne, Carol Hill, Keri R Baum, Minal Bhojani, Kerryl E Greenwood-Quaintance, Suzannah M Schmidt-Malan, Robin Patel, Scott R Evans, Henry F Chambers, Vance G Fowler, David van Duin, for the Antibacterial Resistance Leadership Group
Institutions: Johns Hopkins University, Johns Hopkins Medicine, George Washington University, Ochsner Medical Center, Henry Ford Hospital, Fujita Health University, University of Pittsburgh, Houston Methodist, Houston Methodist Research Institute, University of Michigan, Case Western Reserve University, University of California, Los Angeles, Harbor–UCLA Medical Center, Emory University, NewYork–Presbyterian Hospital, Weill Cornell Medicine, University of Colorado Anschutz, University of Colorado Denver, Mayo Clinic, Wayne State University, Detroit Medical Center, The University of Texas MD Anderson Cancer Center, Duke Medical Center, Duke Clinical Research Institute, University of California, San Francisco, Duke University, University of North Carolina at Chapel Hill
Language: English
Subfield: Molecular Medicine
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,676
Awards: G143167659, The LiaFSR system and antimicrobial peptide resistance in enterococci, G1801780589, G1825169821, G3889605478, POR and Training Program on Multidrug-Resistant Organisms, Dynamics of Colonization and Infection by Multidrug-resistant Pathogens in Immunocompromised and Critically Ill Patients (DYNAMITE)
OpenAlex ID: W4307331189