A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis

Detalhes bibliográficos
Autor(a) principal: Sabino, Sabrina
Data de Publicação: 2019
Outros Autores: Soares, Silvia, Ramos, Fabiano, Moretti, Miriane Melo Silveira, Zavascki, Alexandre Prehn, Rigatto, Maria Helena da Silva Pitombeira
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UFRGS
Texto Completo: http://hdl.handle.net/10183/229345
Resumo: The objective of this study is to evaluate the impact of carbapenem-resistant Enterobacteriaceae (CRE) infection on sepsis 30-day mortality. A retrospective cohort of patients >18 years old with sepsis and organ dysfunction or septic shock was conducted. Univariate analysis was done for variables potentially related to 30-day mortality, and the ones with P values of <0.05 were included in a backward stepwise hierarchic Cox regression model. Variables that remained with P values of <0.05 were retained in the model. A total of 1,190 sepsis episodes were analyzed. Gram-negative bacterial infections occurred in 391 (68.5%) of 571 patients with positive cultures, of which 69 (17.7%) were caused by a CRE organism. Patients with CRE infections had significantly higher 30-day mortality: 63.8% versus 33.4% (P < 0.01). CRE infection was also associated with a lower rate of appropriate empirical therapy (P < 0.01) and with the presence of septic shock (P < 0.01). In the hierarchic multivariate model, CRE remained significant when controlling for demographic variables, comorbidities, and infection site but lost significance when controlling for septic shock and appropriate empirical therapy. Older age (P < 0.01), HIV-positive status (P < 0.01), cirrhosis (P < 0.01), septic shock (P < 0.01), higher quick sepsis-related organ failure assessment (quick-SOFA) (P < 0.01), and appropriate empirical therapy (P = 0.01) remained in the final model. CRE infections were associated with higher crude mortality rates. A lower rate of appropriate empirical therapy and late diagnosis were more frequent in this group, and improvement of stewardship programs is needed.
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spelling Sabino, SabrinaSoares, SilviaRamos, FabianoMoretti, Miriane Melo SilveiraZavascki, Alexandre PrehnRigatto, Maria Helena da Silva Pitombeira2021-09-01T04:27:50Z20192379-5042http://hdl.handle.net/10183/229345001130289The objective of this study is to evaluate the impact of carbapenem-resistant Enterobacteriaceae (CRE) infection on sepsis 30-day mortality. A retrospective cohort of patients >18 years old with sepsis and organ dysfunction or septic shock was conducted. Univariate analysis was done for variables potentially related to 30-day mortality, and the ones with P values of <0.05 were included in a backward stepwise hierarchic Cox regression model. Variables that remained with P values of <0.05 were retained in the model. A total of 1,190 sepsis episodes were analyzed. Gram-negative bacterial infections occurred in 391 (68.5%) of 571 patients with positive cultures, of which 69 (17.7%) were caused by a CRE organism. Patients with CRE infections had significantly higher 30-day mortality: 63.8% versus 33.4% (P < 0.01). CRE infection was also associated with a lower rate of appropriate empirical therapy (P < 0.01) and with the presence of septic shock (P < 0.01). In the hierarchic multivariate model, CRE remained significant when controlling for demographic variables, comorbidities, and infection site but lost significance when controlling for septic shock and appropriate empirical therapy. Older age (P < 0.01), HIV-positive status (P < 0.01), cirrhosis (P < 0.01), septic shock (P < 0.01), higher quick sepsis-related organ failure assessment (quick-SOFA) (P < 0.01), and appropriate empirical therapy (P = 0.01) remained in the final model. CRE infections were associated with higher crude mortality rates. A lower rate of appropriate empirical therapy and late diagnosis were more frequent in this group, and improvement of stewardship programs is needed.application/pdfengmSphere. Washington, DC. Vol. 4, no. 2 (Mar./April 2019), e00052-19, p. 1-9.Enterobacter cloacaeInfecções por enterobacteriaceaeSepseChoque sépticoBacterias gram-negativasEnterobacteriáceas resistentes a carbapenêmicosEstudos de coortesMortalidadeGram-negative bacteriaCarbapenem resistantMortalitySepsisSeptic shockA cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsisEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001130289.pdf.txt001130289.pdf.txtExtracted Texttext/plain35944http://www.lume.ufrgs.br/bitstream/10183/229345/2/001130289.pdf.txt456f5a3b897cc52d96b6f44967147084MD52ORIGINAL001130289.pdfTexto completo (inglês)application/pdf247916http://www.lume.ufrgs.br/bitstream/10183/229345/1/001130289.pdfd76bd4b48510ddd9f45f896c48a5e9edMD5110183/2293452021-09-19 04:37:00.813164oai:www.lume.ufrgs.br:10183/229345Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2021-09-19T07:37Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false
dc.title.pt_BR.fl_str_mv A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
title A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
spellingShingle A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
Sabino, Sabrina
Enterobacter cloacae
Infecções por enterobacteriaceae
Sepse
Choque séptico
Bacterias gram-negativas
Enterobacteriáceas resistentes a carbapenêmicos
Estudos de coortes
Mortalidade
Gram-negative bacteria
Carbapenem resistant
Mortality
Sepsis
Septic shock
title_short A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
title_full A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
title_fullStr A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
title_full_unstemmed A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
title_sort A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
author Sabino, Sabrina
author_facet Sabino, Sabrina
Soares, Silvia
Ramos, Fabiano
Moretti, Miriane Melo Silveira
Zavascki, Alexandre Prehn
Rigatto, Maria Helena da Silva Pitombeira
author_role author
author2 Soares, Silvia
Ramos, Fabiano
Moretti, Miriane Melo Silveira
Zavascki, Alexandre Prehn
Rigatto, Maria Helena da Silva Pitombeira
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Sabino, Sabrina
Soares, Silvia
Ramos, Fabiano
Moretti, Miriane Melo Silveira
Zavascki, Alexandre Prehn
Rigatto, Maria Helena da Silva Pitombeira
dc.subject.por.fl_str_mv Enterobacter cloacae
Infecções por enterobacteriaceae
Sepse
Choque séptico
Bacterias gram-negativas
Enterobacteriáceas resistentes a carbapenêmicos
Estudos de coortes
Mortalidade
topic Enterobacter cloacae
Infecções por enterobacteriaceae
Sepse
Choque séptico
Bacterias gram-negativas
Enterobacteriáceas resistentes a carbapenêmicos
Estudos de coortes
Mortalidade
Gram-negative bacteria
Carbapenem resistant
Mortality
Sepsis
Septic shock
dc.subject.eng.fl_str_mv Gram-negative bacteria
Carbapenem resistant
Mortality
Sepsis
Septic shock
description The objective of this study is to evaluate the impact of carbapenem-resistant Enterobacteriaceae (CRE) infection on sepsis 30-day mortality. A retrospective cohort of patients >18 years old with sepsis and organ dysfunction or septic shock was conducted. Univariate analysis was done for variables potentially related to 30-day mortality, and the ones with P values of <0.05 were included in a backward stepwise hierarchic Cox regression model. Variables that remained with P values of <0.05 were retained in the model. A total of 1,190 sepsis episodes were analyzed. Gram-negative bacterial infections occurred in 391 (68.5%) of 571 patients with positive cultures, of which 69 (17.7%) were caused by a CRE organism. Patients with CRE infections had significantly higher 30-day mortality: 63.8% versus 33.4% (P < 0.01). CRE infection was also associated with a lower rate of appropriate empirical therapy (P < 0.01) and with the presence of septic shock (P < 0.01). In the hierarchic multivariate model, CRE remained significant when controlling for demographic variables, comorbidities, and infection site but lost significance when controlling for septic shock and appropriate empirical therapy. Older age (P < 0.01), HIV-positive status (P < 0.01), cirrhosis (P < 0.01), septic shock (P < 0.01), higher quick sepsis-related organ failure assessment (quick-SOFA) (P < 0.01), and appropriate empirical therapy (P = 0.01) remained in the final model. CRE infections were associated with higher crude mortality rates. A lower rate of appropriate empirical therapy and late diagnosis were more frequent in this group, and improvement of stewardship programs is needed.
publishDate 2019
dc.date.issued.fl_str_mv 2019
dc.date.accessioned.fl_str_mv 2021-09-01T04:27:50Z
dc.type.driver.fl_str_mv Estrangeiro
info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
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dc.identifier.uri.fl_str_mv http://hdl.handle.net/10183/229345
dc.identifier.issn.pt_BR.fl_str_mv 2379-5042
dc.identifier.nrb.pt_BR.fl_str_mv 001130289
identifier_str_mv 2379-5042
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url http://hdl.handle.net/10183/229345
dc.language.iso.fl_str_mv eng
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dc.relation.ispartof.pt_BR.fl_str_mv mSphere. Washington, DC. Vol. 4, no. 2 (Mar./April 2019), e00052-19, p. 1-9.
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eu_rights_str_mv openAccess
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