A cohort study of the impact of carbapenem-resistant Enterobacteriaceae infections on mortality of patients presenting with sepsis
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , |
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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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 |
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info:eu-repo/semantics/publishedVersion |
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publishedVersion |
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 |
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url |
http://hdl.handle.net/10183/229345 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
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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info:eu-repo/semantics/openAccess |
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