Clinical Research Papers:
Bloodstream infection due to Escherichia coli in liver cirrhosis patients: clinical features and outcomes
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Bo Tu1,*, Jingfeng Bi2,*, Dan Wu1,*, Peng Zhao1, Lei Shi1, Yangxin Xie1, Xin Zhang1, Zhe Xu1, Suxia Liu3, Xinhua Wang4, Xiaoxi Li5, Fusheng Wang1,* and Enqiang Qin1,*
1Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
2Center for Clinical Research Management, Beijing 302 Hospital, Beijing 100039, China
3Center for Liver Failure, Beijing 302 Hospital, Beijing 100039, China
4Center for Obstetrics and Gynecology, Beijing 302 Hospital, Beijing 100039, China
5Center for Clinical Laboratory, Beijing 302 Hospital, Beijing 100039, China
*These authors contributed equally to this work
Fusheng Wang, email: [email protected]
Enqiang Qin, email: [email protected]
Keywords: liver cirrhosis; bloodstream infection; MELD; hospital-acquired BSI; ESBL
Received: March 12, 2017 Accepted: May 29, 2017 Epub: December 13, 2017 Published: November 06, 2018
Objectives: The study aimed to investigate the clinical characteristics and antibiotic management, as well as independent indicators for survival within 30 days for Escherichia coli bloodstream infection (BSI) in liver cirrhosis.
Results: Hospital-acquired BSI accounted for 60.07%, with prolonged hospital stay (P = 0.000). The prevalence of Extended Spectrum Beta-Lactamases (ESBL) producing bacteria was 48.26%, which correlated with ICU admission (P = 0.015) and high model for end-stage liver disease (MELD) score at onset of BSI (P = 0.035). Moreover, ESBL producing pathogens showed a high resistant to the common antibiotic families and 27.5% pathogens were confirmed as multidrug-resistant (MDR). MDR infection was significantly correlated with ESBL production, ICU admission, inappropriate empiric therapy, resistance to firstly selected antibiotic, and infection duration (P < 0.05 for all). In addition, appropriate empiric therapy within 48 h (HR = 2.581, 95% CI = 1.166–5.715), ICU admission (HR = 4.434, 95% CI = 2.130–8.823), HE (HR = 2.379, 95% CI = 1.115–5.073) and final MELD (HR = 1.074, 95% CI = 1.044–1.106) were independent indicators for 30-day mortality.
Materials and Methods: The clinical data were collected from 288 eligible patients, and compared according to survival status and sites of infection acquisition. Drug resistance was recorded according to ESBL. In addition, cox regression analysis model was applied to evaluate the risk factors for 30-day mortality.
Conclusions: ESBL production can promote resistance to antibiotics in Escherichia coli. Antibiotic regimens, ICU admission, HE and MELD score can help identify the risk individuals who will benefit from the improved therapeutic regimens.
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