Factors associated with bacteraemia due to multidrug-resistant organisms among bacteraemic patients with multidrug-resistant organism carriage: a case control study

Frédérique Bouchand,Clara Duran,Hélène Mascitti,Ruxandra Câlin,Benjamin Davido,Elisabeth-Marie Nemo,Aurélien Dinh,Alexis Descatha,Jean-Louis Gaillard,François Barbier,Christine Lawrence

doi:10.1186/s13756-018-0412-3

Abstract

BackgroundInfections caused by multidrug-resistant organisms (MDRO) are emerging worldwide. Physicians are increasingly faced with the question of whether patients need empiric antibiotic treatment covering these pathogens. This question is especially essential among MDRO carriers. We aim to determine the occurrence of MDRO bacteraemia among bacteraemic patients colonized with MDRO, and the associated factors with MDRO bacteraemia among this population.MethodsWe performed a retrospective monocentric study among MDRO carriers hospitalized with bacteraemia between January 2013 and August 2016 in a French hospital. We compared characteristics of patients with MDRO and non-MDRO bacteraemia.ResultsOverall, 368 episodes of bacteraemia were reviewed; 98/368 (26.6%) occurred among MDRO carriers.Main colonizing bacteria were extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (40/98; 40.8%), ESBL-producing Klebsiella pneumoniae (35/98; 35.7%); methicillin-resistant Staphylococcus aureus (26/98; 26.5%) and multidrug-resistant Pseudomonas aeruginosa (PA) (12/98; 12.2%).There was no significant difference considering population with MDRO bacteraemia vs. non-MDRO bacteraemia, except for immunosuppression [OR 2.86; p = 0.0207], severity of the episode [OR 3.13; p = 0.0232], carriage of PA [OR 5.24; p = 0.0395], and hospital-acquired infection [OR 2.49; p = 0.034].In the multivariate analysis, factors significantly associated with MDRO bacteraemia among colonized patient were only immunosuppression [OR = 2.96; p = 0.0354] and the hospital-acquired origin of bacteraemia [OR = 2.62; p = 0.0427].ConclusionsAccording to our study, occurrence of bacteraemia due to MDRO among MDRO carriers was high. Factors associated with MDRO bacteraemia were severity of the episode and hospital-acquired origin of the bacteraemia. Thus, during bacteraemia among patients colonized with MDRO, if such characteristics are present, broad-spectrum antimicrobial treatment is recommended.

Highlights

IntroductionPhysicians are increasingly faced with the question of whether patients need empiric antibiotic treatment covering these pathogens
Infections caused by multidrug-resistant organisms (MDRO) are emerging worldwide
In the multivariate analysis (Table 4), factors significantly associated with MDRO bacteraemia among colonized patient were only immunosuppression [odds ratios (OR) = 2.96; p = 0.0354], and the nosocomial origin of bacteraemia [OR = 2.62; p = 0.0427]

Summary

Introduction

Physicians are increasingly faced with the question of whether patients need empiric antibiotic treatment covering these pathogens. This question is especially essential among MDRO carriers. Infections caused by MDRO have been associated with severe adverse clinical outcomes, leading to increased mortality, prolonged hospital stay, and increased costs, mostly because of delayed effective therapy [6,7,8,9]. This dramatic spread takes place in both the community and hospital setting. Colonization with MDRO is a risk factor for infections due to MDRO, especially in transplanted patients and in intensive care unit [10,11,12]

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