Extended-Spectrum beta-Lactamase and Multidrug Resistance in Urinary Sepsis Patients Admitted to the Intensive Care Unit.
10.4266/kjccm.2014.29.4.257
- Author:
Bumjoon KIM
;
Sung Gyun KIM
;
Seung Soon LEE
;
Tae Seok KIM
;
Yong Il HWANG
;
Seung Hun JANG
;
Joo Hee KIM
;
Ki Suck JUNG
;
Sunghoon PARK
- Publication Type:Original Article
- Keywords:
beta-lactamase;
drug resistance, multiple;
intensive care units;
sepsis;
urinary tract infections
- MeSH:
Anti-Bacterial Agents;
beta-Lactamases*;
Drug Resistance, Multiple*;
Female;
Hospital Mortality;
Humans;
Intensive Care Units*;
Mortality;
Multivariate Analysis;
Retrospective Studies;
Sepsis*;
Urinary Tract;
Urinary Tract Infections
- From:Korean Journal of Critical Care Medicine
2014;29(4):257-265
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting. METHODS: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome. RESULTS: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production. CONCLUSIONS: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.
