Infectious Disease

Patients with ceftriaxone-resistant E . coli bloodstream infections have worse outcomes

November 15, 2022

2 min read

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Disclosures:
Van Duin reports receiving funding support from the ARLG of the NIH and the National Institute of Allergy and Infectious Diseases during this study, grants and contracts from the NIH and Merck paid to his institution, grants from Shionogi paid to him, as well as consulting for Achaogen, Actavis, Allergan, Astellas, Entasis, Karius, Medimmune, Merck, Neumedicine, QPex, Pfizer, Roche, Sanofi-Pasteur, Shionogi, Tetraphase, T2Biosystems, Utility, Union and Wellspring, payment for honoraria from Pfizer; and an editor’s grant from BSAC. Please see the study for all other authors’ relevant financial disclosures.

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Patients with ceftriaxone-resistant Escherichia coli bloodstream infections generally had worse outcomes compared with patients with ceftriaxone-susceptible E. coli infections, according to a recent study.

“Ceftriaxone-resistant E. coli are on the rise in the United States. Most ceftriaxone resistance in clinical E. coli isolates is caused by extended-spectrum beta-lactamases (ESBL),” David van Duin, MD, PhD, infectious diseases specialist at the University of North Carolina Chapel Hill, told Healio. “Reports suggest that the rise in ESBL-producing bacteria is secondary to increased spread in the community. The clinical impact of having a bloodstream infection with ESBL-producing E. coli for hospitalized patients in the US is unclear.”

E coli NIAID

When appropriate therapy is given, worse outcomes often occur because of patient factors, which clinicians need to consider, David van Duin, MD, PhD, told Healio. Source: Adobe Stock

With support from the Antibacterial Resistance Leadership Group, van Duin and colleagues conducted a prospective multicenter study to evaluate outcomes in patients with bloodstream infection (BSI) with ESBL-producing E. coli.

According to the study, the patients were hospitalized at 14 US hospitals between November 2020 and April 2021. For each patient with a ceftriaxone-resistant (CRO-R) E. coli BSI enrolled, the next consecutive patient with a ceftriaxone-susceptible (CRO -S) E. coli BSI was included. The primary outcome of the study was desirability of outcome ranking (DOOR) at day 30.

Overall, outcomes were worse in cases vs. controls, with 30-day mortality rates of 13% and 8%, respectively. Van Duin explained that after adjustments for possible confounding variables, these differences were much smaller, suggesting that at least part of the observed effect of resistance is due to patient characteristics rather than the bacteria themselves.

In unadjusted DOOR analyses, researchers found a 58% probability (95% bootstrap CI, 52%-63%) for a worse clinical outcome in CRO-R BSI compared with CRO-S BSI, although in the inverse probability weighting-adjusted cohort, no difference was observed (54%; 95% bootstrap CI, 47%-61%).

According to the study, secondary study outcomes included unadjusted and adjusted differences in the proportion of 30-day mortality between CRO-R and CRO-S BSI — –5.3% (95% CI, –10.3% to –0.4%) and –1.8 (95% CI, -6.7% to 3.2%), respectively — post-culture median length of stay — 8 and 6 days, respectively — and incident admission to a long-term care facility — 22% and 12%, respectively.

“Ceftriaxone resistance is increasingly common in bacteria-causing infections in the US High level of suspicion is needed to provide empiric appropriate therapy,” van Duin said. “When appropriate therapy is given, most of the observed worse outcomes with ceftriaxone-resistant E. coli appears to be due to patient factors that are associated with higher risk of acquisition of resistant E. coli, such as nursing home residence.”

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