Clinical Impact and Risk Factors of Nonsusceptibility to Third-Generation Cephalosporins Among Hospitalized Adults with Monomicrobial Enterobacteriaceae Bacteremia in Southern Taiwan: A Multicenter Study

Abstract

Tsao-Chin Lin,1,2,* Yuan-Pin Hung,3,4,* Ching-Chi Lee,5 Wei-Tang Lin,6 Li-Chen Huang,6 Wei Dai,7 Chi-Shuang Kuo,8 Wen-Chien Ko,4,9 Yeou-Lih Huang1 1Department of Medical Laboratory and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Medical Laboratory, Sinying Hospital, Ministry of Health and Welfare, Tainan, Taiwan; 3Departments of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; 4Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Medical Laboratory, Chiayi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan; 7Experiment and Diagnosis, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; 8Medical Laboratory, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan; 9Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan*These authors contributed equally to this workCorrespondence: Yeou-Lih HuangDepartment of Medical Laboratory and Biotechnology, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708, TaiwanTel [phone] Ext. 2273Fax [phone]Email [email protected]: Reducing the effectiveness of broad-spectrum cephalosporins against Enterobacteriaceae infections has been recognized. This study aimed to investigate risk factors and clinical significance of third-generation cephalosporin nonsusceptibility (3GC-NS) among the cases of monomicrobial Enterobacteriaceae bacteremia (mEB) at regional or district hospitals.Methods: The study was conducted at three hospitals in southern Taiwan between Jan. 2017 and Oct. 2019. Only the first episode of mEB from each adult (aged ≥ 20 years) was included. The primary outcome was in-hospital crude mortality.Results: Overall there were 499 episodes of adults with mEB included, and their mean age was 74.5 years. Female predominated, accounting for 53% of all patients. Escherichia coli (62%) and Klebsiella pneumoniae (21%) were two major causative species. The overall mortality rate was 15% (73/499), and patients infected by 3GC-NS isolates (34%, 172/499) had a higher mortality rate than those by 3GC-susceptible isolates (66%, 327/499) (21% vs 11%, P=0.005). By the multivariate analysis, 3GC-NS was the only independent prognostic determinant (adjusted odds ratio [AOR], 1.78; P=0.04). Of note, male (AOR 2.02, P=0.001), nosocomial-acquired bacteremia (AOR 2.77, P< 0.001), and usage of nasogastric tube (AOR 2.01, P=0.002) were positively associated with 3GC-NS, but P. mirabilis bacteremia (AOR 0.28, P=0.01) and age (AOR 0.98, P=0.04) negatively with 3GC-NS.Conclusion: For adults with Enterobacteriaceae bacteremia, 3GC-NS signifies a significant prognostic impact. Efforts to rapid identification of such antimicrobial resistance profiles should be incorporated into antimicrobial stewardship programs to achieve favorable outcomes.Keywords: third-generation cephalosporin, nonsusceptible, Enterobacteriaceae, Klebsiella pneumoniae, male, nasogastric tube

Keywords

• third-generation cephalosporin
• nonsusceptible
• enterobacteriaceae
• klebsiella pneumoniae
• male
• nasogastric tube.