Original Article

Multidrug-Resistant Bloodstream Infections in Internal Medicine: Results from a Single-Center Study

Authors: Edoardo Pace, MD, Christian Bracco, MD, Corrado Magnino, MD, Marco Badinella Martini, MD, Cristina Serraino, MD, Chiara Brignone, MD, Elisa Testa, MD, Luigi Maria Fenoglio, Massimo Porta

Abstract

Objectives: Infections due to multidrug-resistant organisms (MDROs) are expanding globally and are associated with higher mortality rates and hospital-related costs. The objectives of this study were to analyze the trends of MDRO bacteremia and antimicrobial resistance rates in Internal Medicine wards of our hospital and to identify the variables associated with these infections.

Methods: During a 6-year period (July 1, 2011–June 30, 2017), patients with positive blood culture isolates hospitalized in the Internal Medicine wards in the Santa Croce and Carle Hospital in Cuneo, Italy, were assessed. We performed an analysis taking into consideration the time trends and frequencies of MDRO infections, as well as a case-control study to identify clinical-demographic variables associated with MDRO bacteremias.

Results: During the study period a total of 596 blood cultures were performed in 577 patients. The most frequently identified organism was Escherichia coli (33.7%), followed by Staphylococcus aureus (15.6%) and S epidermidis (7.4%). The percentage of resistance to methicillin among S aureus isolates showed a decreasing trend, whereas rates of extended-spectrum β-lactamase-producing Enterobacteriaceae and carbapenemase-producing Klebsiella pneumoniae increased during the study period. Multivariate analysis showed that the nosocomial origin of the infection, hospitalization during the previous 3 months, residence in long-term care facilities, presence of a device, antibiotic exposure during the previous 3 months, and cerebrovascular disease were independently associated with bacteremia by resistant microorganisms.

Conclusions: Our analysis reveals a concerning microbiological situation in an Internal Medicine setting, in line with other national and regional data. The risk variables for infection by MDRO identified in our study correspond to those reported in the literature, although studies focused on Internal Medicine settings appear to be limited.
Posted in: Bacteremia & Sepsis Syndrome1

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References

1. Cassini A, Högberg LD, Plachouras D, et al. Attributable deaths and disabilityadjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015 : a population-level modelling analysis. Lancet Infect Dis 2019;19:56–66.
 
2. World Health Organitazion. Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2016-2017. https://apps.who.int/iris/bitstream/handle/10665/259744/9789241513449-eng.pdf;jsessionid=386822D2F3B661C205EF1352474B5D28?sequence=1. Published 2017. Accessed March 5, 2022.
 
3. Perencevich EN, Cosgrove SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008;6:751–763.
 
4. O’Neill J. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. https://amr-review.org/sites/default/files/AMRReview Paper-Tackling a crisis for the health and wealth of nations_1.pdf. Published 2014. Accessed March 5, 2022.
 
5. de Kraker MEA, Stewardson AJ, Harbarth S. Will 10 million people die a year due to antimicrobial resistance by 2050? PLoS Med 2016;13:e1002184.
 
6. Lim CJ, Cheng AC, Kong DCM, et al. Community-onset bloodstream infection with multidrug-resistant organisms: a matched case-control study. BMC Infect Dis 2014;14:1–9.
 
7. European Centre for Disease Prevention and Control. Risk assessment on the spread of carbapenemase-producing enterobacteriaceae (CPE) through patient transfer between healthcare facilities, with special emphasis on cross-border transfer. https://www.ecdc.europa.eu/en/publications-data/risk-assessment-spread-carbapenemase-producing-enterobacteriaceae-cpe-through. Published 2011. Accessed March 5, 2022.
 
8. Mascitti H, Duran C, Nemo E, et al. Factors associated with bacteraemia due to multidrug-resistant organisms among bacteraemic patients with multidrug-resistant organism carriage: a case control study. Antimicrob Resist Infect Control 2018;7:116.
 
9. Lagi F, Corti G. Risk factors for extended-spectrum beta-lactamase-producing Enterobacteriales infection: are they the same in neutropenic and non- neutropenic patients? Intern Emerg Med 2019;14:353–354.
 
10. Del Bono V, Giacobbe DR. Bloodstream infections in internal medicine. Virulence 2016;7:353–365.
 
11. Menichetti F, Tagliaferri E. Antimicrobial resistance in internal medicine wards. Intern Emerg Med 2012;7(suppl 3):S271–S281.
 
12. Gudiol C, Cuervo G, Shaw E, et al. Pharmacotherapeutic options for treating Staphylococcus aureus bacteremia. Expert Opin Pharmacother 2017;18: 1947–1963.
 
13. Tong SYC, Davis JS, Eichenberger E, et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015;28:603–661.
 
14. De Rosa FG, Corcione S, Motta I, et al. Risk factors for mortality in patients with Staphylococcus aureus bloodstream infection. J Chemother 2016;28: 187–190.
 
15. Pitout JDD. Infections with extended-spectrum beta-lactamase producing enterobacteriaceae changing epidemiology and drug treatment choices. Drugs 2010;70:313–333.
 
16. Rodriguez-Bano J, Navarro MD, Romero L, et al. Risk-factors for emerging bloodstream infections caused by extended-spectrum. Clin Microbiol Infect 2008;14:180–183.
 
17. Mcdanel J, Schweizer M, Crabb V, et al. Incidence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella infections in the United States: a systematic literature review. Infect Control Hosp Epidemiol 2017;38:1209–1215.
 
18. Lambregts MMC, Hendriks BJC, Visser LG, et al. Using local clinical and microbiological data to develop an institution specific carbapenem-sparing strategy in sepsis: a nested case-control study. Antimicrob Resist Infect Control 2019;8:19.
 
19. van Loon K, Voor in ‘t holt AF, Vos MC. A systematic review and metaanalyses of the clinical epidemiology of carbapenem-resistant enterobacteriaceae. Antimicrob Agents Chemother 2017;62:e01730–17.
 
20. Giacobbe DR, Del Bono V, Bruzzi P, et al. Previous bloodstream infections due to other pathogens as predictors of carbapenem-resistant Klebsiella pneumoniae bacteraemia in colonized patients: results from a retrospective multicentre study. Eur J Clin Microbiol Infect Dis 2017; 36:663–669.
 
21. Charlson M, Pompei P, Ales K, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
 
22. European Committee on Antimicrobial Susceptibility Testing. EUCAST guidelines for the detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. https://www.eucast.org/resistance_mechanisms/. Published 2013. Accessed March 5, 2022.
 
23. Denis B, Lafaurie M, Donay J, et al. Prevalence, risk factors, and impact on clinical outcome of extended-spectrum beta-lactamase-producing Escherichia coli bacteraemia: a five-year study. Int J Infect Dis 2015;39:1–6.
 
24. Giacobbe DR, Del Bono V, Trecarichi EM, et al. Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case-control-control study. Clin Microbiol Infect 2015;21:1106.e1–1106.e8.
 
25. Corcione S, Angilletta R, Raviolo S, et al. Epidemiology and risk factors for mortality in bloodstream infection by CP-Kp, ESBL-E, Candida and CDI: a single center retrospective study. Eur J Intern Med 2018;48:44–49.
 
26. European Centre for Disease Control. Surveillance of antimicrobial resistance in Europe 2017. https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2017. Published 2018. Accessed March 5, 2022.
 
27. Stefania Bellino, Simone Iacchini, Monica Monaco, Francesca Prestinaci, Claudia Lucarelli, Maria Del Grosso, Romina Camilli, Giulia Errico, Fortunato D’Ancona, Patrizio Pezzotti, Annalisa Pantosti and AR-ISS Group 2018, AR-ISS: antibiotic resistance surveillance in Italy. Report for five-year period 2012-2016. vi, 98 p. Rapporti ISTISAN 18/22 (in Italian). https://old.iss.it/documents/20126/45616/18_22_web.pdf/382a1534-ee26-6e67-e3df-1d52617829fb?t=1581095815908.
 
28. Poisson SN, Johnston SC, Josephson SA. Urinary tract infections complicating stroke mechanisms, consequences, and possible solutions. Stroke 2010;41: 180–18.
 
29. Lee HS, Moon J, Shin H, et al. Pneumonia in hospitalized neurologic patients: trends in pathogen distribution and antibiotic susceptibility. Antimicrob Resist Infect Control 2019;8:25.
 
30. Chalmers JD, Rother C, Salih W, et al. Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: a systematic review and meta-analysis. Clin Infect Dis 2014;58:330–339.
 
31. Falcone M, Tiseo G, Dentali F, et al. Predicting resistant etiology in hospitalized patients with blood cultures positive for Gram-negative bacilli. Eur J Intern Med 2018;53:21–28.