Long-term sepsis risks shown in patients colonized with resistant bacteria

People who've had drug-resistant bacteria detected in their urine or feces have a higher risk of developing a drug-resistant bloodstream infection for several years afterward, according to a study presented yesterday at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).

In the study, researchers from the Karolinska Institute in Sweden examined all patients found to have extended-spectrum beta-lactamase producing Enterobacteriaceae (EPE) in their feces or urine from 2007 through 2012, and compared them to a cohort of individuals with no known EPE exposure. EPE are multidrug-resistant pathogens that frequently cause urinary tract and gastrointestinal infections and are a risk factor for subsequent bloodstream infections, but little is known about the long-term risks. All cases of EPE must be reported to the Swedish Public Health Agency.

Overall, the researchers found 22,000 patients with EPE in their feces or urine and followed them for 6 years. Compared with the 44,000 people who had no EPE exposure, patients with EPE in their feces or urine were 57 times and 113 times more likely to develop a bloodstream infection, respectively, with the risk being elevated for at least 3 years. Over the 6-year study period, 2% of patients with EPE in their stool and 4% with an EPE urinary tract infection went on to develop a bloodstream infection, compared with 0.02% in the general population.

"We found that the riskiest time was in the days and weeks after the bacteria were found in the urine or stool sample, but there is still an increased risk up to three years later," lead author Joakim Isendahl, a graduate student at Karolinska Institute, said in an ECCMID press release.

Isendahl suggested the drug-resistant bacteria could be spreading from urine and feces into the bloodstream, or sharing the enzymes that confer resistance to beta-lactams and other antibiotics with other bacteria in the body, which then cause the bloodstream infections.

Sepsis affects up to 30 million people each year and can be deadly if not treated quickly. Isendahl explained that knowing whether a bloodstream infection has been caused by drug-resistant bacteria can help guide proper antibiotic treatment and prevent overuse of last-resort antibiotics.
Apr 23 ECCMID abstract
Apr 22 ECCMID press release

German study notes high use of nonsurgical preventive antimicrobials

Antimicrobial prophylaxis—or using antibiotics and other drugs for preventing infections—outside the operating room accounts for a considerable share of total hospital antimicrobial use, according to a new study in BMC Infectious Diseases.

German investigators analyzed data on 1,020 antimicrobial prescriptions in a university hospital, of which 317 (31%) were given as prophylaxis. Of the 827 antibiotic prescriptions, 17.0% were prescribed for medical prophylaxis, 2.7% for other prevention related to nonsurgical interventions, and 6.9% for surgical prophylaxis. Of the 96 antiviral and 97 antifungal prescriptions, 42.7% and 57.8%, respectively, were for medical prophylaxis.

The study also found a high rate of adherence to protocols. For medical antibiotic prophylaxis, a protocol was followed in 118 of 125 cases (94.4%). For prophylaxis for other nonsurgical interventions and surgical prophylaxis on the wards, protocol adherence rates were 92.3% and 97.6%, respectively. Protocol adherence rates were 95.1% and 96.3%, respectively, for antiviral and antifungal prescriptions.

The authors conclude, "Antimicrobial prophylaxis outside the operating theatre is responsible for a considerable part of total in-hospital antimicrobial use."
Apr 21 BMC Infect Dis study