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

Authors Lin TC, Hung YP, Lee CC, Lin WT, Huang LC, Dai W, Kuo CS, Ko WC, Huang YL

Received 19 December 2020

Accepted for publication 11 February 2021

Published 24 February 2021 Volume 2021:14 Pages 689—697

DOI https://doi.org/10.2147/IDR.S297978

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony


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 work

Correspondence: Yeou-Lih Huang
Department of Medical Laboratory and Biotechnology, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
Tel +886 7 3121101 Ext. 2273
Fax +886 7 3113449
Email yelihu@kmu.edu.tw

Background: 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

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