Expanded-spectrum beta-lactamase (ESBL) bacteremia often leads to severe outcomes like mortality and treatment failure. This study aimed to identify risk factors in patients with ESBL bacteremia. A retrospective cohort analysis was conducted among patients aged 13 years and above who were admitted to Hospital Canselor Tuanku Muhriz (HCTM) due to ESBL bacteremia between the period of January 2015 and August 2019. Patients with polymicrobial bacteremia were excluded. The all-cause in HCTM mortality rate was 30.2%, while the infection-related mortality rate was 22.5%. The risk factors of all-cause in-hospital mortality include hypertension, diabetes mellitus, skin and soft tissue infections (SSTIs), urinary catheterisation and mechanical ventilation. The independent risk factor associated with mortality was mechanical ventilation (AOR 3.12; CI 1.06-9.18; p = 0.04). No association found between appropriate empirical antibiotic treatment with mortality (p = 0.74), treatment success (p = 0.71) or length of hospital stay (p = 0.84). However, appropriate definitive treatment was associated with a lower mortality rate (p<0.01) and higher treatment success (p<0.01). Mechanical ventilation was the only independent risk factor significantly associated with mortality, while appropriate definitive treatment was associated with a lower mortality rate and higher treatment success.
Risk Factors for Severe Outcomes in Extended-Spectrum Beta-Lactamase (ESBL) Bacteremia: A Single-center Study
Abstrak
Bakteremia beta-laktamase spektrum diperluas (ESBL) sering menyebabkan hasil yang teruk seperti kematian dan kegagalan rawatan. Kajian ini bertujuan untuk mengenalpasti faktor risiko bagi pesakit bakteremia ESBL. Analisis kohort retrospektif telah dijalankan terhadap pesakit yang berumur 13 tahun ke atas dan dimasukkan ke Hospital Canselor Tuanku Muhriz (HCTM) untuk bakteremia ESBL dalam tempoh Januari 2015 hingga Ogos 2019. Pesakit dengan bakteria polimikrobial dikecualikan. Kadar kematian pesakit di HCTM ialah sebanyak 30.2%, manakala kadar kematian berkaitan jangkitan ialah 22.5%. Faktor risiko kematian di hospital termasuklah hipertensi, diabetes mellitus, jangkitan kulit dan tisu lembut (SSTI), kateterisasi kencing dan pengudaraan mekanikal. Faktor risiko bebas yang dikaitkan dengan kematian ialah pengudaraan mekanikal (AOR 3.12; CI 1.06-9.18; p = 0.04). Tiada perkaitan ditemui antara rawatan antibiotik empirik yang sesuai dengan kematian (p = 0.74), kejayaan rawatan (p = 0.71), dan tempoh rawatan di hospital (p = 0.84). Walau bagaimanapun, rawatan definitif yang sesuai dikaitkan dengan kadar kematian yang lebih rendah (p<0.01) dan kejayaan rawatan yang lebih tinggi (p<0.01). Pengudaraan mekanikal adalah satu-satunya faktor risiko bebas yang dikaitkan secara signifikan dengan kematian, manakala rawatan definitif yang sesuai dikaitkan dengan kadar kematian yang lebih rendah dan kejayaan rawatan yang lebih tinggi.
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