1. Association of microbiological factors with mortality in Escherichia coli bacteraemia presenting with sepsis/septic shock: a prospective cohort study.
- Author
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Maldonado N, López-Hernández I, López-Cortés LE, Martínez Pérez-Crespo PM, Retamar-Gentil P, García-Montaner A, De la Rosa Riestra S, Sousa-Domínguez A, Goikoetxea J, Pulido-Navazo Á, Del Valle Ortíz M, Natera-Kindelán C, Jover-Sáenz A, Arco-Jiménez AD, Armiñanzas-Castillo C, Aller-García AI, Fernández-Suárez J, Marrodán-Ciordia T, Boix-Palop L, Smithson-Amat A, Reguera-Iglesias JM, Galán-Sánchez F, Bahamonde A, Sánchez-Calvo JM, Gea-Lázaro I, Pérez-Camacho I, Reyes-Bertos A, Becerril-Carral B, Pascual Á, and Rodríguez-Baño J
- Subjects
- Humans, Male, Prospective Studies, Aged, Female, Middle Aged, Aged, 80 and over, Spain epidemiology, Whole Genome Sequencing, Sepsis microbiology, Sepsis mortality, ROC Curve, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents pharmacology, Virulence, Virulence Factors genetics, Escherichia coli Infections microbiology, Escherichia coli Infections mortality, Bacteremia microbiology, Bacteremia mortality, Escherichia coli genetics, Escherichia coli isolation & purification, Escherichia coli pathogenicity, Escherichia coli classification, Shock, Septic microbiology, Shock, Septic mortality
- Abstract
Objectives: This study aimed to determine the association of Escherichia coli microbiological factors with 30-day mortality in patients with bloodstream infection (BSI) presenting with a dysregulated response to infection (i.e. sepsis or septic shock)., Methods: Whole-genome sequencing was performed on 224 E coli isolates of patients with sepsis/septic shock, from 22 Spanish hospitals. Phylogroup, sequence type, virulence, antibiotic resistance, and pathogenicity islands were assessed. A multivariable model for 30-day mortality including clinical and epidemiological variables was built, to which microbiological variables were hierarchically added. The predictive capacity of the models was estimated by the area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI)., Results: Mortality at day 30 was 31% (69 patients). The clinical model for mortality included (adjusted OR; 95% CI) age (1.04; 1.02-1.07), Charlson index ≥3 (1.78; 0.95-3.32), urinary BSI source (0.30; 0.16-0.57), and active empirical treatment (0.36; 0.11-1.14) with an AUROC of 0.73 (95% CI, 0.67-0.80). Addition of microbiological factors selected clone ST95 (3.64; 0.94-14.04), eilA gene (2.62; 1.14-6.02), and astA gene (2.39; 0.87-6.59) as associated with mortality, with an AUROC of 0.76 (0.69-0.82)., Discussion: Despite having a modest overall contribution, some microbiological factors were associated with increased odds of death and deserve to be studied as potential therapeutic or preventive targets., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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