Methods:We conducted a single centre retrospective study on patients admitted to Molinette Hospital, Turin, from January 2013 to April 2015 with CDI or BSI caused by Candida, ESBL-producing Enterobacteriaceae or KPC-Kp. For each patient demographic, clinical and microbiological data were collected. Aim of this study is to describe epidemiology and to evaluate risk factors for in-hospital mortality in this group of patients.
Results: 786 cases were analyzed: 398 CDI, 137 Candida BSI, 126 ESBL-producing Enterobacteriaceae BSI and 125 KPC-Kp BSI. Annual incidence of CDI in medical wards was 0.9%, while the one of KPC-Kp BSI in ICU was 5.7%.
66% had a previous hospitalization. Leading comorbidities were cardiovascular diseases (44.7%), especially among KPC-Kp BSI (57.9%). Hematologic malignancies were documented in 24% of ESBL-producing Enterobacteriaceae BSI, while solid tumors were especially found in Candida BSI (29.2%). In this group was frequent the previous use of total parenteral nutrition (78%). Antibiotics were administered before admission in 43%, while pre-infection antimicrobial therapy was observed in 82.1%, with higher percentage among KPC-Kp BSI (93.7%). In-hospital death occurred in 23.4%. Independent risk factors for mortality were pre-admission antibiotic therapy, cardiovascular diseases, neutropenia, urinary catheterization, TPN, KPC-Kp BSI versus CDI, SIRS and higher creatinine levels at the moment of diagnosis. Previous abdominal surgery, IBD, higher serum albumin levels at the admission and fever when the specimen was collected were protective factors.
Conclusion: The gastrointestinal alterations are well recognized key players in promoting intestinal colonization, overgrowth and diseases by opportunistic microrganisms. To reduce the opportunity of enteropathogenetic infectious syndromes, there is a strong need of a correct antibiotic use and adequate infection control measures.
S. Raviolo, None
C. Filippini, None
L. Fossati, None
R. Cavallo, None
A. Lucchini, None
G. Di Perri, None
F. G. De Rosa, None