@misc{10498/29718,
year = {2022},
month = {6},
url = {http://hdl.handle.net/10498/29718},
abstract = {Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus faecalis and E. faecium are associated with inappropriate empirical treatment and worse outcomes compared to other etiologies. The objective of this study was to investigate the risk factors for enterococcal BT-BSI. Patients with BT-BSI from the PROBAC cohort, including consecutive patients with BSI in 26 Spanish hospitals between October 2016 and March 2017, were selected; episodes caused by E. faecalis or E. faecium and other causes were compared. Independent predictors for enterococci were identified by logistic regression, and a predictive score was developed. Eight hundred fifty episodes of BT-BSI were included; 73 (8.5%) were due to target Enterococcus spp. (48 [66%] were E. faecium and 25 [34%] E. faecalis). By multivariate analysis, the variables independently associated with Enterococcus spp. were (OR; 95% confidence interval): cholangiocarcinoma (4.48;1.32 to 15.25), hospital acquisition (3.58;2.11 to 6.07), use of carbapenems in the previous month (3.35;1.45 to 7.78), biliary prosthesis (2.19;1.24 to 3.90), and moderate or severe chronic kidney disease (1.55;1.07 to 2.26). The AUC of the model was 0.74 [95% CI0.67 to 0.80]. A score was developed, with 7, 6, 5, 4, and 2 points for these variables, respectively, with a negative predictive value of 95% for a score # 6. A model, including cholangiocarcinoma, biliary prosthesis, hospital acquisition, previous carbapenems, and chronic kidney disease showed moderate prediction ability for enterococcal BT-BSI. Although the score will need to be validated, this information may be useful for deciding empirical therapy in biliary tract infections when bacteremia is suspected. IMPORTANCE Biliary tract infections are frequent, and a significant cause of morbidity and mortality. Bacteremia is common in these infections, particularly in the elderly and patients with cancer. Inappropriate empirical treatment has been associated with increased risk of mortality in bacteremic cholangitis, and the probability of receiving inactive empirical treatment is higher in episodes caused by enterococci. This is because many of the antimicrobial agents recommended in guidelines for biliary tract infections lack activity against these organisms. To the best of our knowledge, this is the first study analyzing the predictive factors for enterococcal BT-BSI and deriving a predictive score.},
publisher = {American Society for Microbiology},
keywords = {biliary tract infection},
keywords = {bloodstream infection},
keywords = {Enterococcus spp},
title = {Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project},
doi = {10.1128/spectrum.00051-22},
author = {Mussa, Marco and Martínez Pérez-Crespo, Pedro María and Lopez Cortes, Luis Eduardo and Retamar Gentil, Pilar and Sousa Dominguez, Adrián and Goikoetxea Aguirre, Ane Josune and Reguera Iglesias, José María and León Jiménez, Eva and Fernández Natal, Isabel and Armiñanzas Castillo, Carlos and Boix Palop, Lucía and Cuquet Pedragosa, Jordi and Morán Rodríguez, Miguel Ángel and Fernandez Suarez, Jonathan and del Arco Jiménez, Alfonso and Jóver Saenz, Alfredo and Bahamonde Carrasco, Alberto and Galán Sánchez, Fátima and Sánchez Calvo, Juan Manuel and Smithson Amat, Alejandro and Vinuesa García, David and Sánchez Porto, Antonio and López Hernández, Inmaculada and Rodríguez Baño, Jesús and Lanz García, Joaquín and Montejo, Miguel and Pérez Rodríguez, María Teresa and Corzo Delgado, Enrique and Fariñas, Carmen and Arias Temprano, Marta and Martín Aspas, Andrés and Gea Lázaro, Isabel and Guzmán García, Marcos and Canueto Quintero, Jesús and Reche, Isabel María and Pérez Camacho, Inés and Merino de Lucas, Esperanza and Natera Kindelán, Clara},
}