RT journal article
T1 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
A1 Mussa, Marco
A1 Martínez Pérez-Crespo, Pedro María
A1 Lopez Cortes, Luis Eduardo
A1 Retamar Gentil, Pilar
A1 Sousa Dominguez, Adrián
A1 Goikoetxea Aguirre, Ane Josune
A1 Reguera Iglesias, José María
A1 León Jiménez, Eva
A1 Fernández Natal, Isabel
A1 Armiñanzas Castillo, Carlos
A1 Boix Palop, Lucía
A1 Cuquet Pedragosa, Jordi
A1 Morán Rodríguez, Miguel Ángel
A1 Fernandez Suarez, Jonathan
A1 del Arco Jiménez, Alfonso
A1 Jóver Saenz, Alfredo
A1 Bahamonde Carrasco, Alberto
A1 Galán Sánchez, Fátima
A1 Sánchez Calvo, Juan Manuel
A1 Smithson Amat, Alejandro
A1 Vinuesa García, David
A1 Sánchez Porto, Antonio
A1 López Hernández, Inmaculada
A1 Rodríguez Baño, Jesús
A1 Lanz García, Joaquín
A1 Montejo, Miguel
A1 Pérez Rodríguez, María Teresa
A1 Corzo Delgado, Enrique
A1 Fariñas, Carmen
A1 Arias Temprano, Marta
A1 Martín Aspas, Andrés
A1 Gea Lázaro, Isabel
A1 Guzmán García, Marcos
A1 Canueto Quintero, Jesús
A1 Reche, Isabel María
A1 Pérez Camacho, Inés
A1 Merino de Lucas, Esperanza
A1 Natera Kindelán, Clara
A2 BiomedicinaBiotecnología y Salud Pública
A2 Medicina
K1 biliary tract infection
K1 bloodstream infection
K1 Enterococcus spp
AB 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.
PB American Society for Microbiology
SN 2165-0497
YR 2022
FD 2022-06-30
LK http://hdl.handle.net/10498/29718
UL http://hdl.handle.net/10498/29718
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 07-nov-2026