Kliniske funn og forløp ved bakteriemi forårsaket av gentamicin- og ampicillinresistent Escherichia coli

Abstract

Abstract Background Bacteraemia is estimated to account for 157’000 deaths in Europe per year. The empirical antibiotic therapy for sepsis recommended by the Norwegian Directorate of Health is gentamicin combined with a penicillin. This recommendation is threatened by increasing occurrence of gentamicin resistant Escherichia coli (E. coli). We studied the cases were patients had bacteraemia caused by gentamicin and ampicillin resistant E. coli. Method At Oslo University Hospital, Ullevål there were 15 patients with gentamicin and ampicillin resistant E. coli in their blood in 2015. We studied the patient’s journals in order to gather details regarding clinical findings, symptoms, results of laboratory tests, treatment, course of disease, comorbidities and presence of risk factors for infection. Results The recommended Norwegian empirical antibiotic regimen was given in only 20% of the cases. 47% were given antibiotic treatment covering the bacteria. In 80% of the cases a broad spectrum β-lactam antibiotic was given within 24 hours. One patient died as a result of the bacteraemia. This patient received appropriate empirical antibiotic treatment. The patients had a high occurrence of comorbidities and risk factors for infection with antibiotic resistant bacteria. One third of the infections were hospital acquired. Conclusions The consequences of resistance against the recommended empirical antibiotic regimen among E. coli were small in our study. No deaths could be attributed to insufficient antibiotic treatment. Compliance with the national guidelines for recommended empirical antibiotic regimen was low. Co-resistance against cefotaxime resulted in this treatment only being appropriate in half of the cases, and other broad-spectrum antibiotics might be a better choice when multidrug resistant bacteria are suspected. Known risk factors for infection with resistant bacteria should be carefully considered when deciding the empirical antibiotic therapy for patients with suspected bacteraemia.

Abstract Background Bacteraemia is estimated to account for 157’000 deaths in Europe per year. The empirical antibiotic therapy for sepsis recommended by the Norwegian Directorate of Health is gentamicin combined with a penicillin. This recommendation is threatened by increasing occurrence of gentamicin resistant Escherichia coli (E. coli). We studied the cases were patients had bacteraemia caused by gentamicin and ampicillin resistant E. coli. Method At Oslo University Hospital, Ullevål there were 15 patients with gentamicin and ampicillin resistant E. coli in their blood in 2015. We studied the patient’s journals in order to gather details regarding clinical findings, symptoms, results of laboratory tests, treatment, course of disease, comorbidities and presence of risk factors for infection. Results The recommended Norwegian empirical antibiotic regimen was given in only 20% of the cases. 47% were given antibiotic treatment covering the bacteria. In 80% of the cases a broad spectrum β-lactam antibiotic was given within 24 hours. One patient died as a result of the bacteraemia. This patient received appropriate empirical antibiotic treatment. The patients had a high occurrence of comorbidities and risk factors for infection with antibiotic resistant bacteria. One third of the infections were hospital acquired. Conclusions The consequences of resistance against the recommended empirical antibiotic regimen among E. coli were small in our study. No deaths could be attributed to insufficient antibiotic treatment. Compliance with the national guidelines for recommended empirical antibiotic regimen was low. Co-resistance against cefotaxime resulted in this treatment only being appropriate in half of the cases, and other broad-spectrum antibiotics might be a better choice when multidrug resistant bacteria are suspected. Known risk factors for infection with resistant bacteria should be carefully considered when deciding the empirical antibiotic therapy for patients with suspected bacteraemia.