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Drug-resistant bacteria in urine or stool increases risk for drug-resistant sepsis

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Patients with urine or stool samples positive for drug-resistant bacteria are at an increased risk for developing bloodstream infections that also are resistant to certain antibiotics, according to data presented at the 27^th European Congress of Clinical Microbiology and Infectious Diseases.

Joakim Isendahl, a PhD candidate at Karolinska Institutet, Sweden, said during the conference that “relatively harmless” drug-resistant bacteria found in urine and stool samples may transfer their ability to resist antibiotics to “more dangerous” bacteria in the body, which can cause sepsis.

Joakim Isendahl

In a study of approximately 66,000 people, Isendahl and colleagues found that the risk of developing drug-resistant sepsis is highest shortly after the detection of drug-resistant bacteria and diminishes over time, according to a news release.

“We found that the riskiest time was in the days and weeks after the bacteria were found in the urine or stool sample, but there is still an increased risk up to 3 years later,” Isendahl said in the release.

For the study, Isendahl and colleagues examined data on more than 21,000 individuals from Sweden whose urine or stool samples tested positive for extended-spectrum beta-lactamase-producing Enterobacteriaceae (EPE) between 2007 and 2012. The researchers followed the patients for up to 6 years and compared their data with data from more than 45,000 participants without a recent history of EPE to determine their risk for developing bloodstream infections (BSIs) with EPE.

Compared with the general population, the risk for developing a BSI with EPE was 57.43 (95% CI, 17.41-189.42) times higher among patients with EPE in their stool and 113.11 (95% CI, 35.93-356.10) times higher among patients with EPE in their urine. The incidence of BSI decreased with time from 294.2 per 1,000 person-years among those with EPE-positive urine and 49.6 per 1,000 person-years among those with EPE-positive feces within 7 days of detection to 0.84 per 1,000 person-years in both groups after 2 to 3 years. Overall, 4% of patients with EPE in urine and 2% with EPE in stool developed a BSI with EPE vs. 0.02% of the general population, the release said.

In other results, the researchers found that patients who had quinolones or trimethoprim prescribed in outpatient care were more likely to develop a BSI up to 30 days after pharmacy dispensation; however, there were no substantial long-term effects.

“Although [BSIs] are rare, their consequences are dire and treatment must be given as quickly as possible,” Isendahl said in the release. “Knowing if a patient has had a previous finding of EPE, and how long ago it was, helps inform doctors on when last-resort drugs are essential, but also on when they are not needed. This is important since prudent use is imperative to keep them effective.” – by Stephanie Viguers

Reference: Isendahl J, et al. Abstract #2592. Presented at: 27th European Congress of Clinical Microbiology and Infectious Diseases; April 22-25; Vienna, Austria.

Disclosure: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.