Clinical Impact of Ceftriaxone Resistance in <i>Escherichia coli</i> Bloodstream Infections: A Multicenter Prospective Cohort Study
Pranita D. Tamma, Lauren Komarow, Lizhao Ge, Julia Garcia‐Diaz, Erica Herc, Yohei Doi, César A. Arias, Owen Albin, Elie Saade, Loren G. Miller, Jesse T. Jacob, Michael J. Satlin, Martin Kršák, W. Charles Huskins, Sorabh Dhar, Samuel A. Shelburne, Carol Hill, Keri Baum, Minal Bhojani, Kerryl E. Greenwood‐Quaintance, Suzannah M. Schmidt-Malan, Robin Patel, Scott Evans, Henry F. Chambers, Vance G. Fowler, David van Duin, for the Antibacterial Resistance Leadership Group
Abstract
Abstract Background Ceftriaxone-resistant (CRO-R) Escherichia coli bloodstream infections (BSIs) are common. Methods This is a prospective cohort of patients with E coli BSI at 14 United States hospitals between November 2020 and April 2021. For each patient with a CRO-R E coli BSI enrolled, the next consecutive patient with a ceftriaxone-susceptible (CRO-S) E coli BSI was included. Primary outcome was desirability of outcome ranking (DOOR) at day 30, with 50% probability of worse outcomes in the CRO-R group as the null hypothesis. Inverse probability weighting (IPW) was used to reduce confounding. Results Notable differences between patients infected with CRO-R and CRO-S E coli BSI included the proportion with Pitt bacteremia score ≥4 (23% vs 15%, P = .079) and the median time to active antibiotic therapy (12 hours [interquartile range {IQR}, 1–35 hours] vs 1 hour [IQR, 0–6 hours]; P &lt; .001). Unadjusted DOOR analyses indicated a 58% probability (95% confidence interval [CI], 52%–63%) for a worse clinical outcome in CRO-R versus CRO-S BSI. In the IPW-adjusted cohort, no difference was observed (54% [95% CI, 47%–61%]). Secondary outcomes included unadjusted and adjusted differences in the proportion of 30-day mortality between CRO-R and CRO-S BSIs (−5.3% [95% CI, −10.3% to −.4%] and −1.8 [95% CI, −6.7% to 3.2%], respectively), postculture median length of stay (8 days [IQR, 5–13 days] vs 6 days [IQR, 4–9 days]; P &lt; .001), and incident admission to a long-term care facility (22% vs 12%, P = .045). Conclusions Patients with CRO-R E coli BSI generally have poorer outcomes compared to patients infected with CRO-S E coli BSI, even after adjusting for important confounders.