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Volume 30, Number 5—May 2024
Research

Antimicrobial Resistance as Risk Factor for Recurrent Bacteremia after Staphylococcus aureus, Escherichia coli, or Klebsiella spp. Community-Onset Bacteremia

Salam AbbaraComments to Author , Didier Guillemot, David R.M. Smith, Salma El Oualydy, Maeva Kos, Cécile Poret, Stéphane Breant, Christian Brun-Buisson, and Laurence Watier
Author affiliations: Institut National de la Santé et de la Recherche Médicale, Montigny–Le-Bretonneux, France (S. Abbara, D. Guillemot, C. Brun-Buisson, L. Watier); Versailles Saint Quentin en Yvelines University, Montigny–Le-Bretonneux (S. Abbara, D. Guillemot, C. Brun-Buisson, L. Watier); Institut Pasteur, Paris, France (S. Abbara, D. Guillemot, C. Brun-Buisson, L. Watier); Paris–Cité University, Paris (S. Abbara, D. Guillemot, C. Brun-Buisson, L. Watier); Paris–Saclay University, Le Kremlin–Bicêtre, France (D. Guillemot); Assistance Publique–Hôpitaux de Paris, Paris (D. Guillemot, C. Poret, S. Breant); University of Oxford, Oxford, UK (D.R.M. Smith); Plateforme de Données de Santé, Paris (S. El Oualydy, M. Kos)

Main Article

Table 2

Univariable and multivariable analyses of risk factors for bacteremia recurrence at 1 year after an incident stay with community-onset bacteremia attributable to Staphylococcus aureus, Escherichia coli, or Klebsiella spp., Assistance Publique–Hôpitaux de Paris university hospital group, Paris, France, 2017–2019*

Characteristic Univariable analyses
 Multivariable analyses
HR (95% CI) p value HR (95% CI) p value
Patients
Sex; referent male 0.71 (0.57–0.90) 0.004 0.94 (0.73–1.20) 0.59
Age group, y; referent 35–50 y 0.0005 0.075
>18–35 0.51 (0.25–1.03) 0.66 (0.31–1.38)
50–65 1.23 (0.82–1.83) 1.15 (0.76–1.74)
65–80 1.14 (0.78–1.69) 1.13 (0.76–1.69)
>80 0.68 (0.44–1.05) 0.77 (0.49–1.20)
Charlson comorbidity index; referent 0 <0.0001
1–2 1.95 (1.46–2.62)
>2 2.31 (1.71–3.12)
Underlying conditions
Cancer 2.36 (1.86–3.00) <0.0001 2.03 (1.58–2.62) <0.0001
Heart failure 0.91 (0.64–1.30) 0.61
Diabetes 0.96 (0.73–1.27) 0.79
Vascular disease 0.75 (0.49–1.14) 0.18
Renal disease 1.60 (1.20–2.13) 0.002 1.72 (1.28–2.31) 0.0007
Liver disease 1.89 (1.35–2.65) 0.0007 1.66 (1.17–2.35) 0.007
Chronic pulmonary disease 0.71 (0.40–1.26) 0.24
Dementia 0.56 (0.29–1.09) 0.06
Paralysis (hemiplegia / paraplegia) 0.53 (0.20–1.43) 0.21
Systemic disease
 1.70 (0.70–4.12)
 0.30
Incident stays
Length of stay with bacteremia; referent 7–14 d 0.30
≤7 0.78 (0.59–1.03)
14–30 0.79 (0.55–1.13)
>30 0.97 (0.63–1.50)
Surgery 1.01 (0.71–1.42) 0.97
ICU admission 1.15 (0.89–1.51) 0.30
Septic shock 1.09 (0.73–1.62) 0.68
Infection source; referent urinary tract <0.0001 0.0002
None identified 2.25 (1.62–3.13) 2.26 (1.60–3.19)
Multiple sites 1.19 (0.85–1.68) 1.22 (0.85–1.75)
Lower respiratory tract 1.12 (0.63–1.98) 1.26 (0.70–2.26)
Digestive tract 1.69 (1.13–2.54) 1.57 (1.03–2.38)
Device-related 2.32 (1.44–3.74) 1.93 (1.16–3.23)
Other 0.80 (0.43–1.51) 0.98 (0.51–1.75)
Bacteria resistance; referent MSSA <0.0001 <0.0001
MRSA 0.74 (0.27–2.04) 0.79 (0.29–2.19)
3GC-susceptible E. coli 0.99 (0.72–1.36) 1.16 (0.81–1.66)
3GC-resistant E. coli 1.99 (1.31–3.01) 2.35 (1.50–3.68)
3GC-susceptible Klebsiella spp. 1.64 (1.09–2.49) 1.41 (0.91–2.21)
3GC-resistant Klebsiella spp. 4.11 (2.48–6.81) 3.91 (2.32–6.59)

*p values calculated by using Gray’s test of the subdistribution function for univariable analyses, and Fine–Gray regression models for multivariable analyses. 3GC, third-generation cephalosporin; HR, subdistribution hazard ratio; ICU, intensive care unit; MRSA, methicillin-resistant S. aureus; MSSA, methicillin-susceptible S. aureus.

Main Article

Page created: March 28, 2024
Page updated: April 23, 2024
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