Extended-spectrum beta-lactamase-producing Enterobacterales in patients with suspected sepsis in an acute care setting in Skåne, Sweden: a cohort study

Figures & data

Figure 1. Flow chart of inclusion.

Table 1. Patient characteristics.

Group	Non-Enterobacterales	Non-ESBL- Enterobacterales	ESBL-producing Enterobacterales	p-value*
Total, n	430	180	11
Male sex, n (%)	258 (60.0)	96 (53.3)	5 (45.5)	0.61
Age, median	74.7	76.9	73.1	0.08
Comorbidities, n (%)
Diabetes	98 (22.8)	49 (27.2)	3 (27.3)	1.0
Cardiovascular	225 (52.3)	111 (61.7)	7 (63.6)	0.89
Respiratory	105 (24.4)	35 (19.4)	2 (18.2)	1.0
Renal	48 (11.2)	22 (12.2)	1 (9.1)	1.0
Liver	7 (1.6)	5 (2.8)	1 (9.1)	0.30
Malignancy	76 (17.7)	36 (20.0)	3 (27.3)	0.69
Immunocompromised	69 (16.0)	25 (13.9)	1 (9.1)	1.0
Focus of infection, n (%)
Respiratory tract	239 (55.6)	4 (2.2)	1 (9.1)	0.26
Urinary tract	44 (10.2)	114 (63.3)	6 (54.5)	0.54
Abdomen	19 (4.4)	10 (5.6)	3 (27.3)	0.03
Central Nervous System	5 (1.2)	1 (0.6)	0 (0.0)	1.0
Bone or joint	8 (1.9)	0 (0.0)	0 (0.0)	0.80
Skin/soft tissue	55 (12.8)	18 (10.0)	0 (0.0)	0.60
Other	15 (3.5)	23 (12.8)	0 (0.0)	0.37
Unknown	57 (13.3)	12 (6.7)	1 (9.1)	0.57
Initial antibiotics, n (%)
Cefotaxime	251 (58.4)	107 (59.4)	6 (54.5)	0.35
Benzyl penicillin	56 (13.0)	12 (6.7)	0 (0.0)	1.0
Piperacillin-Tazobactam	44 (10.2)	39 (21.7)	2 (18.2)	1.0
Imipenem	24 (6.5)	11 (6.1)	1 (9.1)	0.52
Meropenem	20 (4.7)	11 (6.1)	2 (18.2)	0.16
Levofloxacin	24 (5.6)	9 (5.0)	1 (9.1)	0.46
Clindamycin	19 (4.4)	4 (2.2)	0 (0.0)	1.0
Metronidazole	11 (2.6)	8 (4.4)	1 (9.1)	0.42
Tobramycin	9 (2.1)	7 (3.9)	0 (0.0)	1.0
Cloxacillin	6 (1.4)	0 (0.0)	0 (0.0)	0.80
Other	10 (2.3)	4 (2.2)	0 (0.0)	0.62
90-day mortality, n (%)	77 (17.9)	32 (17.8)	1 (9.1)	0.46
ICU admission, n (%)	27 (6.3)	11 (6.1)	0 (0.0)	1.0
Sepsis, n (%)	281 (65.3)	153 (85.0)	10 (90.9)	0.59
Septic shock, n (%)	12 (2.8)	11 (6.1)	0 (0.0)	1.0
SOFA day 1, median	3.0	4.0	3.0	0.17
Septic patients with ΔSOFA ≥1, n (% of septic patients)
Cardiovascular	162 (57.7)	94 (61.4)	8 (72.7)	0.24
Central nervous system	94 (33.5)	47 (30.7)	1 (10.0)	0.28
Respiratory	270 (96.1)	147 (96.1)	10 (100.0)	0.39
Liver	18 (6.4)	18 (11.7)	3 (30.0)	0.15
Renal	29 (10.3)	20 (13.3)	0 (0.0)	0.61
Coagulation	14 (5.0)	12 (7.8)	1 (10.0)	0.60

The table express patients with infection.

* p-value comparing patients infected with non-ESBL-Enterobacterales vs ESBL-producing Enterobacterales.

Table 2. Results of microbiological testing.

Sample	Culture ordered	Enterobacterales	S. aureus	S. pneumoniae	Beta-haemolytic streptococci	Other gram positive	Other gram negative
Blood	607 (97.7)	94 (15.1)	14 (2.3)	7 (1.1)	14 (2.3)	50 (8.1)	14 (3.3)
Urine	464 (74.7)	146 (23.5)	6 (1.0)	0 (0.0)	8 (1.3)	44 (7.1)	14 (3.3)
Sputum	24 (3.9)	3 (0.5)	0 (0.0)	2 (0.3)	1 (0.2)	0 (0.0)	12 (2.8)
CSF	11 (1.8)	0 (0.0)	0 (0.0)	2 (0.3)	0 (0.0)	1 (0.2)	0 (0.0)
Stool	19 (3.1)	1 (0.2)	0 (0.0)	0 (0.0)	0 (0.0)	7 (1.1)	0 (0.0)
NPH	385 (62.0)	1 (0.2)	2 (0.3)	9 (1.4)	10 (1.6)	0 (0.0)	37 (3.7)
Wound	74 (11.9)	12 (1.9)	48 (7.7)	0 (0.0)	23 (3.7)	10 (1.6)	15 (3.5)
Antigen in urine	79 (12.7)	0 (0.0)	0 (0.0)	7 (1.1)	0 (0.0)	0 (0.0)	0 (0.0)
Other	80 (12.9)	4 (0.6)	8 (1.3)	1 (0.2)	8 (1.3)	5 (0.8)	3 (0.5)

Numbers in parentheses are the percentage of all infected patients. CSF = cerebrospinal fluid. NPH = nasopharyngeal sample.

Figure 2. Proportion of patients with initial antimicrobial treatment in the various antimicrobial groups. The outer circle of the chart reflects the proportion of patients within each initial antimicrobial category fulfilling risk factors for resistant pathogen or severe disease, n = 764.