Antimicrobial resistance and outcomes of community-onset bacterial bloodstream infections in patients with type 2 diabetes

J Glob Antimicrob Resist. 2018 Dec:15:271-276. doi: 10.1016/j.jgar.2018.08.008. Epub 2018 Aug 16.

Abstract

Objectives: Antimicrobial resistance of bacterial pathogens in the diabetic population with infection is seldom investigated. This study evaluated the antimicrobial resistance and outcomes of community-onset bloodstream infections (CO-BSIs) in patients with diabetes.

Methods: From 2007-2014, 1271 monomicrobial CO-BSIs and 178 polymicrobial CO-BSIs were identified in patients with type 2 diabetes from three teaching hospitals in Taiwan. Antimicrobial-resistant strains of the ten most prevalent bacterial pathogens in monomicrobial CO-BSIs were recorded and were defined according to individual drug resistance. The 30-day mortality rate and factors associated with outcome were analysed.

Results: Antimicrobial-resistant strains were found in 33.7% (379/1125) of monomicrobial CO-BSIs involving the 10 most prevalent pathogens. The leading pathogens in these monomicrobial CO-BSIs were Staphylococcus spp. (33.8%; 430/1271), Escherichia coli (20.9%; 266/1271) and Klebsiella spp. (9.6%; 122/1271); antimicrobial-resistant strains accounted for 61.9%, 18.4% and 10.7% of each, respectively. A higher overall 30-day mortality rate was observed for patients infected by antimicrobial-resistant strains compared with antimicrobial-susceptible strains (9.5% vs. 5.5%; P=0.011, log-rank test). A lower serum albumin level was a predictor of mortality after adjusting for antimicrobial-resistant strains and C-reactive protein level.

Conclusions: Antimicrobial-resistant bacterial pathogens pose a serious threat to diabetic patients with CO-BSIs owing to a higher risk of mortality.

Keywords: Antimicrobial resistance; Community-onset bloodstream infection; Diabetes; Monomicrobial bacteraemia; Polymicrobial bacteraemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / pharmacology*
  • Bacteremia / microbiology*
  • Bacteria / classification
  • Bacteria / drug effects*
  • Bacteria / genetics
  • Bacteria / isolation & purification
  • Bacterial Infections / etiology
  • Bacterial Infections / microbiology*
  • Bacterial Infections / mortality
  • Community-Acquired Infections / etiology
  • Community-Acquired Infections / microbiology*
  • Community-Acquired Infections / mortality
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / microbiology
  • Diabetes Mellitus, Type 2 / mortality
  • Drug Resistance, Bacterial*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Taiwan

Substances

  • Anti-Bacterial Agents