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April 26, 2017

Using national health registries to streamline the treatment of sepsis

During this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), researchers showed that previous exposure to drug-resistant bacteria in stool or urine increases the risk of developing drug-resistant sepsis compared with no prior exposure to drug-resistant bacteria.

By GlobalData Healthcare

During this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), researchers showed that previous exposure to drug-resistant bacteria in stool or urine increases the risk of developing drug-resistant sepsis compared with no prior exposure to drug-resistant bacteria. GlobalData acknowledges the importance of this research in terms of early diagnosis and timely treatment, but ultimately the applicability of these results will depend on how similar other national health registries are to that of Sweden, which was used for this study.

Dr. Isendahl and his colleagues examined urine and stool samples from over 22,000 patients diagnosed with Enterobacteriaceae infection, specifically those conferring resistance through extended spectrum b-lactamases (ESBL)—also known as ESBL-producing Enterobacteriaceae (EPE)—and compared those with 44,000 undiagnosed patients in Sweden between 2007 and 2012. Sweden’s Public Health Agency mandates the reporting of all cases of EPE infections, thereby enabling the researchers to follow up with all patients over a period of six years and check on the future development of EPE blood infections and sepsis.

During the follow-up, researchers found that patients with previous urine or stool EPE infections were overall 57 times more likely to develop EPE bloodstream infections. The risk further increased to 114 times in patients with previous urine EPE infections compared with the general population.

Over the six-year study period, risk for EPE positive bloodstream infections remained high, with 4% of those with a urinary tract infection, and 2% of those with EPE in the bowel developing a bloodstream infection with EPE, compared with an incidence of only 0.02% in undiagnosed patients.

While, the route of transmission from the urine or stool to the bloodstream of EPE-positive patients remains unknown and warrants further investigation, GlobalData highlights that previous screening of urine and stool of EPE positive patients hold great promise in the early diagnosis and appropriate treatment of future life-threatening bloodstream infections in these patient populations.

GlobalData believes that the cost of a patient registry would easily be justified from an antibiotic stewardship and economical perspective, where patients at risk of potential multidrug-resistant bacteria receive the appropriate antibiotics, while all other patients receive conventional antibiotic therapy, thereby reducing the risk of developing resistance to an antibiotic of last resort.

While sepsis is a life-threatening and life-debilitating disease associated with a high financial burden, early and appropriate treatment of complicated multidrug-resistant sepsis results in improved outcomes, shorter hospital stays, and reduced long-term morbidities due to the disease. Identification of high-risk patients through national health registries, such as those with previous EPE bloodstream infections, holds tremendous value in reducing this financial burden.

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