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Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

  • Cheol-In Kang (a1), Sung-Han Kim (a1), Dong Min Kim (a1), Wan Beom Park (a1), Ki-Deok Lee (a1), Hong-Bin Kim (a1), Myoung-don Oh (a1) (a2), Eui-Chong Kim (a3) (a2) and Kang-Won Choe (a1) (a2)...

Abstract

Objective:

To evaluate risk factors and treatment outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP).

Design:

Retrospective case-control study. Stored blood isolates of K. pneumoniae were tested for ESBL production by NCCLS guidelines, double-disk synergy test, or both.

Setting:

A 1,500-bed, tertiary-care university hospital and referral center.

Patients:

Sixty case-patients with bacteremia due to ESBL-KP were compared with 60 matched control-patients with non-ESBL-KP.

Results:

There were no significant differences in age, gender, APACHE II score, or underlying diseases between the groups. Independent risk factors for infections caused by ESBL-KP were urinary catheterization, invasive procedure within the previous 72 hours, and an increasing number of antibiotics administered within the previous 30 days. Complete response rate, evaluated 72 hours after initial antimicrobial therapy, was higher among control-patients (13.3% vs 36.7%; P = .003). Treatment failure rate was higher among case-patients (35.0% vs 15%; P = .011). Overall 30-day mortality rate was 30% for case-patients and 28.3% for control-patients (P = .841). Case-patients who received imipenem or ciprofloxacin as a definitive antibiotic had 10.5% mortality. The mortality rate for initially ineffective therapy was no higher than that for initially effective therapy (9.1% vs 11.1%; P = 1.000), but statistical power was low for evaluating mortality in the absence of septic shock.

Conclusion:

For K. pneumoniae bacteremia, patients with ESBL-KP had a higher initial treatment failure rate but did not have higher mortality if antimicrobial therapy was appropriately adjusted in this study with limited statistical power.

Copyright

Corresponding author

Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong Chongno-gu, Seoul 110-744, Republic of Korea

References

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1.Tsay, RW, Siu, LK, Fung, CP, Chang, FY. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factors for mortality and the impact of capsular serotypes as a herald for community-acquired infection. Arch Intern Med 2002;162:10211027.
2.Watanakunakorn, C, Jura, J. Klebsiella bacteremia: a review of 196 episodes during a decade (1980-1989). Scand J Infect Dis 1991;23:399405.
3.Bush, K. New beta-lactamases in gram-negative bacteria: diversity and impact on the selection of antimicrobial therapy. Clin Infect Dis 2001;32:10851089.
4.Jacoby, GA, Medeiros, AA. More extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1991;35:16971704.
5.Knothe, H, Shah, P, Krcmery, V, Antal, M, Mitsuhashi, S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983;11:315317.
6.Burwen, DR, Banerjee, SN, Gaynes, RP. Ceftazidime resistance among selected nosocomial gram-negative bacilli in the United States. J Infect Dis 1994;170:16221625.
7.Itokazu, GS, Quinn, JP, Bell-Dixon, C, Kahan, FM, Weinstein, RA. Antimicrobial resistance rates among aerobic gram-negative bacilli recovered from patients in intensive care units: evaluation of a national postmarketing surveillance program. Clin Infect Dis 1996;23:779784.
8.Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:11621171.
9.Meyer, KS, Urban, C, Eagen, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353358.
10.Pena, C, Pujol, M, Ardanuy, C, et al.Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1998;42:5358.
11.Schiappa, DA, Hayden, MK, Matushek, MG, et al.Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a case-control and molecular epidemiologic investigation. J Infect Dis 1996;174:529536.
12.Kim, YK, Pai, HJ, Lee, HJ, et al.Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 2002;46:14811491.
13.Wong-Beringer, A, Hindler, J, Loeloff, M, et al.Molecular correlation for the treatment outcomes in bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae with reduced susceptibility to ceftazidime. Clin Infect Dis 2002;34:135146.
14.Paterson, DL, Ko, WC, Von Gottberg, A, et al.Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum beta-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol 2001;39:22062212.
15.Eisenstein, BI, Zaleznik, DEEnterobacteriaceae. In: Mandeli, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases, ed. 5. Philadelphia: Churchill Livingstone; 2000:22942310.
16.Jorgensen, JH, Turnidge, JD, Washington, JA. Antibacterial susceptibility tests: dilution and disk diffusion methods. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology, ed. 7. Washington, DC: American Society for Microbiology; 1999.
17.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002. Approved standard M100-S12.
18.Tzelepi, E, Giakkoupi, P, Sofianou, D, Loukova, V, Kemeroglou, A, Tsakris, A. Detection of extended-spectrum beta-lactamases in clinical isolates of Enterobacter cloacae and Enterobacter aerogenes. J Clin Microbiol 2000;38:542546.
19.Thomson, KS, Sanders, CC. Detection of extended-spectrum beta-lactamases in members of the family Enterobacteriaceae: comparison of the double-disk and three-dimensional tests. Antimicrob Agents Chemother 1992;36:18771882.
20.Tenover, FC, Raney, PM, Williams, PP, et al.Evaluation of the NCCLS extended-spectrum beta-lactamase confirmation methods for Escherichia coli with isolates collected during Project ICARE. J Clin Microbiol 2003;41:31423146.
21.Steward, CD, Rasheed, JK, Hubert, SK, et al.Characterization of clinical isolates of Klebsiella pneumoniae from 19 laboratories using the National Committee for Clinical Laboratory Standards extended-spectrum beta-lactamase detection methods. J Clin Microbiol 2001;39:28642872.
22.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818829.
23.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.
24.Blot, S, Vandewoude, K, De Bacquer, D, Colardyn, F. Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clin Infect Dis 2002;34:16001606.
25.Emery, CL, Weymouth, LA. Detection and clinical significance of extended-spectrum beta-lactamases in a tertiary-care medical center. J Clin Microbiol 1997;35:20612067.
26.Karas, JA, Pillay, DG, Muckart, D, Sturm, AW. Treatment failure due to extended spectrum beta-lactamase. J Antimicrob Chemother 1996;37:203204.
27.Thomson, KS, Moland, ES. Cefepime, piperacillin-tazobactam, and the inoculum effect in tests with extended-spectrum beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2001;45:35483554.

Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

  • Cheol-In Kang (a1), Sung-Han Kim (a1), Dong Min Kim (a1), Wan Beom Park (a1), Ki-Deok Lee (a1), Hong-Bin Kim (a1), Myoung-don Oh (a1) (a2), Eui-Chong Kim (a3) (a2) and Kang-Won Choe (a1) (a2)...

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