Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-ProducingKlebsiella pneumoniae
- 1 October 2004
- journal article
- research article
- Published by Cambridge University Press (CUP) in Infection Control & Hospital Epidemiology
- Vol. 25 (10), 860-867
- https://doi.org/10.1086/502310
Abstract
Objective: To evaluate risk factors and treatment outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producingKlebsiella pneumoniae(ESBL-KP).Design: Retrospective case-control study. Stored blood isolates ofK. pneumoniaewere 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: ForK. pneumoniaebacteremia, 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.Keywords
This publication has 24 references indexed in Scilit:
- Manual of Clinical Microbiology, 8th Edition:Manual of Clinical Microbiology, 8th EditionClinical Infectious Diseases, 2004
- Evaluation of the NCCLS Extended-Spectrum β-Lactamase Confirmation Methods for Escherichia coli with Isolates Collected during Project ICAREJournal of Clinical Microbiology, 2003
- Molecular Correlation for the Treatment Outcomes in Bloodstream Infections Caused byEscherichia coliandKlebsiella pneumoniaewith Reduced Susceptibility to CeftazidimeClinical Infectious Diseases, 2002
- Characterization of Clinical Isolates ofKlebsiella pneumoniaefrom 19 Laboratories Using the National Committee for Clinical Laboratory Standards Extended-Spectrum β-Lactamase Detection MethodsJournal of Clinical Microbiology, 2001
- Antimicrobial Resistance Rates Among Aerobic Gram-Negative Bacilli Recovered from Patients in Intensive Care Units: Evaluation of a National Postmarketing Surveillance ProgramClinical Infectious Diseases, 1996
- Ceftazidime-Resistant Klebsiella pneumoniae and Escherichia coli Bloodstream Infection: A Case-Control and Molecular Epidemiologic InvestigationThe Journal of Infectious Diseases, 1996
- Treatment failure due to extended spectrum βlactamaseJournal of Antimicrobial Chemotherapy, 1996
- Klebsiella bacteremia: A review of 196 episodes during a decade (1980–1989)Scandinavian Journal of Infectious Diseases, 1991
- CDC definitions for nosocomial infections, 1988American Journal of Infection Control, 1988
- APACHE IICritical Care Medicine, 1985