Bacteremic pneumonia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Appropriateness of empirical treatment matters

Cheng, Wan Ling; Hsueh, Po-Ren; Lee, Ching Chi; Li, Chia‐Wen; Li, Ming Ji; Chang, Chia–Ming; Lee, Nan-Yao; Ko, Wen Chien

doi:10.1016/j.jmii.2014.05.003

Cited by 33 publications

(35 citation statements)

References 35 publications

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“…One study was multicenter and performed in 12 countries (Table 1) [15], 6 studies were performed in the Western Pacific region (4 in China [2 of them were performed in Taiwan], 1 in Republic of Korea, and 1 in Singapore) [16, 18, 21, 22, 24, 27], 4 studies were performed in the European region (1 in Italy, 2 in Spain, and 1 in Turkey) [20, 23, 26, 28], and 3 studies were performed in the region of the Americas (1 in Canada and 2 in United States of America) [17, 19, 25]. The isolated pathogens were Escherichia coli in 5 studies [16, 20, 23, 26, 27], Enterobacter cloacae in 2 studies [22, 25], E coli or Klebsiella pneumoniae in 5 studies [17–19, 21, 24], and E coli or K pneumoniae or Proteus mirabilis in 1 study [28].…”

Section: Resultsmentioning

confidence: 99%

“…The isolated pathogens were not specified in 1 study [15]. In addition, 8 studies reported mortality at 30 days [15, 16, 18, 20, 21, 24, 26, 27], 2 studies reported mortality at 28 days [22, 25], 1 study reported mortality at 21 days [28], 1 study reported mortality at 14 days [23], and 2 studies reported outcomes until hospital discharge [17, 19]. A summary of the number and percentage of patients with ESBL-PE BSI categorized according to the source of BSI is provided in the Supplementary Data.…”

Section: Resultsmentioning

confidence: 99%

“…In the first group (4 studies) [18, 26–28], the authors retrospectively reviewed patient charts and included patients with BSI, and the isolated pathogens were susceptible to carbapenems or BL/BLIs. Within the first group, we found that 145 patients were treated empirically with carbapenems (31 of them died; 21.3%) and 183 patients were treated empirically with BL/BLIs (26 of them died; 14.2%).…”

Section: Resultsmentioning

confidence: 99%

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Comparison Between Carbapenems and β-Lactam/β-Lactamase Inhibitors in the Treatment for Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: A Systematic Review and Meta-Analysis

Muhammed

Flokas

Detsis

et al. 2017

Open Forum Infectious Diseases

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Background.Carbapenems are widely used for the management of bloodstream infections (BSIs) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE). However, the wide use of carbapenems has been associated with carbapenem-resistant Enterobacteriaceae development.Methods.We searched the PubMed and Scopus databases (last search date was on June 1, 2016) looking for studies that reported mortality in adult patients with ESBL-PE BSIs that were treated with carbapenems or β-lactam/β-lactamase inhibitors (BL/BLIs).Results.Fourteen studies reported mortality data in adult patients with ESBL-PE BSI that were treated with carbapenems or BL/BLIs. Among them, 13 studies reported extractable data on empiric therapy, with no statistically significant difference in mortality of patients with ESBL-PE BSI that were treated empirically with carbapenems (22.1%; 121 of 547), compared with those that received empiric BL/BLIs (20.5%; 109 of 531; relative risk [RR], 1.05; 95% confidence interval [CI], 0.83–1.37; I2 = 20.7%; P = .241). In addition, 7 studies reported data on definitive therapy. In total, 767 patients (79.3%) received carbapenems and 199 patients (20.6%) received BL/BLIs as definitive therapy, and there was again no statistically significant difference (RR, 0.62; 95% CI, 0.25–1.52; I2 = 84.6%; P < .001). Regarding specific pathogens, the use of empiric BL/BLIs in patients with BSI due to ESBL-Escherichia coli was not associated with a statistically significant difference in mortality (RR, 1.014; 95% CI, 0.491–2.095; I2 = 62.5%; P = .046), compared with the use of empiric carbapenems.Conclusions.These data do not support the wide use of carbapenems as empiric therapy, and BL/BLIs might be effective agents for initial/empiric therapy for patients with BSI caused by likely ESBL-PE, and especially ESBL-E coli.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Comparison Between Carbapenems and β-Lactam/β-Lactamase Inhibitors in the Treatment for Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: A Systematic Review and Meta-Analysis

Muhammed

Flokas

Detsis

et al. 2017

Open Forum Infectious Diseases

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“…When availability of resources is low, capacity to reach these demands is limited. In a situation like ours where antimicrobial stewardship could not be achieved, we would expect survival in BSI to depend on two things: treatment that is started before severe organ failure has developed, and pathogens that are susceptible to the antibiotic that is given empirically [ 23 ]. It is a tragedy, of course, if empirical treatment commonly fails in settings where resistance cannot be identified in time.…”

Section: Discussionmentioning

confidence: 99%

High Mortality from Blood Stream Infection in Addis Ababa, Ethiopia, Is Due to Antimicrobial Resistance

et al. 2015

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BackgroundManaging blood stream infection in Africa is hampered by lack of bacteriological support needed for antimicrobial stewardship, and background data needed for empirical treatment. A combined pro- and retrospective approach was used to overcome thresholds in clinical research in Africa.MethodsOutcome and characteristics including age, HIV infection, pancytopenia and bacteriological results were studied in 292 adult patients with two or more SIRS criteria using univariate and confirming multivariate logistic regression models. Expected randomly distributed resistance covariation was compared with observed co-resistance among gram-negative enteric bacteria in 92 paediatric blood culture isolates that had been harvested in the same hospital during the same period of time.ResultsMortality was fivefold increased among patients with positive blood culture results [50.0% vs. 9.8%; OR 11.24 (4.38–25.88), p < 0.0001], and for this group of patients mortality was significantly associated with antimicrobial resistance [OR 23.28 (3.3–164.4), p = 0.002]. All 11 patients with Enterobacteriaceae resistant to 3rd. generation cephalosporins died. Eighty-nine patients had pancytopenia grade 3–4. Among patients with negative blood culture results, mortality was significantly associated with pancytopenia [OR 3.12 (1.32–7.39), p = 0.01]. HIV positivity was not associated with increased mortality. Antimicrobial resistance that concerned gram-negative enteric bacteria, regardless of species, was characterized by co-resistance between third generation cephalosporins, gentamicin, chloramphenicol, and co-trimoxazole.ConclusionMortality was strongly associated with growth of bacteria resistant to empirical treatment, and these patients were dead or dying when bacteriological reports arrived. Because of co-resistance, alternative efficient antibiotics would not have been available in Ethiopia for 8/11 Enterobacteriaceae-infected patients with isolates resistant to third generation cephalosporins. Strong and significant resistance covariation between 3rd. generation cephalosporins, chloramphenicol, gentamicin, and co-trimoxazole was identified. Pronounced pancytopenia was common and associated with increased mortality. HIV positive patients had no excess mortality.

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“…Many studies tried to investigate the potential impact of bacteremic pneumonia due to a worse outcome. However, clinical studies of bacteremic pneumonia caused by ESBL producers are limited [8].…”

Section: Fatal Hemorrhagic Bacteremic Escherichia Coli Pneumonia In Nmentioning

confidence: 99%

Fatal Hemorrhagic Bacteremic Escherichia Coli Pneumonia in Neonate Post Cardiac Surgery

Hamadah¹,

Kabbani²

2018

J Med Imaging Case Rep

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Pneumonia is an important cause of neonatal infection with the potential of high morbidity and mortality, especially if complicated by blood-borne infection. We presented a fatal case with correlated radiological images of neonatal hemorrhagic bacteremic Escherichia coli pneumonia in cardiac patient post coarctation of aorta repair. The presentation was unusual with massive pulmonary hemorrhage and unilateral lung involvement leading to respiratory and hemodynamic failure that failed mechanical ventilator support and rescue extracorporeal membrane oxygenation (ECMO).

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Bacteremic pneumonia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Appropriateness of empirical treatment matters

Abstract: ESBL-producing bacteremic pneumonia, especially health-care-associated infections, often occurred in adults with comorbidities. Appropriate empirical therapy was associated with a favorable outcome.

Cited by 33 publications

References 35 publications

Comparison Between Carbapenems and β-Lactam/β-Lactamase Inhibitors in the Treatment for Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: A Systematic Review and Meta-Analysis

Comparison Between Carbapenems and β-Lactam/β-Lactamase Inhibitors in the Treatment for Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: A Systematic Review and Meta-Analysis

High Mortality from Blood Stream Infection in Addis Ababa, Ethiopia, Is Due to Antimicrobial Resistance

Fatal Hemorrhagic Bacteremic Escherichia Coli Pneumonia in Neonate Post Cardiac Surgery

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