Bloodstream Infections Due to Extended-Spectrum β - Lactamase-Producing Escherichia coli and Klebsiella pneumoniae : Risk Factors for Mortality and Treatment Outcome, with Special Emphasis on Antimicrobial Therapy

Abstract

This study was conducted to evaluate risk factors for mortality and treatment outcome of bloodstream infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK). ESBL production in stored K. pneumoniae and E. coli blood isolates from Jan 1998 to Dec 2002 was phenotypically determined according to NCCLS guidelines and/or the double-disk synergy test. A total of 133 patients with ESBL-EK bacteremia, including 66 patients with ESBL-producing K. pneumoniae and 67 with ESBL-producing E. coli, were enrolled. The overall 30-day mortality rate was 25.6% (34 of 133). Independent risk factors for mortality were severe sepsis, peritonitis, neutropenia, increasing Acute Physiology and Chronic Health Evaluation II score, and administration of broad-spectrum cephalosporin as definitive antimicrobial therapy (P < 0.05 for each of these risk factors). In 117 of the 133 patients, excluding 16 patients who died within 3 days after blood culture sample acquisition, the 30-day mortality rates according to definitive antibiotics were as follows: carbapenem, 12.9% (8 of 62); ciprofloxacin, 10.3% (3 of 29); and others, such as cephalosporin or an aminoglycoside, 26.9% (7 of 26). When patients who received appropriate definitive antibiotics, such as carbapenem or ciprofloxacin, were evaluated, mortality in patients receiving inappropriate empirical antimicrobial therapy was found not to be significantly higher than mortality in those receiving appropriate empirical antimicrobial therapy (18.9 versus 15.5%; P ‫؍‬ 0.666). Carbapenem and ciprofloxacin were the most effective antibiotics in antimicrobial therapy for ESBL-EK bacteremia. A delay in appropriate definitive antimicrobial therapy was not associated with higher mortality if antimicrobial therapy was adjusted appropriately according to the susceptibility results. Our data suggest that more prudent use of carbapenem as empirical antibiotic may be reasonable.

Evaluation of the New VITEK 2 Extended-Spectrum Beta-Lactamase (ESBL) Test for Rapid Detection of ESBL Production in Enterobacteriaceae Isolates

“…Kang et al (19) maintain that delays in starting appropriate therapy have no significant effect on the outcome of ESBL bloodstream infections if therapy is promptly adjusted in accordance with in vitro susceptibility data. Therefore, these data must be reported to the physician as soon as possible, especially in high-risk cases.…”

Carriage of Class 1 and 2 Integrons in Quinolone, Extended-Spectrum-β-Lactamase-Producing and Multi Drug Resistant E.coli and K.pneumoniae: High Burden of Antibiotic Resistance

“…Similar reports are available which supports this finding. [26][27][28] Though these two bacteria are leading cause of clinical infections in hospital as well as community based patients, 9 however, increasing trend of antimicrobial resistance is a serious concern which has tempered the therapeutic options. Forty five (31.91%) of E.coli (34/110; 30.9%) and K.pneumoniae (11/31; 35.4%) obtained from urine specimens were resistant to nalidixic acid and those | 339…”

Gram-negative superbugs: inappropriate antimicrobial therapy and mortality

“…producing Escherichia coli and K. pneumoniae and investigated risk factors for mortality and also highlighted antimicrobial therapy [3]. The overall risk for 30-day mortality was approximately 26%; approximately 32% for those with K. pneumoniae and approximately 19% for those with E. coli.…”