Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum β-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence

Marra, Alexandre R.; Wey, Sérgio Barsanti; Castelo, Adauto; Gales, Ana Cristina; Cal, Ruy Guilherme Rodrigues; Filho, José Rodrigues do Carmo; Edmond, Michael B.; Pereira, Carlos Alberto Pires

doi:10.1186/1471-2334-6-24

Cited by 104 publications

(80 citation statements)

References 29 publications

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“…Furthermore, review of literature shows that hospitalization for a long period of time is a risk factor for the isolation of various highly resistant organisms [18,[25][26][27]. In our study, while prolonged hospitalization was a risk factor for bacteraemia due to a MDR ESBL-EK, APECHE II score, used to assess severity of the patients, was not.…”

Section: Discussionmentioning

confidence: 40%

Bloodstream infections caused by ESBL-producing E. Coli and K. pneumoniae: risk factors for multidrug-resistance

Şerefhanoğlu¹,

Turan²,

Timurkaynak³

et al. 2009

Braz J Infect Dis

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to evaluate risk factors for multidrug resistance among extended-spectrum-b-lactamase-producing Escherichia coli and Klebsiella spp. (ESBL-EK) isolates in blood cultures. All adult patients (≥18 years old) whose blood cultures grew ESBL-EK during the study period were included. An ESBL-EK isolate was defined as MDR if it was resistant to at least one member of following two classes of antibiotics: aminoglycosides (amikacin, gentamicin, or netilmycin) and fluoroquinolones (ofloxacin, or ciprofloxacin). Case patients were those with a MDR ESBL-EK isolate, and control patients were those with a non-MDR ESBL-EK isolate. A total of 94 bloodstream infections, including 37 (39,4%) bloodstream infections with ESBL-producing E. coli and 57 (60,6%) with ESBL-producing K. pneumoniae, in 86 patients were enrolled. Thirty episodes (31.9%) were due to MDR ESBL-EK. The only independent risk factor for MDR ESBL-EK was duration of hospitalization before bacteraemia (OR 3.88; 95% CI 1.55-9.71; p=0.004). The rate of multidrug resistance among ESBL-EK bloodstream isolates was high, and duration of hospitalization before bacteraemia was the only indeepended risk factor for the MDR ESBL-EK bloodstream infections.

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Section: Discussionmentioning

confidence: 40%

Bloodstream infections caused by ESBL-producing E. Coli and K. pneumoniae: risk factors for multidrug-resistance

Şerefhanoğlu¹,

Turan²,

Timurkaynak³

et al. 2009

Braz J Infect Dis

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“…The role of antibiotics use has been emphasized as the leading risk factor associated with ESBLproducing organisms [2,11,16,17]. Although some studies did not maintain that association, recent data supports the hypothesis that previous use of antibiotics is one of the significant factors.…”

Section: Discussionsupporting

confidence: 57%

Epidemiology and risk factors for ESBL-producing Klebsiella pneumoniae: a case control study

Demirdag

Hoşoğlu

2010

J Infect Dev Ctries

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Introduction: Increased production of extended-spectrum β-lactamases (ESBLs) has become an important issue for treatment of severe Klebsiella pneumoniae (K. pneumoniae) infections. This study aimed to evaluate risk factors of infection from ESBLproducing K. pneumoniae (ESBL-KP). Methodology: Risk factors were evaluated using a retrospective case control design. Fifty-two patients admitted to Firat University Hospital (FUH) with invasive infections from ESBL-KP were employed as cases. Patients admitted to FUH with non-ESBL-producing K. pneumoniae invasive infection were chosen as controls. Potential risk factors of the cases and controls were evaluated using hospital charts. Pulsed-field Gel Electrophoresis (PFGE) was used to show the relatedness of ESBL-KP strains. Results: In univariate analysis, the following factors were found significant for ESBL-KP: pre-infection hospital stay, nosocomial origin, central venous catheterization, surgical intervention, antibiotic use longer than one week, and previous hospitalization. In contrast, stepwise logistic regression analysis showed that two variables, previous antibiotic use (p = 0.000) and surgical intervention (p = 0.006), remained significantly associated with risk for infection with an ESBL-KP. Molecular epidemiology identified several clusters among the ESBL-producing isolates. Conclusions: Antibiotic use and surgical intervention were significant associated factors for infections with ESBL-KP.

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“…This risk factor had not been confirmed previously. 12,13 In our hospital, cefepime is commonly used for the treatment of severe community pneumonia at the emergency room. The use of cefepime is a modifiable risk factor, and restriction of cefepime use could be an approach to decrease ESBL-KP in our institution.…”

Section: Discussionmentioning

confidence: 99%

Klebsiella ESBL bacteremia-mortality and risk factors

Tuon¹,

Kruger²,

Terreri³

et al. 2011

Braz J Infect Dis

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Background: Extended spectrum β-lactamase (ESBL)-producing bacteria have become recognized as a problem in South America. The aim of this study was to evaluate risk factors and mortality rate in bacteremia caused by ESBL-producing Klebsiella pneumoniae in a Brazilian hospital. Methods: A three-year retrospective cohort study with 104 cases of K. pneumoniae bacteremia (61 ESBL and 43 non-ESBL). Several clinical and laboratory variables were evaluated. The outcome of interest was 30-day mortality. The adequate treatment was evaluated according to antibiotic susceptibility. Results: Multivariable analysis showed that central venous catheter and mechanical ventilation were independent risk factors for ESBL. The duration of hospitalization before the bacteremia was not a risk factor. Mortality was similar in ESBL and non-ESBL and inadequate therapy was not shown to be a risk factor. Conclusion: ESBL-producing Klebsiella bacteremia can occur early, suggesting that a carbapenem should be included in the initial empirical therapy for bacteremia in patients under mechanical ventilation and/or central venous catheter in our institution.

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Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum β-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence

Abstract: Background: The frequency of ESBL producing Klebsiella pneumoniae bloodstream infections (BSI) is high in Brazilian hospitals, however little is known regarding what role, if any, resistance plays in the expected outcome in hospitals with a high prevalence of these pathogens.

Cited by 104 publications

References 29 publications

Bloodstream infections caused by ESBL-producing E. Coli and K. pneumoniae: risk factors for multidrug-resistance

Bloodstream infections caused by ESBL-producing E. Coli and K. pneumoniae: risk factors for multidrug-resistance

Epidemiology and risk factors for ESBL-producing Klebsiella pneumoniae: a case control study

Klebsiella ESBL bacteremia-mortality and risk factors

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