Risk factors associated with extended-spectrum β-lactamase-producing organisms at a tertiary care hospital

Graffunder, Eileen; Preston, Karen E.; Evans, Ann M.; Venezia, Richard A.

doi:10.1093/jac/dki180

Cited by 77 publications

(65 citation statements)

References 30 publications

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“…This is not surprising, since most of our MDR Gram-negative isolates were enterobacteria-producing ESBL, a mechanism of resistance that may be induced by the exposure to this class of antibiotics. [28][29][30] The other risk factor for MDR Gram-negative bacteremia found in the present study was being at a specific HSCT center. Interestingly, in that particular center no patient was exposed to third-generation cephalosporins.…”

Section: S R Nt S R Nt S R Nt S R Nt S R Nt S R Ntmentioning

confidence: 68%

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Oliveira

Souza

Carvalho-Dias

et al. 2007

Bone Marrow Transplant

151

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The incidence of Gram-negative bacteremia has increased in hematopoietic stem cell transplant (HSCT) recipients. We prospectively collected data from 13 Brazilian HSCT centers to characterize the epidemiology of bacteremia occurring early post transplant, and to identify factors associated with infection due to multi-drug-resistant (MDR) Gram-negative isolates. MDR was defined as an isolate with resistance to at least two of the following: third-or fourth-generation cephalosporins, carbapenems or piperacillin-tazobactam. Among 411 HSCT, fever occurred in 333, and 91 developed bacteremia (118 isolates): 47% owing to Gram-positive, 37% owing to Gram-negative, and 16% caused by Gram-positive and Gram-negative bacteria. Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (19%) and Escherichia coli (17%) accounted for the majority of Gram-negative isolates, and 37% were MDR. These isolates were recovered from 20 patients, representing 5% of all 411 HSCT and 22% of the episodes with bacteremia. By multivariate analysis, treatment with third-generation cephalosporins (odds ratio (OR) 10.65, 95% confidence interval (CI) 3. 75-30.27) and being at one of the hospitals (OR 9.47, 95% CI 2.60-34.40) were associated with infection due to MDR Gram-negative isolates. These findings may have important clinical implications in the decision of giving prophylaxis and selecting the empiric antibiotic regimen.

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Section: S R Nt S R Nt S R Nt S R Nt S R Nt S R Ntmentioning

confidence: 68%

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Oliveira

Souza

Carvalho-Dias

et al. 2007

Bone Marrow Transplant

151

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“…Previous use of antimicrobial treatment has been one of the factors more extensively related to identification of ESBL-producing E. coli and K. pneumoniae in patients infected and/or colonized by these microorganisms. [7][8][9] Almost half of the case patients received delayed adequate antimicrobial treatment. Not considering the possibility of an ESBLproducing microorganisms isolation could be the cause of this delay.…”

mentioning

confidence: 99%

Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Quirante¹,

Cerrato²,

Pardos³

2011

Braz J Infect Dis

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The objective of this study was to identify risk factors for bacteremia by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective casecontrol study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5% vs 17%, p < 0.001). Binary logistic regression showed that the number (> 2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR = 2.29, 95% CI 1.35-3.88, p = 0.002). Conclusion: Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.

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“…Large nosocomial outbreaks caused by ESBL-producing gram-negative bacilli have been reported, with Escherichia coli and Klebsiella pneumoniae being the most frequently involved pathogens (10,15,18,27,28). Selective antibiotic pressure, particularly that caused by the intensive use of expandedspectrum cephalosporins and cross-transmission, has been associated with the emergence and dissemination of ESBLproducing members of the family Enterobacteriaceae (9,13).…”

mentioning

confidence: 99%

Nosocomial Outbreak Due to Extended-Spectrum-Beta-Lactamase- Producing Enterobacter cloacae in a Cardiothoracic Intensive Care Unit

et al. 2007

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Enterobacter cloacae has been associated with several outbreaks, usually involving strains that overproduce chromosomal ␤-lactamase or, uncommonly, strains expressing extended-spectrum ␤-lactamases (ESBL). Only sporadic cases of ESBL-producing E. cloacae have been identified in our hospital in recent years. We describe the epidemiology and clinical and microbiological characteristics of an outbreak caused by ESBL-producing E. cloacae in a cardiothoracic intensive care unit (CT-ICU). Prospective surveillance of patients with infection or colonization by ESBL-producing E. cloacae among patients admitted to the CT-ICU was performed during the outbreak. Production of ESBL was determined by decreased susceptibility to expanded-spectrum cephalosporins and a positive double-disk test result. Clone relatedness was determined by pulsed-field gel electrophoresis (PFGE). From July to September 2005, seven patients in the CT-ICU with ESBL-producing E. cloacae were identified (four males; median age, 73 years; range, 45 to 76 years); six patients had cardiac surgery. Four patients developed infections; three had primary bacteremia, one had ventilator-associated pneumonia, and one had tracheobronchitis. ESBLproducing E. cloacae showed resistance to quinolones and aminoglycosides. PFGE revealed two patterns.

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Risk factors associated with extended-spectrum β-lactamase-producing organisms at a tertiary care hospital

Cited by 77 publications

References 30 publications

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Nosocomial Outbreak Due to Extended-Spectrum-Beta-Lactamase- Producing Enterobacter cloacae in a Cardiothoracic Intensive Care Unit

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