Hostname: page-component-745bb68f8f-l4dxg Total loading time: 0 Render date: 2025-01-09T22:49:41.178Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

Published online by Cambridge University Press:  02 January 2015

Cheol-In Kang ,
Sung-Han Kim ,
Dong Min Kim ,
Wan Beom Park ,
Ki-Deok Lee ,
Hong-Bin Kim ,
Myoung-don Oh ,
Eui-Chong Kim  and
Kang-Won Choe
Cheol-In Kang
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Sung-Han Kim
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Dong Min Kim
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Wan Beom Park
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Ki-Deok Lee
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Hong-Bin Kim
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Myoung-don Oh*
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
Eui-Chong Kim
Affiliation:
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
Kang-Won Choe
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
*
Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong Chongno-gu, Seoul 110-744, Republic of Korea
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate risk factors and treatment outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP).

Design:

Retrospective case-control study. Stored blood isolates of K. pneumoniae were 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:

For K. pneumoniae bacteremia, 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.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 10 , October 2004 , pp. 860 - 867
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Tsay, RW, Siu, LK, Fung, CP, Chang, FY. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factors for mortality and the impact of capsular serotypes as a herald for community-acquired infection. Arch Intern Med 2002;162:1021–1027.Google Scholar
2. Watanakunakorn, C, Jura, J. Klebsiella bacteremia: a review of 196 episodes during a decade (1980-1989). Scand J Infect Dis 1991;23:399–405.Google Scholar
3. Bush, K. New beta-lactamases in gram-negative bacteria: diversity and impact on the selection of antimicrobial therapy. Clin Infect Dis 2001;32:1085–1089.Google Scholar
4. Jacoby, GA, Medeiros, AA. More extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1991;35:1697–1704.Google Scholar
5. Knothe, H, Shah, P, Krcmery, V, Antal, M, Mitsuhashi, S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens . Infection 1983;11:315–317.Google Scholar
6. Burwen, DR, Banerjee, SN, Gaynes, RP. Ceftazidime resistance among selected nosocomial gram-negative bacilli in the United States. J Infect Dis 1994;170:1622–1625.Google Scholar
7. Itokazu, GS, Quinn, JP, Bell-Dixon, C, Kahan, FM, Weinstein, RA. Antimicrobial resistance rates among aerobic gram-negative bacilli recovered from patients in intensive care units: evaluation of a national postmarketing surveillance program. Clin Infect Dis 1996;23:779–784.10.1093/clinids/23.4.779Google Scholar
8. Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:1162–1171.10.1086/319757Google Scholar
9. Meyer, KS, Urban, C, Eagen, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353–358.10.7326/0003-4819-119-5-199309010-00001Google Scholar
10. Pena, C, Pujol, M, Ardanuy, C, et al. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1998;42:53–58.Google Scholar
11. Schiappa, DA, Hayden, MK, Matushek, MG, et al. Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a case-control and molecular epidemiologic investigation. J Infect Dis 1996;174:529–536.Google Scholar
12. Kim, YK, Pai, HJ, Lee, HJ, et al. Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 2002;46:1481–1491.Google Scholar
13. Wong-Beringer, A, Hindler, J, Loeloff, M, et al. Molecular correlation for the treatment outcomes in bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae with reduced susceptibility to ceftazidime. Clin Infect Dis 2002;34:135–146.Google Scholar
14. Paterson, DL, Ko, WC, Von Gottberg, A, et al. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum beta-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol 2001;39:2206–2212.Google Scholar
15. Eisenstein, BI, Zaleznik, DE Enterobacteriaceae. In: Mandeli, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases, ed. 5. Philadelphia: Churchill Livingstone; 2000:2294–2310.Google Scholar
16. Jorgensen, JH, Turnidge, JD, Washington, JA. Antibacterial susceptibility tests: dilution and disk diffusion methods. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology, ed. 7. Washington, DC: American Society for Microbiology; 1999.Google Scholar
17. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002. Approved standard M100-S12.Google Scholar
18. Tzelepi, E, Giakkoupi, P, Sofianou, D, Loukova, V, Kemeroglou, A, Tsakris, A. Detection of extended-spectrum beta-lactamases in clinical isolates of Enterobacter cloacae and Enterobacter aerogenes . J Clin Microbiol 2000;38:542–546.Google Scholar
19. Thomson, KS, Sanders, CC. Detection of extended-spectrum beta-lactamases in members of the family Enterobacteriaceae: comparison of the double-disk and three-dimensional tests. Antimicrob Agents Chemother 1992;36:1877–1882.Google Scholar
20. Tenover, FC, Raney, PM, Williams, PP, et al. Evaluation of the NCCLS extended-spectrum beta-lactamase confirmation methods for Escherichia coli with isolates collected during Project ICARE. J Clin Microbiol 2003;41:3142–3146.10.1128/JCM.41.7.3142-3146.2003Google Scholar
21. Steward, CD, Rasheed, JK, Hubert, SK, et al. Characterization of clinical isolates of Klebsiella pneumoniae from 19 laboratories using the National Committee for Clinical Laboratory Standards extended-spectrum beta-lactamase detection methods. J Clin Microbiol 2001;39:2864–2872.Google Scholar
22. Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
23. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
24. Blot, S, Vandewoude, K, De Bacquer, D, Colardyn, F. Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clin Infect Dis 2002;34:1600–1606.Google Scholar
25. Emery, CL, Weymouth, LA. Detection and clinical significance of extended-spectrum beta-lactamases in a tertiary-care medical center. J Clin Microbiol 1997;35:2061–2067.Google Scholar
26. Karas, JA, Pillay, DG, Muckart, D, Sturm, AW. Treatment failure due to extended spectrum beta-lactamase. J Antimicrob Chemother 1996;37:203–204.Google Scholar
27. Thomson, KS, Moland, ES. Cefepime, piperacillin-tazobactam, and the inoculum effect in tests with extended-spectrum beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2001;45:3548–3554.Google Scholar