Background:This study was performed to characterize the clinical features and to identify the risk factors for resistance to extended-spectrum cephalosporins (ESCs) and for mortality in patients with Citrobacter freundii bacteremia. Patients and Methods: 105 patients (aged ≥ 15 years) with C. freundii bacteremia in 1991-2000 were retrospectively analyzed. Results: Nosocomial acquisition was identified in 78.1% of the patients. Hepatic, biliary and pancreatic disease was the most common underlying disease (65.7%) and the biliary tract was the most common site of infection (50.5%). The overall resistance rate to ESCs was 59.0% and was significantly associated with hepatic, biliary and pancreatic disease, recent surgery and procedure, biliary drainage catheter and previous antibiotic therapy in univariate analysis. However, only previous antibiotic therapy with ESCs (OR = 5.0, 95% CI 1.6-15.7, p = 0.006) and recent surgery or procedure (OR = 3.1, 95% CI 1.1-8.4, p = 0.03) were strong, independent risk factors in multivariate analysis. Mortality directly related to C. freundii bacteremia was 21.9% and there was no difference between cases with resistance and susceptibility to ESCs (19.4% vs 25.6%; p = 0.45). Mortality was significantly associated with rapidly fatal or ultimately fatal underlying disease, a solid tumor, septic shock and polymicrobial bacteremia in univariate analysis. Among patients who had therapeutic surgical procedures, mortality was lower (4.5%, p = 0.04). Multivariate analysis revealed rapidly or ultimately fatal disease, septic shock and polymicrobial bacteremia as independent prognostic factors.
The clinical implication of extended-spectrum cephalosporin (ESC) resistance has been unclear in patients with Streptococcus pneumoniae meningitis (SPM). We collected the clinical data of 120 patients with SPM in 12 hospitals of the Republic of Korea. The clinical characteristics and outcomes of 23 ESC-nonsusceptible SPM episodes were compared to those of 97 ESC-susceptible episodes. Hospital acquisition, presence of other foci of pneumococcal infection, septic shock at initial presentation, or concomitant bacteremia were more commonly observed in ESC-nonsusceptible than ESC-susceptible SPM. Empiric antimicrobial therapy with vancomycin and ESC combination was very common in both groups. Although there was a tendency towards higher early fatality in ESC-nonsusceptible SPM (3-day mortality; 17.4 % vs. 4.4 %, p = 0.05), in-hospital mortality (26.1 % vs. 20.9 %, p = 0.59) and median length of hospital stay (20 days vs. 24 days, p = 0.34) did not differ between ESC-nonsusceptible and ESC-susceptible SPM.
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