Risk factors for and mortality of extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli nosocomial bloodstream infections

Abstract

SUMMARYA case-control study, involving patients with positive blood cultures for Klebsiella pneumoniae (KP) or Escherichia coli (EC) EC and controls with positive blood cultures for non-ESBL-KP or EC, was performed to assess risk factors for extended-spectrum-blactamase (ESBL) production from nosocomial bloodstream infections (BSIs). Mortality among patients with BSIs was also assessed. The study included 145 patients (81, 59.5% with K. pneumoniae and 64, 44.1% with E. coli BSI); 51 (35.2%) isolates were ESBL producers and 94 (64.8%) nonproducers. Forty-five (55.6%) K. pneumoniae isolates were ESBL producers, while only six (9.4%) E. coli isolates produced the enzyme. Multivariate analysis showed that recent exposure to piperacillin-tazobactam (adjusted Odds Ratio [aOR] 6.2; 95%CI 1.1-34.7) was a risk factor for ESBL BSI. K. pneumoniae was significantly more likely to be an ESBL-producing isolate than E. coli (aOR 6.7; 95%CI 2.3-20.2). No cephalosporin class was independently associated with ESBLs BSI; however, in a secondary model considering all oxymino-cephalosporins as a single variable, a significant association was demonstrated (aOR 3.7; 95%CI 1.3-10.8). Overall 60-day mortality was significantly higher among ESBL-producing organisms. The finding that piperacillintazobactam use is a risk factor for ESBL-production in KP or EC BSIs requires attention, since this drug can be recommended to limit the use of third-generation cephalosporins.

Nosocomial infection and characterization of extended-spectrum β-lactamases-producing Enterobacteriaceae in Northeast Brazil

“…In this study, 37.5% (63/168) of the K. pneumoniae strains were producers of ESBLs, which supports similar results in other studies 18 . A frequency of approximately 50% is observed in Brazil, versus 5% in the United States and Japan, 15-20% in Europe, and 20-50% in Asian countries 6,13,19,20 .…”

“…Similar results have been reported in members of the family Enterobacteriaceae 7,13,18,19 and in a multicenter study investigating bacterial resistance in Brazilian hospitals 6 . In contrast, E. coli was found to be the most prevalent ESBL-producing microorganism in Saudi Arabia 1 , France 16 and Italy 15 .…”

Caracterización clínica y molecular de bacteriemias causadas por enterobacterias productoras de β -lactamasas de espectro extendido: 2004-2007

“…Las bacterias productoras de BLEE causan distintos tipos de infecciones, incluyendo bacteriemias. Éstas se asocian a un aumento de dos a tres veces en la mortalidad global y de 1,7 veces en la mortalidad relacionada a la infección [5][6][7][8][9] . También se asocian a sepsis grave persistente 10 , aumento de l os dí as de hospitalización, retardo en el inicio del tratamie nto apropiado, fracaso ter apéutico y mayores costos en salud 11 .…”

“…También se asocian a sepsis grave persistente 10 , aumento de l os dí as de hospitalización, retardo en el inicio del tratamie nto apropiado, fracaso ter apéutico y mayores costos en salud 11 . Se han descrito factores de riesgo para la presencia de BLEE en bacteriemias por enterobacterias: uso previo de antimicrobianos (especialmente cefalosporinas de 3ª generación), patologías crónicas, neutropenia, shock séptico, hospitalizaciones recientes y procedimientos invasores 6,[8][9][10][12][13][14][15][16] . El uso previo de antimicrobianos y el tratamiento inicial inapropiado han de mos tra do ser predictores independientes de mortalidad [17][18][19] .…”

RESISTENSI <em>Klebsiella</em> sp TERHADAP MEROPENEM DI RSUD PROF. DR. MARGONO SOEKARJO PURWOKERTO

“…merupakan patogen utama di rumah sakit terkait dengan meningkatnya insidensi bakteri penghasil extended spectrum β-lactamase (ESBL) (Superti et al, 2009), dan dapat menginfeksi pasien yang menjalani rawat inap dalam waktu lama (Ludden et al, 2015). Bakteri penghasil ESBL berperan penting pada tingginya kejadian infeksi nosokomial di rumah sakit.…”