Clinical characteristics of bacteraemia caused by extended-spectrum β-lactamase-producing Enterobacteriaceae in the era of CTX-M-type and KPC-type β-lactamases

Abstract

A multicenter, case-control study was conducted to assess risk factors and patient outcomes from bacteremia due to Enterobacteriaceae producing extended-spectrum β-lactamases (ESBL) and Klebsiella pneumoniae carbapenemases (KPCs). One hundred five and 20 patients with bacteremia due to ESBL and KPC-producing organisms were matched to controls that had bacteremia with non-ESBL/KPC-producing organisms, respectively. Independent risk factors for ESBL production included admission from a nursing home (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.64–8.16), chronic renal failure (OR, 2.09; 95% CI, 1.11–3.92), the presence of a gastrostomy tube (OR, 3.36; 95% CI, 1.38–8.18), length of hospital stay before infection (OR, 1.02; 95% CI, 1.01–1.03), transplant recipients (OR, 2.48; 95% CI, 1.24–4.95) and receipt of antibiotics with Gram-negative activity in the preceding 30 days (OR, 1.76; 95% CI, 1.00–3.08). 28-day crude mortality rates for patients infected with ESBL or KPC-producing organisms and controls were 29.1% (34/117) and 19.5% (53/272), respectively (OR 1.70; 95% CI 1.04–2.80). On multivariate analysis, inadequate empiric therapy (OR, 2.26; 95% CI, 1.18–4.34), onset of bacteremia while in ICU (OR, 2.74; 95% CI, 1.47–5.11), Apache II score (OR, 1.17; 95% CI, 1.12–1.23), and malignancy (OR, 2.66; 95% CI, 1.31–5.41) were independent risk factors for mortality. CTX-M was the most common ESBL type in E. coli, whereas SHV predominated in Klebsiella spp. and Enterobacter spp.

Molecular and Epidemiological Characterization of IMP-Type Metallo-β-Lactamase-Producing Enterobacter cloacae in a Large Tertiary Care Hospital in Japan

“…To the best of our knowledge, this is the first study to systematically elucidate independent risk factors for the isolation of IMP-producing E. cloacae. For the risk factor analyses, we carefully included risk factors known to be associated with the isolation of multidrug-resistant Enterobacteriaceae species (28)(29)(30). In addition, two individuals (an infectious diseases specialist and an infection preventionist) independently reviewed the patients' medical records and visited each ward as often as possible to rule out any common source of infection other than those included in the risk factor analyses.…”

Częstość zakażeń i kolonizacji Klebsiella pneumoniae izolowanych od chorych leczonych na oddziale anestezjologii i intensywnej terapii

“…Znanych jest ponad 300 wariantów beta-laktamaz ESBL [13]. Najczęściej izolowane są szczepy gatunków z rodziny Enterobacteriaceae wytwarzające beta-laktamazy typu ESBL z rodzin: CTX-M, TEM i SHV [14]. Szczepy wytwarzające beta--laktamazy CTX-M dominują w Europie, Kanadzie, Ameryce Południowej i Azji [14−16].…”

The Combination of Doripenem and Colistin Is Bactericidal and Synergistic against Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae

“…nfections with carbapenemase-producing Klebsiella pneumoniae (KPC) are emerging causes of morbidity and mortality at institutions worldwide (2,11,(14)(15)(16). KPC isolates are defined by resistance to carbapenems and are generally resistant to most other antimicrobial classes.…”