Comparison of Predictors and Mortality Between Bloodstream Infections Caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae

Abstract

OBJECTIVETo compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypesMETHODSAs part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.RESULTSThe study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non-CTX-M ESBLs were detected.CONCLUSIONSClinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.CLINICAL TRIALS IDENTIFIERClinicalTrials.gov. Identifier: NCT01764490.Infect Control Hosp Epidemiol 2018;39:660-667.

Screening for Intestinal Carriage of Extended-spectrum Beta-lactamase–producing Enterobacteriaceae in Critically Ill Patients: Expected Benefits and Evidence-based Controversies

“…One may suggest that patients colonized with ESBL-producing K. pneumoniae or Enterobacter spp. differ from those carrying ESBL-producing E. coli in terms of comorbidities and prior contacts with the healthcare system [12,13]. This could reflect more requirements for nursing care and invasive procedures, as well as more frequent antimicrobial exposure (that is, a more severe intestinal dysbiosis, with a higher faecal relative abundance of ESBL-E), resulting in an increase in the probability of cross-transmission events.…”

Analysis of blood stream infections: Antimicrobial susceptibility and associated types of extended spectrum β-lactamases

“…High resistance such as was seen in the ESBL-KP and EBLS-EC BSIs in the present investigation indicates that there could be limited treatment options available to clinicians in healthcare settings [11]. Reports by the infectious Disease Society of America [25] listed ESBL-KP and ESBL-EC among the six MDR bacteria to which there is a need for urgent treatment options.…”

Treatment of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLs) infections: what have we learned until now?

“…Of utmost importance is to clearly characterize (a) the isolate with the in vitro susceptibilities, (b) the location of the infection, (c) the degree of source control of the infection, and finally (d) the clinical condition of the patient ( Table 1). In addition, recently published studies propose that all ESBL-PE do not belong in the same homogenous group as far as comorbidities, presentation, and outcome are concerned 6 . In particular, data have shown that bloodstream infections (BSIs) associated with ESBL-producing E. coli were more frequently of a urinary source and community onset compared with BSIs with ESBL-producing Klebsiella spp.…”

“…In particular, data have shown that bloodstream infections (BSIs) associated with ESBL-producing E. coli were more frequently of a urinary source and community onset compared with BSIs with ESBL-producing Klebsiella spp. 6 .…”