Risk factors for bloodstream infection caused by extended-spectrum β-lactamase–producing Escherichia coli and Klebsiella pneumoniae: A focus on antimicrobials including cefepime

Chopra, Teena; Marchaim, Dror; Johnson, Paul C.; Chalana, Indu K.; Tamam, Zeinab; Mohammed, Mazin; Alkatib, Shatha; Tansek, Ryan; Chaudhry, Khawar; Zhao, Jing; Pogue, Jason M.; Kaye, Keith S.

doi:10.1016/j.ajic.2015.02.030

Cited by 34 publications

(30 citation statements)

References 16 publications

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“…In addition, we analyzed possible risk factors of mortality of https://icjournal.org https://doi.org/10.3947/ic.2020.52.1.59 cancer patients with KP bacteremia. Overall, our findings were similar to previous reports in which study populations were not limited to oncology patients [12][13][14][15][16][17]. Our finding that exposure to a third-generation cephalosporin was more frequently found in those with ESBL-KP bacteremia was consistent with previous reports [15,18,19].…”

Section: Discussionsupporting

confidence: 93%

Characteristics and Clinical Outcomes of Extended-Spectrum beta-lactamase-producingKlebsiella pneumoniaeBacteremia in Cancer Patients

et al. 2020

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Background: Cancer patients can be at a higher risk of infection due to drug-resistant bacteria than the general population for various reasons. We performed a retrospective study to evaluate possible risk factors and outcomes of extended-spectrum beta-lactamaseproducing Klebsiella pneumoniae (ESBL-KP) bacteremia in cancer patients. Materials and Methods: Cases were divided into two groups based on whether or not the isolated strain produced ESBL and multivariable regressions were done to identify possible risk factors of ESBL-KP bacteremia and mortality. For ESBL-producing strain, additional molecular analysis was done. Results: 278 cases with KP bacteremia were identified between 2010 and 2012, of which ESBLproducers were 50 (18%). The presence of percutaneous drainage catheter [odds ratio (OR) 4.99, P <0.001] and prior exposure to certain classes of antibiotics including third-generation cephalosporin (OR 2.14, P = 0.03) had significant associations with ESBL-KP bacteremia. Individuals who died within 14 days after the onset of KP bacteremia were more likely to have higher mean Pitt bacteremia score (1.56 in survival group vs. 3.43 in mortality group, P <0.001), hemodialysis (OR 17.03, P = 0.01) and chronic liver disease (OR 5.57, P = 0.01). Although 14-day mortality was higher with ESBL production (OR 2.76, P = 0.04), no significant differences in 30day mortality (OR 1.67, P = 0.20) and other morbidity indices were observed. 49 ESBL-KP isolates, 65.4% of them produced CTX-M-14 and CTX-M-15 enzymes, and ST711 was the most common. Conclusion: There were several differences in clinical characteristics between ESBL-KP and non-ESBL-KP bacteremia in cancer patients, similar to previous reports including non-cancer patients.

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Section: Discussionsupporting

confidence: 93%

Characteristics and Clinical Outcomes of Extended-Spectrum beta-lactamase-producingKlebsiella pneumoniaeBacteremia in Cancer Patients

et al. 2020

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“…Previous antibiotic therapy, especially the use of cephalosporins, has been consistently recognized as a risk factor for third-generation cephalosporin-resistant Enterobacteriaceae bacteremia in many studies [2, 3, 6, 23]. Our study also demonstrated a significant association between previous antibiotic use and CTXNS-En bacteremia in the univariate analysis.…”

Section: Discussionsupporting

confidence: 74%

Clinical and microbiologic characteristics of cefotaxime-non-susceptible Enterobacteriaceae bacteremia: a case control study

et al. 2017

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BackgroundCefotaxime plays an important role in the treatment of patients with bacteremia due to Enterobacteriaceae, although cefotaxime resistance is reported to be increasing in association with extended-spectrum β-lactamase (ESBL) and AmpC β-lactamase (AmpC).MethodsWe conducted a case-control study in a Japanese university hospital between 2011 and 2012. We assessed the risk factors and clinical outcomes of bacteremia due to cefotaxime-non-susceptible Enterobacteriaceae (CTXNS-En) and analyzed the resistance mechanisms.ResultsOf 316 patients with Enterobacteriaceae bacteremia, 37 patients with bacteremia caused by CTXNS-En were matched to 74 patients who had bacteremia caused by cefotaxime-susceptible Enterobacteriaceae (CTXS-En). The most common CTXNS-En was Escherichia coli (43%), followed by Enterobacter spp. (24%) and Klebsiella spp. (22%). Independent risk factors for CTXNS-En bacteremia included previous infection or colonization of CTXNS-En, cardiac disease, the presence of intravascular catheter and prior surgery within 30 days. Patients with CTXNS-En bacteremia were less likely to receive appropriate empirical therapy and to achieve a complete response at 72 h than patients with CTXS-En bacteremia. Mortality was comparable between CTXNS-En and CTXS-En patients (5 vs. 3%). CTXNS-En isolates exhibited multidrug resistance but remained highly susceptible to amikacin and meropenem. CTX-M-type ESBLs accounted for 76% of the β-lactamase genes responsible for CTXNS E. coli and Klebsiella spp. isolates, followed by plasmid-mediated AmpC (12%). Chromosomal AmpC was responsible for 89% of CTXNS Enterobacter spp. isolates.ConclusionsCTXNS-En isolates harboring ESBL and AmpC caused delays in appropriate therapy among bacteremic patients. Risk factors and antibiograms may improve the selection of appropriate therapy for CTXNS-En bacteremia. Prevalent mechanisms of resistance in CTXNS-En were ESBL and chromosomal AmpC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2150-6) contains supplementary material, which is available to authorized users.

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“…Extensive use of expanded-spectrum antibiotics including β-lactams is one of the most important risk factors associated with high prevalence of ESBLs (Chopra et al, 2015;Shukla et al, 2004;Oteo et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae clinical isolates in a Senegalese teaching hospital: A cross sectional study

Camara¹,

Mane²,

Ba-Diallo³

et al. 2017

Afr. J. Microbiol. Res.

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Extended spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE) have been increasingly reported worldwide. The objective of this study is to determine the prevalence of these multidrug-resistant strains in a major university teaching hospital in Dakar, Senegal. A total of 1205 Enterobacteriaceae stains were tested for ESBL and carbapenemase production. Antibiotics susceptibility test was performed with disk diffusion method. ESBL was detected using a double-disk synergy method. Carbapenemase production was detected with ertapenem 10 µg disk charge. The overall prevalence of ESBL-and carbapenemase-producing Enterobacteriaceae was 26.2 (316/1205) and 5.1% (62/1205), respectively. Interestingly, 3.8% of these pathogens were both ESBL-carbapenemase producers. Among the Enterobacteriaceae ESBL positive, Escherichia coli (45.2%, 143/316), Klebsiella pneumoniae (26.3%, 83/316), Enterobacter cloacae (12.7%, 40/316), and Proteus vulgaris (9.2%, 29/316) were the most prevalent. These strains were mainly isolated from urine (56.6%) and pus (22.7%) specimen. The most prevalent CPEs were E. coli (45.2%, 28/62), K. pneumoniae (27.4%, 17/62), and E. cloacae (16.1%, 10/62), particularly isolated from urine (58%) and pus (19.3%). The majority of these MDR strains were isolated from patients hospitalized in urology (32.4%), surgery (27.7%), internal medicine (18.5%), and intensive care units (10%). ESBL-producing Enterobacteriaceae remain highly susceptible to fosfomycin (94.1%), amikacin (92.5%) and ertapenem (88.6%), while carbapenemase producers were fully susceptible to amikacin (100%), and to a lesser extent, fosfomycin (66.7%) and colistin (60%). This study revealed increasing prevalence of ESBL-and carbapenemase-producing Enterobacteriaceae with limited therapeutic options, suggesting a need for continuous multi-drug resistant (MDR) surveillance patterns particularly in hospital settings.

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Risk factors for bloodstream infection caused by extended-spectrum β-lactamase–producing Escherichia coli and Klebsiella pneumoniae: A focus on antimicrobials including cefepime

Cited by 34 publications

References 16 publications

Characteristics and Clinical Outcomes of Extended-Spectrum beta-lactamase-producingKlebsiella pneumoniaeBacteremia in Cancer Patients

Characteristics and Clinical Outcomes of Extended-Spectrum beta-lactamase-producingKlebsiella pneumoniaeBacteremia in Cancer Patients

Clinical and microbiologic characteristics of cefotaxime-non-susceptible Enterobacteriaceae bacteremia: a case control study

Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae clinical isolates in a Senegalese teaching hospital: A cross sectional study

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