Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Abstract

The objective of this study was to identify risk factors for bacteremia by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective casecontrol study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5% vs 17%, p < 0.001). Binary logistic regression showed that the number (> 2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR = 2.29, 95% CI 1.35-3.88, p = 0.002). Conclusion: Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.

Risk factors for bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli in a Turkish hospital

“…Although elongated intensive care unit stay is commonly a risk factor for nosocomial infections due to multidrug resistant microorganisms such as Acinetobacter baumannii and ESBL-producing Escherichia coli, our results were not consistent with this [9,10] and may be explained by short duration of stay in intensive care unit by our patients.…”

Antibiotic prescriptions in critically-ill patients: A Latin American experience

“…In one-third of the patients, broad-spectrum cephalosporins or fluoroquinolones were used, both of which are in close relationship with the selection of MDR microorganisms; mainly, ESBL-producing Gram-negatives, the microorganisms most frequently isolated in our study. [1819]…”

Rapid molecular detection of extended-spectrum β-lactamase gene variants with a novel ligation-mediated real-time PCR

“…The ability to detect transmissible antibiotic resistance, responsible for increased morbidity and mortality and prolonged hospital stays, one day earlier could positively influence the effectiveness of infection control (KluytmansVandenbergh et al, 2005;Quirante et al, 2011;Song et al, 2009). Rapid laboratory detection is necessary to take appropriate infection control measures, according to the Dutch guidelines for preventing nosocomial transmission of highly resistant micro-organisms.…”

“…Moreover, detection is often associated with amino acid substitutions, resulting in high variations in different ESBL types (Bradford, 2001;Cohen Stuart et al, 2010). However, because of the emergence of ESBLs, rapid and adequate detection of the most common ESBLs is crucial for infection control measures as well as for the choice of correct antimicrobial therapy (Quirante et al, 2011;Song et al, 2009). Several DNA-based ESBL assays that might meet these demands have already been evaluated, comprising standard PCR (Dallenne et al, 2010;Voets et al, 2011) and/or microarray analysis (Cohen Stuart et al, 2010;Endimiani et al, 2010;Nijhuis et al, 2011).…”