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PMID: 16436702 Published · ppublish English Journal Article Research Support, Non-U.S. Gov't

Bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome.

Antimicrobial agents and chemotherapy ·Vol. 50 ·No. 2 ·2006-02-00 ·Pages 498-504

Tumbarello M, Spanu T, Sanguinetti M, Citton R, Montuori E, Leone F, Fadda G, Cauda R

Abstract

Bloodstream infections caused by extended-spectrum-beta-lactamase (ESBL)-producing Klebsiella pneumoniae isolates are a major concern for clinicians, since they markedly increase the rates of treatment failure and death. One hundred forty-seven patients with K. pneumoniae bloodstream infections were identified over a 5-year period (January 1999 to December 2003). The production of ESBLs in bloodstream isolates was evaluated by molecular methods. A retrospective case-case-control study was conducted to identify risk factors for the isolation of ESBL-producing K. pneumoniae or non-ESBL-producing K. pneumoniae isolates in blood cultures. Forty-eight cases infected with ESBL-producing K. pneumoniae isolates and 99 cases infected with non-ESBL-producing K. pneumoniae isolates were compared to controls. Risk factors for isolation of ESBL-producing K. pneumoniae isolates were exposure to antibiotic therapy (odds ratio [OR], 11.81; 95% confidence interval [CI], 2.72 to 51.08), age (OR, 1.14; 95% CI, 1.08 to 1.21), and length of hospitalization (OR, 1.10; 95% CI, 1.04 to 1.16). Independent determinants for isolation of non-ESBL-producing K. pneumoniae were previous urinary tract infection (OR, 8.50; 95% CI, 3.69 to 19.54) and length of hospitalization (OR, 1.07; 95% CI, 1.04 to 1.10). When the initial response was assessed at 72 h after antimicrobial therapy, the treatment failure rate for the ESBL-producing K. pneumoniae-infected group was almost twice as high as that of the non-ESBL-producing K. pneumoniae-infected group (31% versus 17%; OR, 2.19; 95% CI, 0.98 to 4.89). The 21-day mortality rate for all patients was 37% (54 of 147); it was 52% (25 of 48) for patients with ESBL-producing K. pneumoniae bloodstream infections and 29% (29 of 99) for patients with non-ESBL-producing K. pneumoniae bloodstream infections (OR, 2.62; 95% CI, 1.28 to 5.35). In summary, this investigation identifies epidemiological characteristics that distinguish ESBL-producing K. pneumoniae infections from non-ESBL-producing K. pneumoniae ESBL bloodstream infections.

MeSH Terms
Adult Aged Bacteremia/drug therapy,epidemiology,microbiology Case-Control Studies Female Humans Intensive Care Units Klebsiella Infections/drug therapy,epidemiology,microbiology Klebsiella pneumoniae/enzymology,genetics Male Middle Aged Risk Factors beta-Lactamases/biosynthesis,classification
Chemicals
beta-Lactamases
Authors & Affiliations
8 authors, click to expand affiliations / ORCID
Tumbarello Mario
Departments of Infectious Diseases, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy. tumbarello@rm.unicatt.it
Spanu Teresa
Sanguinetti Maurizio
Citton Rita
Montuori Eva
Leone Fiammetta
Fadda Giovanni
Cauda Roberto
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Article Info
Journal
Antimicrobial agents and chemotherapy
Abbr.
Antimicrob Agents Chemother
ISSN
0066-4804
DOI
10.1128/AAC.50.2.498-504.2006
Email
tumbarello@rm.unicatt.it
Published
2006-02-00
Pages
498-504
Language
English
Region
United States
NLM ID
0315061
PMCID
PMC1366869
Subset
IM
External Links
PubMed source DOI: 10.1128/AAC.50.2.498-504.2006 PMC Full Text View journal details
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