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Antimicrobial Agents and Chemotherapy, October 2004, p. 3720-3728, Vol. 48, No. 10
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.10.3720-3728.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Epidemiology and Clinical Features of Bloodstream Infections Caused by AmpC-Type-ß-Lactamase-Producing Klebsiella pneumoniae

Hyunjoo Pai,1,{dagger} Cheol-In Kang,2,{dagger} Jeong-Hum Byeon,1 Ki-Deok Lee,2 Wan Beom Park,2 Hong-Bin Kim,2 Eui-Chong Kim,3,4 Myoung-don Oh,2,4* and Kang-Won Choe2,4

Department of Internal Medicine, Hanyang University College of Medicine,1 Departments of Internal Medicine,2 Laboratory Medicine, Seoul National University College of Medicine,3 Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea4

Received 1 November 2003/ Returned for modification 16 January 2004/ Accepted 19 May 2004

Cases of bacteremia caused by AmpC-type-ß-lactamase-producing Klebsiella pneumoniae isolates were retrospectively studied to determine the epidemiologic features and clinical outcomes of bloodstream infections. Among 389 blood isolates recovered from 1998 to 2002, 65 isolates (16.7%) were found to be extended-spectrum ß-lactamase (ESBL) or AmpC ß-lactamase producers. The ß-lactamases from 61 of the 65 isolates were characterized; 28 of 61 isolates produced AmpC-type enzymes (14 isolates each produced DHA-1 and CMY-1-like enzymes), 32 isolates produced TEM or SHV-related ESBLs, and 1 isolate produced a CTX-M-14-like enzyme. To compare the clinical features and outcomes of bloodstream infections caused by AmpC producers with those caused by TEM- or SHV-related ESBL producers, 27 patients infected with isolates producing AmpC-type enzymes (AmpC group) and 25 patients infected with isolates producing TEM- or SHV-related enzymes (ESBL group) were analyzed. There was no significant difference between the AmpC and the ESBL groups in terms of risk factors. When the initial response was assessed at 72 h after antimicrobial therapy, the treatment failure rate for the AmpC group was 51.9% (14 of 27 patients) and the 7- and 30-day mortality rates were 14.8 and 29.6%, respectively, which were similar to those for the ESBL group. When the mortality rate for the patients who received extended-spectrum cephalosporins as definitive treatment was assessed, all four patients in the DHA-1 group and one of three patients in the CMY-1-like group died. In summary, the prevalence of AmpC enzyme-producing K. pneumoniae was high at the Seoul National University Hospital, and the clinical features and outcomes for the patients infected with AmpC-producing organisms were similar to those for the patients infected with TEM- or SHV-related ESBL producers.

* Corresponding author. Mailing address: Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong Chongno-gu, Seoul 110-744, Republic of Korea. Phone: 82-2-760-2945. Fax: 82-2-762-9662. E-mail: mdohmd{at}snu.ac.kr.

{dagger} H.P. and C.-I.K. contributed equally to the study.

Antimicrobial Agents and Chemotherapy, October 2004, p. 3720-3728, Vol. 48, No. 10
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.10.3720-3728.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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