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Antimicrobial Agents and Chemotherapy, December 2004, p. 4574-4581, Vol. 48, No. 12
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.12.4574-4581.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Bloodstream Infections Due to Extended-Spectrum ß-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae: Risk Factors for Mortality and Treatment Outcome, with Special Emphasis on Antimicrobial Therapy

Cheol-In Kang,1 Sung-Han Kim,1 Wan Beom Park,1 Ki-Deok Lee,1 Hong-Bin Kim,1 Eui-Chong Kim,2,3 Myoung-Don Oh,1,3* and Kang-Won Choe1,3

Departments of Internal Medicine,1 Laboratory Medicine, Seoul National University College of Medicine,2 Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea3

Received 13 January 2004/ Returned for modification 24 April 2004/ Accepted 29 August 2004

This study was conducted to evaluate risk factors for mortality and treatment outcome of bloodstream infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK). ESBL production in stored K. pneumoniae and E. coli blood isolates from Jan 1998 to Dec 2002 was phenotypically determined according to NCCLS guidelines and/or the double-disk synergy test. A total of 133 patients with ESBL-EK bacteremia, including 66 patients with ESBL-producing K. pneumoniae and 67 with ESBL-producing E. coli, were enrolled. The overall 30-day mortality rate was 25.6% (34 of 133). Independent risk factors for mortality were severe sepsis, peritonitis, neutropenia, increasing Acute Physiology and Chronic Health Evaluation II score, and administration of broad-spectrum cephalosporin as definitive antimicrobial therapy (P < 0.05 for each of these risk factors). In 117 of the 133 patients, excluding 16 patients who died within 3 days after blood culture sample acquisition, the 30-day mortality rates according to definitive antibiotics were as follows: carbapenem, 12.9% (8 of 62); ciprofloxacin, 10.3% (3 of 29); and others, such as cephalosporin or an aminoglycoside, 26.9% (7 of 26). When patients who received appropriate definitive antibiotics, such as carbapenem or ciprofloxacin, were evaluated, mortality in patients receiving inappropriate empirical antimicrobial therapy was found not to be significantly higher than mortality in those receiving appropriate empirical antimicrobial therapy (18.9 versus 15.5%; P = 0.666). Carbapenem and ciprofloxacin were the most effective antibiotics in antimicrobial therapy for ESBL-EK bacteremia. A delay in appropriate definitive antimicrobial therapy was not associated with higher mortality if antimicrobial therapy was adjusted appropriately according to the susceptibility results. Our data suggest that more prudent use of carbapenem as empirical antibiotic may be reasonable.

* 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 address: mdohmd{at}snu.ac.kr.

Antimicrobial Agents and Chemotherapy, December 2004, p. 4574-4581, Vol. 48, No. 12
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.12.4574-4581.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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