This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Copyright Information Books from ASM Press MicrobeWorld Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tumbarello, M. Articles by Cauda, R. Search for Related Content PubMed PubMed Citation Articles by Tumbarello, M. Articles by Cauda, R.

Bloodstream Infections Caused by Extended-Spectrum-ß-Lactamase-Producing Klebsiella pneumoniae: Risk Factors, Molecular Epidemiology, and Clinical Outcome

Departments of Infectious Diseases,¹ Microbiology, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy²

Received 10 April 2005/ Returned for modification 6 July 2005/ Accepted 31 October 2005

Bloodstream infections caused by extended-spectrum-ß-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.

This article has been cited by other articles:

• Marchaim, D., Navon-Venezia, S., Schwaber, M. J., Carmeli, Y. (2008). Isolation of Imipenem-Resistant Enterobacter Species: Emergence of KPC-2 Carbapenemase, Molecular Characterization, Epidemiology, and Outcomes. Antimicrob. Agents Chemother. 52: 1413-1418 [Abstract] [Full Text]  
• Giske, C. G., Monnet, D. L., Cars, O., Carmeli, Y., on behalf of ReAct-Action on Antibiotic Resistance, (2008). Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli. Antimicrob. Agents Chemother. 52: 813-821 [Full Text]  
• Millar, M., Philpott, A., Wilks, M., Whiley, A., Warwick, S., Hennessy, E., Coen, P., Kempley, S., Stacey, F., Costeloe, K. (2008). Colonization and Persistence of Antibiotic-Resistant Enterobacteriaceae Strains in Infants Nursed in Two Neonatal Intensive Care Units in East London, United Kingdom. J. Clin. Microbiol. 46: 560-567 [Abstract] [Full Text]  
• Schwaber, M. J., Carmeli, Y. (2007). Mortality and delay in effective therapy associated with extended-spectrum {beta}-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 60: 913-920 [Abstract] [Full Text]  
• Lockhart, S. R., Abramson, M. A., Beekmann, S. E., Gallagher, G., Riedel, S., Diekema, D. J., Quinn, J. P., Doern, G. V. (2007). Antimicrobial Resistance among Gram-Negative Bacilli Causing Infections in Intensive Care Unit Patients in the United States between 1993 and 2004. J. Clin. Microbiol. 45: 3352-3359 [Abstract] [Full Text]  
• Rello, J. (2007). Importance of appropriate initial antibiotic therapy and de-escalation in the treatment of nosocomial pneumonia. ERR 16: 33-39 [Abstract] [Full Text]  
• Tumbarello, M., Sanguinetti, M., Montuori, E., Trecarichi, E. M., Posteraro, B., Fiori, B., Citton, R., D'Inzeo, T., Fadda, G., Cauda, R., Spanu, T. (2007). Predictors of Mortality in Patients with Bloodstream Infections Caused by Extended-Spectrum-{beta}-Lactamase-Producing Enterobacteriaceae: Importance of Inadequate Initial Antimicrobial Treatment. Antimicrob. Agents Chemother. 51: 1987-1994 [Abstract] [Full Text]  
• Kasbekar, N. (2006). Tigecycline: A new glycylcycline antimicrobial agent.. Am J Health Syst Pharm 63: 1235-1243 [Abstract] [Full Text]