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Comparison of Predictors and Mortality Between Bloodstream Infections Caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae

  • Oded Scheuerman (a1) (a2) (a3), Vered Schechner (a1) (a2) (a3), Yehuda Carmeli (a1) (a2) (a3), Belen Gutiérrez-Gutiérrez (a4) (a5), Esther Calbo (a6), Benito Almirante (a7), Pier-Luigy Viale (a8), Antonio Oliver (a9), Patricia Ruiz-Garbajosa (a10), Oriol Gasch (a11), Monica Gozalo (a12), Johann Pitout (a13), Murat Akova (a14), Carmen Peña (a15), Jose Molina (a16), Alicia Hernández-Torres (a17), Mario Venditti (a18), Nuria Prim (a19), Julia Origüen (a20), German Bou (a21), Evelina Tacconelli (a22), Maria Tumbarello (a23), Axel Hamprecht (a24), Ilias Karaiskos (a25), Cristina de la Calle (a26), Federico Pérez (a27), Mitchell J. Schwaber (a1) (a2) (a3), Joaquin Bermejo (a28), Warren Lowman (a29), Po-Ren Hsueh (a30), Carolina Navarro-San Francisco (a31), Robert A. Bonomo (a27) (a32), David L. Paterson (a33), Alvaro Pascual (a4) (a5), Jesus Rodríguez-Baño (a4) (a5) and the REIPI/ESGBIS/INCREMENT investigators...

Abstract

OBJECTIVE

To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes

METHODS

As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.

RESULTS

The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.

CONCLUSIONS

Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.

CLINICAL TRIALS IDENTIFIER

ClinicalTrials.gov. Identifier: NCT01764490.

Infect Control Hosp Epidemiol 2018;39:660–667

Copyright

Corresponding author

Address correspondence to O. Scheuerman, MD, Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center Tel Aviv and Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel (odedshv@clalit.org.il).

Footnotes

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a

Other investigators in the REIPI/ESGBIS/INCREMENT project: J. Guzmán Puche, University General Hospital Attikoni, Greece; M. Souli, Case Western Reserve University School of Medicine, Cleveland Ohio, United States; J. Gálvez, Hospital Universitario Virgen Macarena, Seville, Spain; M. Falcone and A. Russo, Policlinico Umberto I, Rome, Italy; G. Daikos, Laikon General Hospital, Athens, Greece; E. M. Trecarichi and A. R. Losito, Catholic University of the Sacred Heart, Rome, Italy; J. Gómez and E. García-Vázquez, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; E. Iosifidis and E. Roilides, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece; I. Karaiskos, Hygeia General Hospital, Athens, Greece; Y. Doi, University of Pittsburgh, Pittsburgh, Pennsylvania, United States; F. F. Tuon, Hospital da Universidade Federal do Paraná, Paraná, Brazil; J. A. Martínez, L. Morata and A. Soriano, Hospital Clinic, Barcelona, Spain; F. Navarro and B. Mirelis, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; R. San Juan and M. Fernández-Ruiz, Hospital 12 de Octubre, Madrid, Spain; N. Larrosa and M. Puig, Hospital Universitario Vall d’Hebrón, Barcelona, Spain; J. Molina and V. González, Hospital Universitario Virgen del Rocío, Seville, Spain; V. Rucci, Hospital Español, Rosario, Argentina; E. Ruiz de Gopegui and C. I. Marinescu, Hospital Universitario Son Espases, Palma de Mallorca, Spain; M. C. Fariñas, M. E. Cano, and M. Gozalo, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; J. R. Paño-Pardo and Marta Mora-Rillo, Hospital Universitario La Paz-IDIPAZ, Madrid, Spain; S. Gómez-Zorrilla and F. Tubau, Hospital de Bellvitge, Barcelona, Spain; S. Pournaras, A. Tsakris, and O. Zarkotou, University of Athens, Athens, Greece; Ö. K. Azap, Baskent University, Ankara, Turkey; M. Souli, A. Antoniadou, and G. Poulakou, University General Hospital Attikon, Chiadiri, Greece; D. Virmani, University of Calgary, Calgary, Canada; Á. Cano and J. Guzmán-Puche, Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain; Ö. Helvaci and A. O. Sahin, Hacettepe University, Ankara, Turkey; V. Pintado and R. Cantón, Hospital Ramón y Cajal, Madrid, Spain; M. Bartoletti and M. Giannella, Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy; S. Peter, Tübingen University Hospital, Tübingen, Germany; C. Badia and M. Xercavins, Hospital Universitario Mútua de Terrassa, Terrassa, Spain; D. Fontanals and E. Jové, Hospital Parc Taulí, Sabadell, Spain.

Footnotes

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