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Comparison of Predictors and Mortality Between Bloodstream Infections Caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae
Published online by Cambridge University Press: 05 April 2018
Abstract
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
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.
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.
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.
ClinicalTrials.gov. Identifier: NCT01764490.
Infect Control Hosp Epidemiol 2018;39:660–667
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- © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved
Footnotes
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.
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