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Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

Published online by Cambridge University Press:  02 January 2015

Cheol-In Kang
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Sung-Han Kim
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Dong Min Kim
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Wan Beom Park
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Ki-Deok Lee
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Hong-Bin Kim
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Myoung-don Oh
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
Eui-Chong Kim
Affiliation:
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
Kang-Won Choe
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea

Abstract

Objective:

To evaluate risk factors and treatment outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP).

Design:

Retrospective case-control study. Stored blood isolates of K. pneumoniae were tested for ESBL production by NCCLS guidelines, double-disk synergy test, or both.

Setting:

A 1,500-bed, tertiary-care university hospital and referral center.

Patients:

Sixty case-patients with bacteremia due to ESBL-KP were compared with 60 matched control-patients with non-ESBL-KP.

Results:

There were no significant differences in age, gender, APACHE II score, or underlying diseases between the groups. Independent risk factors for infections caused by ESBL-KP were urinary catheterization, invasive procedure within the previous 72 hours, and an increasing number of antibiotics administered within the previous 30 days. Complete response rate, evaluated 72 hours after initial antimicrobial therapy, was higher among control-patients (13.3% vs 36.7%; P = .003). Treatment failure rate was higher among case-patients (35.0% vs 15%; P = .011). Overall 30-day mortality rate was 30% for case-patients and 28.3% for control-patients (P = .841). Case-patients who received imipenem or ciprofloxacin as a definitive antibiotic had 10.5% mortality. The mortality rate for initially ineffective therapy was no higher than that for initially effective therapy (9.1% vs 11.1%; P = 1.000), but statistical power was low for evaluating mortality in the absence of septic shock.

Conclusion:

For K. pneumoniae bacteremia, patients with ESBL-KP had a higher initial treatment failure rate but did not have higher mortality if antimicrobial therapy was appropriately adjusted in this study with limited statistical power.

Type
Orginal Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae
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