Clinical impact of infections caused by ESBL-producing E. coli and K. pneumoniae

The outcome of infections occurring at different anatomic sites caused by ESBL-producing E. coli or K. pneumoniae was retrospectively analysed for a 3-y period. 23 cases were compared to 46 controls with infections caused by third-generation cephalosporin-susceptible strains matched by age, severity of illness and duration of hospitalization before onset of infection. Only 27.8% of cases received appropriate empirical antimicrobial therapy compared with 79.6% of controls (ORpaired=0.053, p=0.001). This did not result in higher costs of antibiotic therapy, a longer median post-infection hospital stay or higher mortality in cases of patients with urinary tract or wound infections. In cases of patients with respiratory tract and bloodstream infections (RTI/BSI), median costs of definitive antibiotic treatment were significantly higher than in controls (325 vs 58.9 Euros, p=0.002). Moreover, more case patients with RTI/BSI had a post-infection stay exceeding the 75th percentile of 15 d on ICU and of 18 d in hospital, respectively (50% vs 6.67%, p=0.034). There was no difference in in-hospital mortality between case and control patients with RTI/BSI (25% vs 20%, p=1.0).

[1]  D. Raveh,et al.  Assessment of the Clinical Significance of Production of Extended-spectrum β-Lactamases (ESBL) by Enterobacteriaceae , 2006, Infection.

[2]  Yehuda Carmeli,et al.  Clinical and Economic Impact of Bacteremia with Extended- Spectrum-β-Lactamase-Producing Enterobacteriaceae , 2006, Antimicrobial Agents and Chemotherapy.

[3]  A. Marra,et al.  Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum β-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence , 2006, BMC infectious diseases.

[4]  G. Fadda,et al.  Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae: Risk Factors, Molecular Epidemiology, and Clinical Outcome , 2006, Antimicrobial Agents and Chemotherapy.

[5]  Robert A. Bonomo,et al.  Extended-Spectrum (cid:2) -Lactamases: a Clinical Update , 2005 .

[6]  A. Mehio-Sibai,et al.  Epidemiology and risk factors for extended-spectrum beta-lactamase-producing organisms: a case control study at a tertiary care center in Lebanon. , 2005, American journal of infection control.

[7]  G. Rossolini,et al.  Proteus mirabilis Bloodstream Infections: Risk Factors and Treatment Outcome Related to the Expression of Extended-Spectrum β-Lactamases , 2005, Antimicrobial Agents and Chemotherapy.

[8]  W. Bilker,et al.  Impact of inadequate initial antimicrobial therapy on mortality in infections due to extended-spectrum beta-lactamase-producing enterobacteriaceae: variability by site of infection. , 2005, Archives of internal medicine.

[9]  M. Oh,et al.  Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae , 2004, Infection Control & Hospital Epidemiology.

[10]  J. Woo,et al.  Clinical implications of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae bacteraemia. , 2002, The Journal of hospital infection.

[11]  P. Bradford,et al.  Molecular epidemiology of a citywide outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  The Cost of Antibiotic Resistance: Effect of Resistance Among Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa on Length of Hospital Stay , 2002, Infection Control & Hospital Epidemiology.

[13]  E. Kim,et al.  Bloodstream Infections by Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae in Children: Epidemiology and Clinical Outcome , 2002, Antimicrobial Agents and Chemotherapy.

[14]  Samson S. Y. Wong,et al.  Bacteremia Caused by Escherichia coli producing Extended-spectrum Beta-lactamase: a Case-control Study of Risk Factors and Outcomes , 2002, Scandinavian journal of infectious diseases.

[15]  D. Paterson.  Extended-spectrum beta-lactamases: the European experience , 2001, Current opinion in infectious diseases.

[16]  W. Bilker,et al.  Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  Y. Carmeli,et al.  Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance: a systematic review. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  D. Paterson.  Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs). , 2000, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[19]  J. Lucet,et al.  Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing enterobacteriaceae in a university hospital. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  J. Ariza,et al.  Epidemiology and Successful Control of a Large Outbreak Due to Klebsiella pneumoniae Producing ExtendedSpectrum β-Lactamases , 1998, Antimicrobial Agents and Chemotherapy.

[21]  R A Weinstein,et al.  Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a case-control and molecular epidemiologic investigation. , 1996, The Journal of infectious diseases.

[22]  K S Meyer,et al.  Nosocomial Outbreak of Klebsiella Infection Resistant to Late-Generation Cephalosporins , 1993, Annals of Internal Medicine.

[23]  S. B. Singer,et al.  Outbreak of ceftazidime resistance due to a novel extended-spectrum beta-lactamase in isolates from cancer patients , 1992, Antimicrobial Agents and Chemotherapy.

[24]  B. Yangco,et al.  CDC definitions for nosocomial infections. , 1989, American journal of infection control.

[25]  J M Hughes,et al.  CDC definitions for nosocomial infections, 1988. , 1988, American journal of infection control.

[26]  Patrick Legrand,et al.  TRANSFERABLE ENZYMATIC RESISTANCE TO THIRD-GENERATION CEPHALOSPORINS DURING NOSOCOMIAL OUTBREAK OF MULTIRESISTANT KLEBSIELLA PNEUMONIAE , 1987, The Lancet.

[27]  E. Spitznagel,et al.  ASA Physical Status Classifications: A Study of Consistency of Ratings , 1978, Anesthesiology.

[28]  J. Rickman,et al.  Guilt and dynamics of psychological disorder. , 1948, Lancet.

[29]  M. Ferraro.  Performance standards for antimicrobial susceptibility testing , 2001 .

[30]  K. Riesenberg,et al.  Clinical significance and impact on mortality of extended-spectrum beta lactamase-producing Enterobacteriaceae isolates in nosocomial bacteremia. , 2001, Scandinavian journal of infectious diseases.

[31]  Mary Jane Ferraro,et al.  Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically : approved standard , 2000 .