Nosocomial bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae resistant to third-generation cephalosporins, Finland, 1999-2013: Trends, patient characteristics and mortality

• Published in: Infectious diseases (London, England) Vol. 48; no. 3; pp. 229 - 234
• Main Authors: Martelius, Timi, Jalava, Jari, Kärki, Tommi, Möttönen, Teemu, Ollgren, Jukka, Lyytikäinen, Outi
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03.03.2016
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - mortality; beta-Lactamases - biosynthesis; blood stream infection; Cephalosporin Resistance; Cephalosporins - pharmacology; Cephalosporins - therapeutic use; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - mortality; ESBL; Escherichia coli - drug effects; Escherichia coli - enzymology; Escherichia coli - isolation & purification; Escherichia coli Infections - drug therapy; Escherichia coli Infections - epidemiology; Escherichia coli Infections - mortality; Female; Finland - epidemiology; Humans; Infant, Newborn; Klebsiella Infections - drug therapy; Klebsiella Infections - epidemiology; Klebsiella Infections - mortality; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - enzymology; Klebsiella pneumoniae - isolation & purification; Middle Aged; Nosocomial; Prospective Studies; surveillance; Finland; ESBL; surveillance; blood stream infection; Nosocomial
• ISSN: 2374-4235; 2374-4243
• DOI: 10.3109/23744235.2015.1109135

Background: Few systematically collected multi-centre surveillance data on nosocomial bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli or Klebsiella pneumoniae have been published. Aim: To evaluate trends, patient characteristics and mortality of such infections, nosocomial BSI data reported by the 4-17 hospitals participating in the prospective laboratory-based surveillance during 1999-2013 were analysed. Methods: Data were collected by local infection control nurses, patient-days were obtained from the hospital's administrative database, and dates of deaths from the population registry. Resistance to third-generation cephalosporins was further examined in the national reference laboratory. Findings: A total of 16 028 nosocomial BSIs were identified; 2217 (14%) were caused by E. coli and 661 (4%) by K. pneumoniae; 207 (7%) were non-susceptible to third-generation cephalosporins, with an increasing trend from 0% in 1999 to 17% in 2013. Patient characteristics did not differ significantly between BSIs caused by third-generation susceptible and resistant E. coli and K. pneumonia, but the case fatality tended to be higher. Most (88%) of the isolates reported as non-susceptible to third-generation cephalosporins had ESBL phenotype, CTX-M (79%) being the most common enzyme. Conclusion: A sharp increase in nosocomial BSIs caused by ESBL producing bacteria was observed. Identification of patients for screening pose a challenge, emphasising the role of infection control guidelines and antibiotic policy in prevention