Molecular epidemiology of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae from bloodstream infections and risk factors for mortality

Abstract The prevalence of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae is growing worldwide. Infections with these bacteria are suspected to be related to increased mortality. We aimed to estimate the distribution of ESBL genotypes and to assess the impact on mortality ass...

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Published inJournal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 20; no. 12; pp. 817 - 819
Main Authors Gürntke, Stephan, Kohler, Christian, Steinmetz, Ivo, Pfeifer, Yvonne, Eller, Christoph, Gastmeier, Petra, Schwab, Frank, Leistner, Rasmus
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier Ltd 01.12.2014
Subjects
Aged
Bacteremia - microbiology
beta-Lactamases - biosynthesis
beta-Lactamases - genetics
Bloodstream infection
ESBL
Female
Genotype
Germany - epidemiology
Hematology, Oncology and Palliative Medicine
Humans
Klebsiella Infections - epidemiology
Klebsiella Infections - microbiology
Klebsiella pneumoniae
Klebsiella pneumoniae - drug effects
Klebsiella pneumoniae - enzymology
Klebsiella pneumoniae - genetics
Male
Middle Aged
Molecular Epidemiology
Proportional Hazards Models
Retrospective Studies
Risk Factors
Germany
ESBL
Molecular epidemiology
Bloodstream infection
Klebsiella pneumoniae
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Summary:Abstract The prevalence of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae is growing worldwide. Infections with these bacteria are suspected to be related to increased mortality. We aimed to estimate the distribution of ESBL genotypes and to assess the impact on mortality associated with ESBL positivity in cases of bloodstream infection (BSI) due to K. pneumoniae . We performed a cohort study on patients with K. pneumoniae BSI between 2008 and 2011. Presence of ESBL genes was analyzed by PCR and sequencing. Risk factors for mortality were analyzed by Cox-proportional hazard regression. We identified 286 ESBL-negative (81%) and 66 (19%) ESBL-positive cases. 97% ( n  = 64) of the ESBL-positive isolates were susceptible for meropenem. The most common ESBL genotypes were CTX-M-15 (60%), SHV-5 (27%) and CTX-M-3 (5%). Significant risk factors for mortality were chronic pulmonary disease (HR 1.747) and moderate/severe renal disease (HR 2.572). ESBL positivity was not associated with increased mortality.
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ISSN:1341-321X
1437-7780
DOI:10.1016/j.jiac.2014.08.012