Mortality caused by extended-spectrum beta-lactamase–producing Enterobacteriaceae bacteremia; a case control study: alert to Enterobacteriaceae strains with high minimum inhibitory concentrations of piperacillin/tazobactam

• Published in: Diagnostic microbiology and infectious disease Vol. 94; no. 3; pp. 287 - 292
• Main Authors: Namikawa, Hiroki, Yamada, Koichi, Yamairi, Kazushi, Shibata, Wataru, Fujimoto, Hiroki, Takizawa, Etsuko, Niki, Makoto, Nakaie, Kiyotaka, Oinuma, Ken-Ichi, Niki, Mamiko, Takemoto, Yasuhiko, Kaneko, Yukihiro, Shuto, Taichi, Kakeya, Hiroshi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2019
• Subjects: Bacteremia; Extended-spectrum beta-lactamase; Febrile neutropenia; Piperacillin/tazobactam; Sepsis; CLSI; CRP; OR; CI; FN; MICs; UTI; Bacteremia; SD; Extended-spectrum beta-lactamase; PE; Alb; ND; Piperacillin/tazobactam; MRSA; PTZ; ESBL; Sepsis; Febrile neutropenia
• ISSN: 0732-8893; 1879-0070; 1879-0070
• DOI: 10.1016/j.diagmicrobio.2019.01.018

This study aimed to assess the prognostic factors of patients with bacteremia due to extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE) as well as the antimicrobial susceptibility, particularly to piperacillin/tazobactam (PTZ), among ESBL-PE strains. The medical records of 65 patients with ESBL-PE bacteremia divided into the survivor group (n = 52) and nonsurvivor group (n = 13) were retrospectively reviewed. The male-to-female ratio, age, underlying disease, leukocyte count, C-reactive protein level, and treatment did not differ between the 2 groups. Multivariate analysis showed that the independent predictors associated with hospital mortality of ESBL-PE bacteremia were sepsis (P = 0.047) and febrile neutropenia (P = 0.008); thus, early assessment of these conditions is important. Further, the minimum inhibitory concentration values of ESBL-PE isolates in nonsurvivors tended to be higher than those in survivors. PTZ should be used with caution in cases of ESBL-PE strains with low susceptibility to the drug. •Sepsis and febrile neutropenia were independent predictors of hospital mortality in extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE) bacteremia.•The ESBL-PE minimum inhibitory concentration values of piperacillin/tazobactam (PTZ) in nonsurvivors tended to be higher than those in survivors.•PTZ should be used with caution in cases of ESBL-PE strains with low susceptibility to the drug.