Factors Associated with Extended-spectrum β-lactamase-producing Enterobacteria Isolated from Respiratory Samples

• Published in: Internal Medicine Vol. 62; no. 14; pp. 2043 - 2050
• Main Authors: Matsumoto, Hiroyuki, Komiya, Kosaku, Ichihara, Shogo, Nagaoka, Yuhei, Yamanaka, Marimu, Nishiyama, Yoshiki, Hiramatsu, Kazufumi, Kadota, Jun-ichi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.07.2023; Japan Science and Technology Agency
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteria; beta-Lactamases; Enterobacteriaceae; Escherichia coli; Escherichia coli Infections - drug therapy; Humans; Internal medicine; Klebsiella Infections - drug therapy; Klebsiella pneumoniae; macrolide; Multivariate analysis; odds ratio; Original; quinolone; Respiratory tract infection; Risk Factors; Sputum; β Lactamase; quinolone; odds ratio; Escherichia coli; macrolide
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.0690-22

Objective Although extended-spectrum β-lactamase (ESBL)-producing bacteria are a global threat, as they may cause respiratory infection, the factors associated with the isolation of these bacteria from sputum remain unclear. We therefore explored the factors related to ESBL-producing Klebsiella pneumoniae and Escherichia coli isolated from sputum samples. Methods This study included consecutive patients admitted to our department from 2010 to 2021 with K. pneumoniae or E. coli isolated from their sputum. The patients were categorized into ESBL-producing and non-ESBL-producing groups, and the factors associated with ESBL-producing bacteria isolation were assessed using a binomial logistic regression analysis. Results We included 82 patients, and ESBL-producing pathogens were isolated from 23 (28%). The usage rates of cephem [odds ratio (OR) 4.000, 95% confidence interval (CI) 1.402-11.409, p=0.010], quinolone (OR 2.961, 95% CI 1.097-7.996, p=0.032), and macrolide (OR 4.273, 95% CI 1.518-12.028, p=0.006) in the past year were significantly higher in the ESBL-producing group than in the non-ESBL-producing group. The multivariate analysis revealed that the applications of cephem (adjusted OR: 4.130, 95% CI: 1.233-13.830, p=0.021) and macrolide (adjusted OR: 6.365, 95% CI: 1.922-21.077, p=0.002) was independently associated with the isolation of ESBL-producing bacteria. Conclusion A history of cephem and macrolide use can be considered a risk factor for ESBL-producing bacteria isolation from sputum samples. Physicians need to consider these risk factors when determining antibiotics for the treatment of patients with respiratory infections.