Clinical Characteristics of Bacteremia Due to Extended-Spectrum β-Lactamase (ESBL)-Producing Enterobacteriaceae in the Era of CTX-M and KPC-type β-Lactamases

• Published in: Clinical microbiology and infection Vol. 18; no. 9; pp. 887 - 893
• Main Authors: Qureshi, Zubair A., Paterson, David L., Peleg, Anton Y., Adams-Haduch, Jennifer M., Shutt, Kathleen A., Pakstis, Diana L., Sordillo, Emilia, Polsky, Bruce, Sandkovsky, Gabriel, Bhussar, Manveen K., Doi, Yohei
• Format: Journal Article
• Language: English
• Published: 26.09.2011
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/j.1469-0691.2011.03658.x

A multicenter, case-control study was conducted to assess risk factors and patient outcomes from bacteremia due to Enterobacteriaceae producing extended-spectrum β-lactamases (ESBL) and Klebsiella pneumoniae carbapenemases (KPCs). One hundred five and 20 patients with bacteremia due to ESBL and KPC-producing organisms were matched to controls that had bacteremia with non-ESBL/KPC-producing organisms, respectively. Independent risk factors for ESBL production included admission from a nursing home (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.64–8.16), chronic renal failure (OR, 2.09; 95% CI, 1.11–3.92), the presence of a gastrostomy tube (OR, 3.36; 95% CI, 1.38–8.18), length of hospital stay before infection (OR, 1.02; 95% CI, 1.01–1.03), transplant recipients (OR, 2.48; 95% CI, 1.24–4.95) and receipt of antibiotics with Gram-negative activity in the preceding 30 days (OR, 1.76; 95% CI, 1.00–3.08). 28-day crude mortality rates for patients infected with ESBL or KPC-producing organisms and controls were 29.1% (34/117) and 19.5% (53/272), respectively (OR 1.70; 95% CI 1.04–2.80). On multivariate analysis, inadequate empiric therapy (OR, 2.26; 95% CI, 1.18–4.34), onset of bacteremia while in ICU (OR, 2.74; 95% CI, 1.47–5.11), Apache II score (OR, 1.17; 95% CI, 1.12–1.23), and malignancy (OR, 2.66; 95% CI, 1.31–5.41) were independent risk factors for mortality. CTX-M was the most common ESBL type in E. coli , whereas SHV predominated in Klebsiella spp. and Enterobacter spp.