Comparison of Predictors and Mortality Between Bloodstream Infections Caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae

• Published in: Infection control and hospital epidemiology 2018-06, Vol.39 (6), p.660-667
• Main Authors: Scheuerman, Oded, Schechner, Vered, Carmeli, Yehuda, Gutiérrez-Gutiérrez, Belen, Calbo, Esther, Almirante, Benito, Viale, Pier-Luigy, Oliver, Antonio, Ruiz-Garbajosa, Patricia, Gasch, Oriol, Gozalo, Monica, Pitout, Johann, Akova, Murat, Peña, Carmen, Molina, Jose, Hernández-Torres, Alicia, Venditti, Mario, Prim, Nuria, Origüen, Julia, Bou, German, Tacconelli, Evelina, Tumbarello, Maria, Hamprecht, Axel, Karaiskos, Ilias, de la Calle, Cristina, Pérez, Federico, Schwaber, Mitchell J, Bermejo, Joaquin, Lowman, Warren, Hsueh, Po-Ren, Navarro-San Francisco, Carolina, Bonomo, Robert A, Paterson, David L, Pascual, Alvaro, Rodríguez-Baño, Jesus
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Comorbidity; Demographics; E coli; Epidemiology; Genotypes; HIV; Hospitals; Human immunodeficiency virus; Kidney diseases; Laboratories; Length of stay; Mortality; Mortality risk; Nosocomial infections; Nursing; Patients; Risk factors; Sepsis; Software; Urogenital system
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2018.63

OBJECTIVETo compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypesMETHODSAs part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.RESULTSThe study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non-CTX-M ESBLs were detected.CONCLUSIONSClinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.CLINICAL TRIALS IDENTIFIERClinicalTrials.gov. Identifier: NCT01764490.Infect Control Hosp Epidemiol 2018;39:660-667.