RISK FACTORS FOR AND MORTALITY OF EXTENDED-SPECTRUM-β-LACTAMASE-PRODUCING Klebsiella pneumoniae AND Escherichia coli NOSOCOMIAL BLOODSTREAM INFECTIONS

• Published in: Revista do Instituto de Medicina Tropical de São Paulo 2009-07, Vol.51 (4), p.211-216
• Main Authors: VARGAS SUPERTI, Silvana, AUGUSTI, Gustavo, PREHN ZAVASCKI, Alexandre
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacteremia - microbiology; Bacteremia - mortality; Bacterial diseases; Bacterial sepsis; beta-Lactamases - biosynthesis; Biological and medical sciences; Brazil - epidemiology; Case-Control Studies; Cross Infection - microbiology; Cross Infection - mortality; Drug Resistance, Multiple, Bacterial; Escherichia coli - drug effects; Escherichia coli - enzymology; Escherichia coli Infections - mortality; Female; General aspects; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Infectious diseases; Klebsiella Infections - metabolism; Klebsiella Infections - mortality; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - enzymology; Male; Medical sciences; Middle Aged; Multivariate Analysis; Risk Factors; Survival Rate; TROPICAL MEDICINE
• ISSN: 0036-4665; 1678-9946; 1678-9946; 0036-4665
• DOI: 10.1590/S0036-46652009000400006

A case-control study, involving patients with positive blood cultures for Klebsiella pneumoniae (KP) or Escherichia coli (EC) EC and controls with positive blood cultures for non-ESBL-KP or EC, was performed to assess risk factors for extended-spectrum-beta-lactamase (ESBL) production from nosocomial bloodstream infections (BSIs). Mortality among patients with BSIs was also assessed. The study included 145 patients (81, 59.5% with K. pneumoniae and 64, 44.1% with E. coli BSI); 51 (35.2%) isolates were ESBL producers and 94 (64.8%) nonproducers. Forty-five (55.6%) K. pneumoniae isolates were ESBL producers, while only six (9.4%) E. coli isolates produced the enzyme. Multivariate analysis showed that recent exposure to piperacillin-tazobactam (adjusted Odds Ratio [aOR] 6.2; 95%CI 1.1-34.7) was a risk factor for ESBL BSI. K. pneumoniae was significantly more likely to be an ESBL-producing isolate than E. coli (aOR 6.7; 95%CI 2.3-20.2). No cephalosporin class was independently associated with ESBLs BSI; however, in a secondary model considering all oxymino-cephalosporins as a single variable, a significant association was demonstrated (aOR 3.7; 95%CI 1.3-10.8). Overall 60-day mortality was significantly higher among ESBL-producing organisms. The finding that piperacillin-tazobactam use is a risk factor for ESBL-production in KP or EC BSIs requires attention, since this drug can be recommended to limit the use of third-generation cephalosporins.