Risk factors for and mortality of extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli nosocomial bloodstream infections Fatores de risco e mortalidade de infecções da corrente sanguínea por Klebsiella pneumoniae and Escherichia coli produtores de beta-lactamase de espectro estendido

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: Silvana Vargas Superti, Gustavo Augusti, Alexandre Prehn Zavascki
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 2009
• Subjects: Escherichia coli; Klebsiella pneumoniae; Extended-spectrum-beta-lactamase; Bacteremia; Bloodstream infection; Drug resistance; Bacterial; Risk factors; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1590/S0036-46652009000400006; https://doaj.org/article/3b79de6cf29943a0ab386626788748b6

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-β-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. Estudo de caso-controle, onde os casos foram pacientes com hemocultura positiva para Klebsiella pneumoniae (KP) ou Escherichia coli (EC) produtores de beta lactamase de espectro estendido (ESBL) e os controles foram pacientes com hemoculturas positivas para EC ou KP não produtores de ESBL foi realizado para avaliar os fatores de risco para produção destas enzimas em infecções da corrente sanguínea (ICS). Mortalidade dos pacientes com ICS também foi avaliada. Foram incluídos 145 pacientes (81, 59,5% tinham Klebsiella pneumoniae e 64, 44,1% tinham Escherichia coli); 51 (35,2%) ...