Outcomes and characteristics of ertapenem-nonsusceptible Klebsiella pneumoniae bacteremia at a university hospital in Northern Taiwan: a matched case-control study.

Abstract

BACKGROUND AND PURPOSE:

Carbapenem-resistant Klebsiella pneumoniae is an emerging problem worldwide. The object of this study was to investigate the risk factors, characteristics and outcomes of ertapenem-nonsusceptible K pneumoniae (ENSKp) bacteremia.

METHODS:

We conducted a 1:2 ratio matched case-control study. The controls were randomly selected among patients with ertapenem-susceptible K pneumoniae (ESKp) bacteremia and were matched with ENSKp cases for bacteremia.

RESULTS:

Seventy-five patients were included in this study (25 cases and 50 controls). Bivariate analysis showed that prior exposure to either β-Lactam/β-Lactam-lactamase inhibitors (p = 0.008) or 4(th) generation cephalosporins (p < 0.001), chronic obstructive pulmonary disease (COPD) (p = 0.001), acute renal failure (p = 0.021), chronic kidney disease without dialysis (p = 0.021), recent hospital stay (p = 0.016), intensive care unit stay (p = 0.002), mechanical ventilation (p = 0.003), central venous catheter placement (p = 0.016), Foley indwelling (p = 0.022), polymicrobial bacteremia (p = 0.003) and higher Pittsburgh bacteremia score (p < 0.001) were associated with ENSKp bacteremia. The multivariate analysis showed that prior exposure to 4(th) generation cephalosporins (odds ratio [OR], 28.05; 95% confidence interval [CI], 2.92-269.85; p = 0.004), COPD (OR, 21.38; 95% CI, 2.95-154.92; p = 0.002) and higher Pittsburgh bacteremia score (OR, 1.35; 95% CI, 1.10-1.66; p = 0.004) were independent factors for ENSKp bacteremia. ENSKp bacteremia had a higher 14-day mortality rate than ESKp bacteremia (44.0% vs. 22.0%; p = 0.049). The overall in-hospital mortality rates for these two groups were 60.0% and 40.0% respectively (p = 0.102).

CONCLUSION:

ENSKp bacteremia had a poor outcome and the risk factors were prior exposure of 4(th) generation cephalosporins, COPD and higher Pittsburgh bacteremia score. Antibiotic stewardship may be the solution for the preventive strategy.

• Authors: Shi-Wei Liu, Hong-Jyun Chang, Ju-Hsin Chia, An-Jing Kuo, Tsu-Lan Wu, Ming-Hsun Lee
• Journal: Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi (J Microbiol Immunol Infect) Vol. 45 Issue 2 Pg. 113-9 (Apr 2012) ISSN: 1995-9133 [Electronic] England
• PMID: 22154994 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011. Published by Elsevier B.V.

Chemical References

• Anti-Bacterial Agents
• beta-Lactams
• Ertapenem

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (pharmacology)
• Bacteremia (drug therapy, epidemiology, microbiology, pathology)
• Case-Control Studies
• Ertapenem
• Female
• Hospitals, University
• Humans
• Klebsiella Infections (drug therapy, epidemiology, microbiology, pathology)
• Klebsiella pneumoniae (drug effects, isolation & purification)
• Male
• Middle Aged
• Risk Factors
• Survival Analysis
• Taiwan
• Treatment Outcome
• beta-Lactam Resistance
• beta-Lactams (pharmacology)