Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Ferrández Quirante, Olivia; Grau Cerrato, Santiago; Luque Pardos, Sonia

doi:10.1016/S1413-8670(11)70207-0

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Abstract

The objective of this study was to identify risk factors for bacteremia by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective case-control study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5% vs 17%, p<0.001). Binary logistic regression showed that the number (>2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR=2.29, 95% CI 1.35−3.88, p=0.002).

Conclusion

Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.

Keywords:

bacteremia

β-lactamases

risk factors

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References

[1.]

D.J. Biedenbach, G.J. Moet, R.N. Jones.

Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002).

Diagn Microbiol Infect Dis, 50 (2004), pp. 59-69

http://dx.doi.org/10.1016/j.diagmicrobio.2004.05.003 | Medline

[2.]

J.R. Le Gall, S. Lemeshow, F. Saulnier.

A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.

JAMA, 270 (1993), pp. 2957-2963

Medline

[3.]

A.R. Marra, G.M.L. Bearman, R.P. Wenzel, M.B. Edmond.

Comparison of severity of illness scoring system for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa.

BMC Infect Dis, 6 (2006), pp. 132

http://dx.doi.org/10.1186/1471-2334-6-132 | Medline

[4.]

P.R. Hutson.

Hematology: red and white blood cell tests.

Basic skills in interpreting laboratory data, pp. 441-467

[5.]

I. Siempos, E. Ioannidou, M. Falagas.

The difference between adequate and appropriate antimicrobial treatment.

Clin Infect Dis, 46 (2008), pp. 642-644

http://dx.doi.org/10.1086/527039 | Medline

[6.]

Performance standards for antimicrobial susceptibility testing: 20th informational supplement.

Twentieth Informational Supplement.

Clinical and Laboratory Standards Institute (CLSI), (2010),

[7.]

R. Friedmann, D. Raveh, E. Zartzer, et al.

Prospective evaluation of colonization with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing Enterobacteriaceae among patients during hospitalization.

Infect Control Hosp Epidemiol, 30 (2009), pp. 534-542

http://dx.doi.org/10.1086/597505 | Medline

[8.]

E.M. Graffunder, K.E. Preston, A.M. Evans, R.A. Venezia.

Risk factors associated with extended-spectrum β-lactamase-producing organisms at a tertiary care hospital.

J Antimicrob Chemother, 56 (2005), pp. 139-145

http://dx.doi.org/10.1093/jac/dki180 | Medline

[9.]

E. Lautenbach, J.B. Patel, W.B. Bilker, P.H. Edelstein, N.O. Fishman.

Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes.

Clin Infect Dis, 32 (2001), pp. 1162-1171

http://dx.doi.org/10.1086/319757 | Medline

[10.]

M. Ortega, F. Marco, A. Soriano, et al.

Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome.

J Antimicrob Chemother, 63 (2009), pp. 568-574

http://dx.doi.org/10.1093/jac/dkn514 | Medline

[11.]

B. Du, Y. Long, H. Liu, et al.

Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome.

Intensive Care Med, 28 (2002), pp. 1718-1723

http://dx.doi.org/10.1007/s00134-002-1521-1 | Medline

[12.]

D.L. Paterson, W.C. Ko, A. Von Gottberg, et al.

International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum β-lactamase production in nosocomial Infections.

Ann Intern Med, 140 (2004), pp. 26-32

Medline

[13.]

J.A. Martínez, J. Aguilar, M. Almela, et al.

Prior use of carbapenems may be a significant risk factor for extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella spp. in patients with bacteraemia.

J Antimicrob Chemother, 58 (2006), pp. 1082-1085

http://dx.doi.org/10.1093/jac/dkl367 | Medline

[14.]

J. Rodríguez-Baño, M.D. Navarro, L. Romero, et al.

Risk-factors for emerging bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli.

Clin Microbiol Infect, 14 (2008), pp. 180-183

http://dx.doi.org/10.1111/j.1469-0691.2007.01884.x | Medline

[15.]

M. Tumbarello, T. Spanu, M. Sanguinetti, et al.

Bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome.

Antimicrob Agents Chemother, 50 (2006), pp. 498-504

http://dx.doi.org/10.1128/AAC.50.2.498-504.2006 | Medline

[16.]

C.I. Kang, S.H. Kim, D.M. Kim, et al.

Risk factors for and clinical outcomes of bloodstream infections caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae.

Infect Control Hosp Epidemiol, 25 (2004), pp. 860-867

http://dx.doi.org/10.1086/502310 | Medline

[17.]

H. MacAdam, T.E. Zaoutis, L.B. Gasink, W.B. Bilker, E. Lautenbach.

Investigating the association between antibiotic use and antibiotic resistance: impact of different methods of categorising prior antibiotic use.

Int J Antimicrob Agents, 28 (2006), pp. 325-332

http://dx.doi.org/10.1016/j.ijantimicag.2006.04.014 | Medline

[18.]

J.L. Mosqueda-Gómez, A. Montaño-Loza, A.L. Rolón, et al.

Molecular epidemiology and risk factors of bloodstream infections caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae: A case-control study.

Int J Infect Dis, 12 (2008), pp. 653-659

http://dx.doi.org/10.1016/j.ijid.2008.03.008 | Medline

[19.]

K. Serefhanoglu, H. Turan, F.E. Timurkaynak, H. Arslan.

Bloodstream infections caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae: risk factors for multidrug-resistance.

Braz J Infect Dis, 13 (2009), pp. 403-407

Medline

[20.]

J.C. McGregor, S.E. Rich, A.D. Harris, et al.

A systematic review of the methods used to assess the association between appropriate antibiotic therapy and mortality in bacteremic patients.

Clin Infect Dis, 45 (2007), pp. 329-337

http://dx.doi.org/10.1086/519283 | Medline