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Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome.
Ann Hematol 2013; 92(4):533-41AH

Abstract

Escherichia coli and Klebsiella pneumoniae are main pathogens in neutropenic fever even if the proportion of Gram-positive cocci is increasing. Extended-spectrum β-lactamases (ESBL)-producing organisms are an emerging problem in nosocomial infection. Nevertheless, until now, information about risk factors for the acquisition and clinical outcomes of bacteremia due to ESBL-producing organisms is limited in neutropenic patients. From medical records collected between January 2007 and December 2008, we identified a total of 101 consecutive patients who developed bacteremia due to E. coli (n = 87) or K. pneumoniae (n = 14). Twenty-six (26 %) cases of bacteremia were caused by ESBL-producing organisms. A hospital stay of >2 weeks during the 3 months preceding bacteremia [adjusted odds ratio (OR), 5.887; 95 % confidence interval (CI), 1.572-22.041] and the use of broad-spectrum cephalosporins in the 4 weeks prior to bacteremia (adjusted OR, 6.186; 95 % CI, 1.616-23.683) were significantly related to the acquisition of ESBL. Twenty-four (92 %) of the ESBL-producing organisms were susceptible to either piperacillin-tazobactam or amikacin. Aminoglycosides (amikacin or isepamicin) were the main appropriate antimicrobial agents used against the ESBL-producing isolates during the initial empirical treatment (16/22, 73 %). However, the 30-day mortality rates for ESBL bacteremia and non-ESBL bacteremia were not significantly different (15 vs 5 %; p = 0.199). As alternatives to carbapenem, piperacillin-tazobactam plus amikacin or isepamicin combinations may be effective empirical therapeutic options for patients with neutropenic fever who are at high risk of developing bacteremia with ESBL-producing pathogens.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article

Language

eng

PubMed ID

23161391

Citation

Kim, Si-Hyun, et al. "Escherichia Coli and Klebsiella Pneumoniae Bacteremia in Patients With Neutropenic Fever: Factors Associated With Extended-spectrum Β-lactamase Production and Its Impact On Outcome." Annals of Hematology, vol. 92, no. 4, 2013, pp. 533-41.
Kim SH, Kwon JC, Choi SM, et al. Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome. Ann Hematol. 2013;92(4):533-41.
Kim, S. H., Kwon, J. C., Choi, S. M., Lee, D. G., Park, S. H., Choi, J. H., ... Min, W. S. (2013). Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome. Annals of Hematology, 92(4), pp. 533-41. doi:10.1007/s00277-012-1631-y.
Kim SH, et al. Escherichia Coli and Klebsiella Pneumoniae Bacteremia in Patients With Neutropenic Fever: Factors Associated With Extended-spectrum Β-lactamase Production and Its Impact On Outcome. Ann Hematol. 2013;92(4):533-41. PubMed PMID: 23161391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome. AU - Kim,Si-Hyun, AU - Kwon,Jae-Cheol, AU - Choi,Su-Mi, AU - Lee,Dong-Gun, AU - Park,Sun Hee, AU - Choi,Jung-Hyun, AU - Yoo,Jin-Hong, AU - Cho,Byung-Sik, AU - Eom,Ki-Seong, AU - Kim,Yoo-Jin, AU - Kim,Hee-Je, AU - Lee,Seok, AU - Min,Chang-Ki, AU - Cho,Seok-Goo, AU - Kim,Dong-Wook, AU - Lee,Jong-Wook, AU - Min,Woo-Sung, Y1 - 2012/11/17/ PY - 2012/10/27/received PY - 2012/11/05/accepted PY - 2012/11/20/entrez PY - 2012/11/20/pubmed PY - 2013/4/30/medline SP - 533 EP - 41 JF - Annals of hematology JO - Ann. Hematol. VL - 92 IS - 4 N2 - Escherichia coli and Klebsiella pneumoniae are main pathogens in neutropenic fever even if the proportion of Gram-positive cocci is increasing. Extended-spectrum β-lactamases (ESBL)-producing organisms are an emerging problem in nosocomial infection. Nevertheless, until now, information about risk factors for the acquisition and clinical outcomes of bacteremia due to ESBL-producing organisms is limited in neutropenic patients. From medical records collected between January 2007 and December 2008, we identified a total of 101 consecutive patients who developed bacteremia due to E. coli (n = 87) or K. pneumoniae (n = 14). Twenty-six (26 %) cases of bacteremia were caused by ESBL-producing organisms. A hospital stay of >2 weeks during the 3 months preceding bacteremia [adjusted odds ratio (OR), 5.887; 95 % confidence interval (CI), 1.572-22.041] and the use of broad-spectrum cephalosporins in the 4 weeks prior to bacteremia (adjusted OR, 6.186; 95 % CI, 1.616-23.683) were significantly related to the acquisition of ESBL. Twenty-four (92 %) of the ESBL-producing organisms were susceptible to either piperacillin-tazobactam or amikacin. Aminoglycosides (amikacin or isepamicin) were the main appropriate antimicrobial agents used against the ESBL-producing isolates during the initial empirical treatment (16/22, 73 %). However, the 30-day mortality rates for ESBL bacteremia and non-ESBL bacteremia were not significantly different (15 vs 5 %; p = 0.199). As alternatives to carbapenem, piperacillin-tazobactam plus amikacin or isepamicin combinations may be effective empirical therapeutic options for patients with neutropenic fever who are at high risk of developing bacteremia with ESBL-producing pathogens. SN - 1432-0584 UR - https://www.unboundmedicine.com/medline/citation/23161391/Escherichia_coli_and_Klebsiella_pneumoniae_bacteremia_in_patients_with_neutropenic_fever:_factors_associated_with_extended_spectrum_β_lactamase_production_and_its_impact_on_outcome_ L2 - https://dx.doi.org/10.1007/s00277-012-1631-y DB - PRIME DP - Unbound Medicine ER -