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Bloodstream infections due to extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae Risk factors for mortality and clinical outcome, with special emphasis on antimicrobial therapy



Bloodstream infections due to extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae Risk factors for mortality and clinical outcome, with special emphasis on antimicrobial therapy



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 43: 364



Background: This study was conducted to evaluate risk factors for mortality and treatment outcome of bloodstream infections due to extended spectrum beta-lactamase producing E. coli and K. pneumoniae (ESBL-EK). Methods: ESBL production was phenotypically determined according to NCCLS guidelines and/or double-disk synergy test, in stored K. pneumoniae and E. coli blood isolates from Jan 1998 to Dec 2002. 66 patients with ESBL-producing K. pneumoniae bacteremia and 67 with ESBL-producing E. coli bacteremia were enrolled in this study. Results: Overall 30-day mortality was 25.6% (34/133). Independent risk factors for mortality were severe sepsis, peritonitis, neutropenia, increasing APACHE II score, and administration of broad spectrum cephalosporin as definitive antimicrobial therapy (All P-value <0.05). However, administration of cephalosporin as initial empirical antimicrobial therapy was not significant risk factor for mortality (OR=1.10, 95% CI=0.42-2.87, P=0.842). The 30-day mortality was 16% (16/100) in group received carbapenem or ciprofloxacin as definitive antibiotic and 55% (18/33) in group received broad spectrum cephalosporin+-aminoglycoside. When evaluating patients who had received carbapenem or ciprofloxacin susceptible in vitro as definitive antibiotics, the mortality for the group received delayed effective antimicrobial therapy was not significantly higher than that for the group received initial effective antimicrobial therapy (18.9% vs. 15.5%, P=0.666). Conclusions: Carbapenem and ciprofloxacin were the most effective antibiotics in antimicrobial therapy for ESBL-EK bacteremia. However, delay in effective definitive antimicrobial therapy was not associated with higher mortality if antimicrobial therapy was adjusted appropriately when antibiotic susceptibility results were returned.

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Accession: 034498149

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