JSTOR: Infection Control and Hospital Epidemiology, Vol. 25, No. 10 (October 2004), pp. 860-867

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Infection Control and Hospital Epidemiology Publication Info

Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America

Article DOI: 10.1086/502310

Stable URL: http://www.jstor.org/stable/10.1086/502310

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Original Articles

Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended‐Spectrum Beta‐Lactamase–Producing Klebsiella pneumoniae

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Abstract
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Abstract(back to top)

OBJECTIVE. To evaluate risk factors and treatment outcomes of bloodstream infections caused by extended‐spectrum beta‐lactamase–producing Klebsiella pneumoniae (ESBL‐KP).

DESIGN. Retrospective case–control study. Stored blood isolates of K. pneumoniae were tested for ESBL production by NCCLS guidelines, double‐disk synergy test, or both.

SETTING. A 1,500‐bed, tertiary‐care university hospital and referral center.

PATIENTS. Sixty case‐patients with bacteremia due to ESBL‐KP were compared with 60 matched control‐patients with non–ESBL‐KP.

RESULTS. There were no significant differences in age, gender, APACHE II score, or underlying diseases between the groups. Independent risk factors for infections caused by ESBL‐KP were urinary catheterization, invasive procedure within the previous 72 hours, and an increasing number of antibiotics administered within the previous 30 days. Complete response rate, evaluated 72 hours after initial antimicrobial therapy, was higher among control‐patients (13.3% vs 36.7%; P = .003). Treatment failure rate was higher among case‐patients (35.0% vs 15%; P = .011). Overall 30‐day mortality rate was 30% for case‐patients and 28.3% for control‐patients (P = .841). Case‐patients who received imipenem or ciprofloxacin as a definitive antibiotic had 10.5% mortality. The mortality rate for initially ineffective therapy was no higher than that for initially effective therapy (9.1% vs 11.1%; P = 1.000), but statistical power was low for evaluating mortality in the absence of septic shock.

CONCLUSION. For K. pneumoniae bacteremia, patients with ESBL‐KP had a higher initial treatment failure rate but did not have higher mortality if antimicrobial therapy was appropriately adjusted in this study with limited statistical power.

Bibliographic Information(back to top)

Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended‐Spectrum Beta‐Lactamase–Producing Klebsiella pneumoniae
Cheol‐In Kang , MD, Sung‐Han Kim , MD, Dong Min Kim , MD, Wan Beom Park , MD, Ki‐Deok Lee , MD, Hong‐Bin Kim , MD, Myoung‐don Oh , MD, Eui‐Chong Kim , MD and Kang‐Won Choe , MD
Infection Control and Hospital Epidemiology
Vol. 25, No. 10 (October 2004) (pp. 860-867)

Author Information(back to top)

Cheol‐In Kang , MD; Sung‐Han Kim , MD; Dong Min Kim , MD; Wan Beom Park , MD; Ki‐Deok Lee , MD; Hong‐Bin Kim , MD; Myoung‐don Oh , MD; Eui‐Chong Kim , MD; Kang‐Won Choe , MD

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Notes

Drs. Kang, S‐H. Kim, D. M. Kim, Park, Lee, H‐B. Kim, Oh, and Choe are from the Department of Internal Medicine and Dr. E‐C. Kim is from the Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea. Drs. Oh, E‐C. Kim, and Choe are also from the Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.Address reprint requests to Myoung‐don Oh, MD, Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon‐dong Chongno‐gu, Seoul 110‐744, Republic of Korea.Presented in part at the 13th European Congress of Clinical Microbiology and Infectious Diseases; May 10‐13, 2003; Glasgow, United Kingdom.

Items Citing this Item (back to top)

8 item(s) in JSTOR cite this item

Potential Role of Active Surveillance in the Control of a Hospital‐Wide Outbreak of Carbapenem‐Resistant Klebsiella pneumoniae Infection •
Debby Ben‐David , MD; Yasmin Maor , MD; Nathan Keller , MD; Gili Regev‐Yochay , MD; Ilana Tal , MS; Dalit Shachar , RN; Amir Zlotkin , PhD; Gill Smollan , MD; Galia Rahav , MD
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Role of Matching in Case‐Control Studies of Antimicrobial Resistance •
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Vol. 30, No. 5 (May 2009) pp. 479-483
Stable URL: http://www.jstor.org/stable/10.1086/597061
Clinical and Molecular Epidemiology of Healthcare‐Associated Infections Due to Extended‐Spectrum β‐Lactamase (ESBL)–Producing Strains of Escherichia coli and Klebsiella pneumoniae That Harbor Multiple ESBL Genes •
Anucha Apisarnthanarak , MD; Pattarachai Kiratisin , MD, PhD; Linda M. Mundy , MD
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Vol. 29, No. 11 (November 2008) pp. 1026-1034
Stable URL: http://www.jstor.org/stable/10.1086/591864
Intensive Care Unit Outbreak of Extended-Spectrum β-Lactamase–Producing Klebsiella Pneumoniae Controlled by Cohorting Patients and Reinforcing Infection Control Measures
C. Laurent MDMDRNRNMD, PhDMScMD, PhDMD, PhD; H. Rodriguez-Villalobos MDMDRNRNMD, PhDMScMD, PhDMD, PhD; F. Rost MDMDRNRNMD, PhDMScMD, PhDMD, PhD; H. Strale MDMDRNRNMD, PhDMScMD, PhDMD, PhD; J.-L. Vincent MDMDRNRNMD, PhDMScMD, PhDMD, PhD; A. Deplano MDMDRNRNMD, PhDMScMD, PhDMD, PhD; M. J. Struelens MDMDRNRNMD, PhDMScMD, PhDMD, PhD; B. Byl MDMDRNRNMD, PhDMScMD, PhDMD, PhD
Infection Control and Hospital Epidemiology
Vol. 29, No. 6 (June 2008) pp. 517-524
Stable URL: http://www.jstor.org/stable/10.1086/588004
Risk Factors for and Outcomes of Healthcare‐Associated Infection Due to Extended‐Spectrum β‐Lactamase–Producing Escherichia coli or Klebsiella pneumoniae in Thailand •
Anucha Apisarnthanarak , MD; Pattarachai Kiratisin , MD, PhD; Payawan Saifon , BSc; Rungrueng Kitphati , MD; Surang Dejsirilert , MSc; Linda M. Mundy , MD
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Vol. 28, No. 7 (July 2007) pp. 873-876
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Impact of Different Methods for Describing the Extent of Prior Antibiotic Exposure on the Association Between Antibiotic Use and Antibiotic‐Resistant Infection •
Emily P. Hyle , MD; Warren B. Bilker , PhD; Leanne B. Gasink , MD, MSCE; Ebbing Lautenbach , MD, MPH, MSCE
Infection Control and Hospital Epidemiology
Vol. 28, No. 6 (June 2007) pp. 647-654
Stable URL: http://www.jstor.org/stable/10.1086/516798
Prevalence, Treatment, and Outcome of Infection Due to Extended‐Spectrum β‐Lactamase–Producing Microorganisms •
Anucha Apisarnthanarak , MD; Linda M. Mundy , MD
Infection Control and Hospital Epidemiology
Vol. 27, No. 3 (March 2006) p. 325
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Clinical Epidemiology of Ciprofloxacin Resistance and Its Relationship to Broad‐Spectrum Cephalosporin Resistance in Bloodstream Infections Caused by Enterobacter Species •
Cheol‐In Kang , MD; Sung‐Han Kim , MD; Wan Beom Park , MD; Ki‐Deok Lee , MD; Hong‐Bin Kim , MD; Eui‐Chong Kim , MD; Myoung‐don Oh , MD; Kang‐Won Choe , MD
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Vol. 26, No. 1 (January 2005) pp. 88-92
Stable URL: http://www.jstor.org/stable/10.1086/502492

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