Epidemiology and clinical features of community-onset bacteremia caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae.

Abstract

There is limited clinical information regarding community-onset bacteremia caused by extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae. This study was performed to evaluate risk factors and clinical outcomes of community-onset bacteremia caused by ESBL-producing K. pneumoniae. A total of 435 patients with community-onset K. pneumoniae bacteremia were included and data from patients with ESBL-producing K. pneumoniae bacteremia were compared to those with non-ESBL-producing bacteremia. Isolates with ESBLs were microbiologically characterized. Of 435 patients with community-onset K. pneumoniae bacteremia, 33 (7.6%) were infected with ESBL producers, of which 25 were further classified as healthcare-associated infections. The most common underlying diseases were solid tumors (n = 20, 60.6%) and diabetes mellitus (n = 10, 30.3%), and the most common infection was intra-abdominal infection (n = 20, 60.6%). Multivariate analysis showed that corticosteroid use (odds ratio [OR] = 13.73, 95% confidence interval [CI] = 1.93-97.6, p = 0.009), percutaneous tubes (OR = 7.30, 95% CI = 2.41-22.12, p < 0.001), and prior receipt of antibiotics (OR = 5.65, 95% CI = 2.43-14.16, p < 0.001) were significant factors associated with ESBL producers. When the 30-day mortality rate was evaluated, no significant difference was found between ESBL group and non-ESBL group (12.1% [4/32] vs. 16.0% [35/192]; p = 0.429). Among 16 isolates, for which the ESBL characterization was performed by PCR, the most common types of ESBLs were SHV (n = 16) and cefotaxime-M-2 (n = 5). Pulsed-field gel electrophoresis analysis of the ESBL-producing organisms showed extensive clonal diversity. ESBL-producing K. pneumoniae is a significant cause of bacteremia, even in patients with community-onset infections, particularly in patients with corticosteroid use, percutaneous tube, prior receipt of antibiotics, or healthcare-associated infections.

• Authors: Jeong-a Lee, Cheol-In Kang, Eun-Jeong Joo, Young Eun Ha, Seung-Ji Kang, So Yeon Park, Doo Ryeon Chung, Kyong Ran Peck, Kwan Soo Ko, Nam Yong Lee, Jae-Hoon Song
• Journal: Microbial drug resistance (Larchmont, N.Y.) (Microb Drug Resist) Vol. 17 Issue 2 Pg. 267-73 (Jun 2011) ISSN: 1931-8448 [Electronic] United States
• PMID: 21388296 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Anti-Bacterial Agents
• beta-Lactamases

Topics

• Administration, Cutaneous
• Adrenal Cortex Hormones (adverse effects, pharmacology)
• Anti-Bacterial Agents (pharmacology)
• Case-Control Studies
• Community-Acquired Infections (complications, drug therapy, epidemiology, microbiology, mortality)
• Comorbidity
• Cross Infection (complications, drug therapy, microbiology, mortality)
• Diabetes Complications
• Diabetes Mellitus (drug therapy, pathology)
• Humans
• Klebsiella Infections (complications, drug therapy, epidemiology, microbiology, mortality)
• Klebsiella pneumoniae (classification, drug effects, genetics, isolation & purification)
• Neoplasms (complications, drug therapy, pathology)
• Phylogeny
• Republic of Korea (epidemiology)
• Risk Factors
• Survival Analysis
• Treatment Outcome
• beta-Lactam Resistance (drug effects, genetics)
• beta-Lactamases (metabolism)