Clinical characteristics of urosepsis caused by extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumonia and their emergence in the community.

Abstract

BACKGROUND:

The purpose of this study is to delineate clinical characteristics of urosepsis caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) in different clinical settings, with an emphasis on community-acquired infections.

METHODS:

A retrospective study was conducted at two medical centers in Taiwan. From May 2002 to August 2007, clinical data of adults with urosepsis caused by ESBL-EK were collected. Patients were categorized into three groups according to the place of acquisition. Baseline characteristics, microbiological data and clinical outcomes were compared.

RESULTS:

Ninety-three cases of ESBL-EK urosepsis were included. Their mean age was 69.4 years, and 48.4% were men. Eleven (11.8%), 41 (44.1%), and 41 (44.1%) patients were categorized as having community-acquired, healthcare-associated, and hospital-acquired infections, respectively. Cases of ESBL-EK urosepsis from different settings shared similar characteristics in terms of age, gender, comorbidity and resistance profiles of bacterial strains. Of the bacterial isolates, 75% and 38.7% were resistant to fluoroquinolones and aminoglycosides, respectively. Cases of community-acquired urosepsis had a lower disease severity than those acquired in healthcare facilities or hospitals. Of note, there was no case fatality in 11 cases of community-acquired urosepsis and, in contrast, a crude mortality rate of 41.5% was found among adults with hospital-acquired urosepsis (p < 0.001).

CONCLUSION:

A limited number of adults with community-acquired urosepsis caused by ESBL-EK in the present study had a favorable outcome. Nonetheless, clinicians should be cautious of the emergence of urinary tract infections caused by ESBL-producers in the community setting.

• Authors: Jen-Chieh Lee, Nan-Yao Lee, Hsin-Chun Lee, Wei-Han Huang, Ko-Chung Tsui, Chia-Ming Chang, Ching-Chi Lee, Po-Lin Chen, Chi-Jung Wu, Po-Ren Hsueh, Wen-Chien Ko
• Journal: Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi (J Microbiol Immunol Infect) Vol. 45 Issue 2 Pg. 127-33 (Apr 2012) ISSN: 1995-9133 [Electronic] England
• PMID: 22041167 (Publication Type: Journal Article)
• Copyright: Copyright © 2011. Published by Elsevier B.V.

Chemical References

• beta-Lactamases

Topics

• Adult
• Aged
• Aged, 80 and over
• Community-Acquired Infections (complications, epidemiology, microbiology, pathology)
• Escherichia coli (enzymology, isolation & purification)
• Escherichia coli Infections (epidemiology, microbiology, pathology)
• Female
• Humans
• Klebsiella Infections (epidemiology, microbiology, pathology)
• Klebsiella pneumoniae (enzymology, isolation & purification)
• Male
• Middle Aged
• Prevalence
• Retrospective Studies
• Sepsis (epidemiology, microbiology, pathology)
• Taiwan (epidemiology)
• Urinary Tract Infections (complications, epidemiology, microbiology, pathology)
• beta-Lactamases (metabolism)