Nosocomial extended-spectrum beta-lactamase-producing Klebsiella pneumoniae bacteremia in hemodialysis patients and the implications for antibiotic therapy.

Abstract

BACKGROUND:

In the face of increasing treatment options for extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) hemodialysis (HD) access-related bacteremia, the difference in clinical effectiveness between ertapenem and flomoxef remains unclear. We conducted this retrospective study to determine their efficacies and treatment outcomes.

METHODS:

Patients on maintenance HD with fistula-, graft-, or catheter-related ESBL-Kp bacteremia were enrolled. Data related to clinical features and antibiotic treatments were collected. Outcome was determined by mortality resulting from bacteremia during the 14-day period after the collection of the first positive blood culture for flomoxef-susceptible ESBL-Kp.

RESULTS:

The 64 patients studied had severe septicemia as determined by the Pitt bacteremia score; 50% (32/64) were in the intensive care unit (ICU) at the time of bacteremia. Old age (>65 years; 57.8%), malnutrition (albumin<3.5g/dl; 92.2%), a history of severe illnesses (defined by shock, intubation, or ICU stay; 82.5%), and prolonged hospitalization prior to the onset of bacteremia (>30 days; 75%) were also highly prevalent. The study population comprised nine fistula-, 10 graft-, and 45 HD catheter-related bacteremia cases, and the mortality rate was high (38/64, 59.4%). The mortality rate was significantly higher in the flomoxef treatment group than in the ertapenem treatment group (22/30, 73% vs. 16/34, 47%, p<0.05). Among patients with catheter-related bacteremia, multivariate analyses revealed that flomoxef use (odds ratio (OR) 2.52, 95% confidence interval (CI) 1.34-35.17) and Pitt bacteremia score (OR 4.37, 95% CI 1.28-5.26) were independently associated with mortality.

CONCLUSIONS:

In accordance with our previous study, our results have demonstrated the inferiority of flomoxef to carbapenems in the treatment of HD access-related ESBL-Kp bacteremia and provide an insight into the possibility of using ertapenem rather than flomoxef as an initial or de-escalating therapy for infections caused by ESBL-producing bacteria.

• Authors: Chih-Chao Yang, Chien-Hsing Wu, Chien-Te Lee, Han-Tsung Liu, Jin-Bor Chen, Chien-Hua Chiu, Chih-Hung Chen, Feng-Rong Chuang
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 28 Pg. 3-7 (Nov 2014) ISSN: 1878-3511 [Electronic] Canada
• PMID: 25200093 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• beta-Lactams
• beta-Lactamases
• Ertapenem
• flomoxef

Topics

• Aged
• Anti-Bacterial Agents (therapeutic use)
• Bacteremia (drug therapy, microbiology, mortality)
• Cephalosporins (therapeutic use)
• Cross Infection (drug therapy, microbiology, mortality)
• Ertapenem
• Female
• Humans
• Klebsiella Infections (drug therapy, microbiology, mortality)
• Klebsiella pneumoniae (enzymology, isolation & purification)
• Male
• Middle Aged
• Renal Dialysis
• Retrospective Studies
• Treatment Outcome
• beta-Lactamases (metabolism)
• beta-Lactams (therapeutic use)