Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases.

Abstract

The prevalence of extended-spectrum beta -lactamase (ESBL) production by Klebsiella pneumonia approaches 50% in some countries, with particularly high rates in eastern Europe and Latin America. No randomized trials have ever been performed on treatment of bacteremia due to ESBL-producing organisms; existing data comes only from retrospective, single-institution studies. In a prospective study of 455 consecutive episodes of Klebsiella pneumoniae bacteremia in 12 hospitals in 7 countries, 85 episodes were due to an ESBL-producing organism. Failure to use an antibiotic active against ESBL-producing K. pneumoniae was associated with extremely high mortality. Use of a carbapenem (primarily imipenem) was associated with a significantly lower 14-day mortality than was use of other antibiotics active in vitro. Multivariate analysis including other predictors of mortality showed that use of a carbapenem during the 5-day period after onset of bacteremia due to an ESBL-producing organism was independently associated with lower mortality. Antibiotic choice is particularly important in seriously ill patients with infections due to ESBL-producing K. pneumoniae.

• Authors: David L Paterson, Wen-Chien Ko, Anne Von Gottberg, Sunita Mohapatra, Jose Maria Casellas, Herman Goossens, Lutfiye Mulazimoglu, Gordon Trenholme, Keith P Klugman, Robert A Bonomo, Louis B Rice, Marilyn M Wagener, Joseph G McCormack, Victor L Yu
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 39 Issue 1 Pg. 31-7 (Jul 01 2004) ISSN: 1537-6591 [Electronic] United States
• PMID: 15206050 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Imipenem
• beta-Lactamases

Topics

• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Bacteremia (drug therapy, mortality)
• Drug Resistance, Bacterial
• Drug Utilization
• Female
• Humans
• Imipenem (pharmacology, therapeutic use)
• Klebsiella Infections (drug therapy, mortality)
• Klebsiella pneumoniae (drug effects, enzymology)
• Male
• Multivariate Analysis
• beta-Lactam Resistance (physiology)
• beta-Lactamases (metabolism)