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Volume 39, Number 6, December 2006

Bacteremia due to extended-spectrum beta-lactamase-producing Enterobacteriaceae other than Escherichia coli and Klebsiella


Shie-Shian Huang, Ming-Hsun Lee, Hsieh-Shong Leu
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Received: June 3, 2005    Revised: January 25, 2006    Accepted: March 20, 2006   

 

Corresponding author:

Dr. Hsieh-Shong Leu, Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Shin St., Kweishan 333, Taoyuan, Taiwan. E-mail: hsleu@adm.cgmh.org.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

Carbapenems are considered the drugs of choice for the treatment of serious infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella and Escherichia coli. However, controversy exists about the antibiotic choice for infections due to ESBL-producing organisms of other genera.

 



 

Methods:

This retrospective study evaluated the risk factors and outcomes of 54 adult patients with bacteremia due to ESBL-producing Enterobacteriaceae other than Klebsiella spp. or E. coli treated at a tertiary care hospital in northern Taiwan from January 2001-December 2003. Patients were categorized into carbapenem (n = 22) and non-carbapenem (n = 32) treatment groups. All patients had at least one positive blood culture together with fever or other clinical features compatible with systemic infection.
 



 

Results:

Higher Acute Physiology and Chronic Health Evaluation II score, glucocorticoid use, and presentation of septic shock were significant risk factors for mortality (p<0.05). Patients treated with a carbapenem had a better 14-day or overall survival rate (i.e., survived to discharge) than those treated with non-carbapenem antibiotics, although this difference was not significant. Among patients in the non-carbapenem group, the overall survival rates of ciprofloxacin, aminoglycoside, and ceftazidime were 70% (14/20), 62.5% (5/8), and 50% (2/4), respectively (p=0.877). The overall survival rates of the carbapenem (72.7%) and ciprofloxacin (70.0%) groups were similar.

 



 

Conclusion:

The results suggest that ciprofloxacin, when indicated based on antimicrobial susceptibility testing, may serve as an alternative choice for infections caused by ESBL-producing Enterobacteriaceae other than E. coli or Klebsiella spp. and may not affect the clinical outcome at discharge.

 



 

Key words:

Bacteremia, beta-lactamase, carbapenems



 



 

J Microbiol Immunol Infect 2006;39:496-502.