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Volume 42, Number 4, August 2009

Extended-spectrum β-lactamase–producing phenotype signifies a poor prognosis for patients with cefpodoxime-resistant Escherichia coli or Klebsiella pneumoniae bacteremia


Chih-I Lee, Nan-Yao Lee, Jing-Jou Yan, Hsin-Chun Lee, Nai-Ying Ko, Chia-Ming Chang, Chi-Jung Wu, Po-Ling Chen, Li-Rong Wang, Wen-Chien Ko
J Microbiol Immunol Infect. 2009;42:303-309.

Received: December 8, 2009    Revised: December 8, 2009    Accepted: December 8, 2009   

 

Corresponding author:

Wen-Chein Ko, Division of Infectious Disease, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Rd., 704 Tainan, Taiwan.



 

Background and purpose: 

Bloodstream infections caused by multidrug-resistant Enterobacteriaceae are a major concern. This study explored the clinical impact of extended-spectrum B-lactamase (ESBL) production among cefpodoxime-resistant Escherichia coli and Klebsiella pneumoniae bacteremia.



 

Methods:

The medical charts and microbiological results of patients with cefpodoxime-resistant E. coli or K. pneumoniae bacteremia in a tertiary hospital in southern Taiwan between June 2003 and December 2006 were retrospectively reviewed. The clinical characteristics, medical histories, and clinical outcomes were evaluted. ESBL production was indicated by the double-disk synergy test.



 

Results:

 278 episodes of bacteremia cuased by cefpodoxime-resistant K. pneumoniae or E. coli were identified, of which 115 (41%) were ESBL producing. Compared with non-ESBL-producing bactermia, bacteremic episodes cuased by ESBL producers were less often community acquired (4.3% vs 26.4%; P<0.001). Underlying diabetes mellitus (48.7% vs 35.0%; p=0.002), liver cirrhosis (22.6% vs 11.7%; p=0.002, or uremia (21.7% vs 3.7%; P<0.001)were more common in ESBL-producing  bacteremia. In contrast, solid tumors were more frequent in non-ESBL-producing bacteremia (44.8% vs 27.8%; p=0.004). Overall, patients with ESBL-producing bacteremia had higher disease severity indicated by a Pittsburgh bacteremia score>=4, longer duration of hospital stay (51.1 days vs 31.9 days; p=0.007), more admission to intensive care units (19.1% vs 8.0%; P=0.006), and a higher mortality rate at 28 days (34.8% vs 23.9%; p=0.03).

 



 

Conclusion:

 ESBL production signifies a poor clinical outcome for patients with bacteremia caused by cefpodoxime-resistant E. coli or K. pneumoniae.



 

Key words:

Bacteremia; beta-lactamases; Cefpodoxime; Drug resistance, microbial; Escherichia coli; Klebisella pneumoniae