Outcomes and characteristics of ertapenemnonsusceptible Klebsiella pneumoniae bacteremia at a university hospital in Northern Taiwan: A matched case-control study
Shi-Wei Liu, Hong-Jyun Chang, Ju-Hsin Chia, An-Jing Kuo, Tsu-Lan Wu, Ming-Hsun Lee
Received: December 12, 2010 Revised: April 13, 2011 Accepted: June 19, 2011
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Gueishan 333, Taoyuan, Taiwan.
E-mail address: firstname.lastname@example.org (M.-H. Lee).
Background and purpose:
Carbapenem-resistant Klebsiella pneumoniae is an emerging problem worldwide. The object of this study was to investigate the risk factors, characteristics and outcomes of ertapenem-nonsusceptible K pneumoniae (ENSKp) bacteremia.
We conducted a 1:2 ratio matched case-control study. The controls were randomly selected among patients with ertapenem-susceptible K pneumoniae (ESKp) bacteremia and were matched with ENSKp cases for bacteremia.
Seventy-five patients were included in this study (25 cases and 50 controls). Bivariate analysis showed that prior exposure to either b-Lactam/b-Lactam-lactamase inhibitors (p Z 0.008) or 4th generation cephalosporins (p < 0.001), chronic obstructive pulmonary disease (COPD) (p Z 0.001), acute renal failure (p Z 0.021), chronic kidney disease without dialysis (p Z 0.021), recent hospital stay (p Z 0.016), intensive care unit stay (p Z 0.002), mechanical ventilation (p Z 0.003), central venous catheter placement (p Z 0.016), Foley indwelling (p Z 0.022), polymicrobial bacteremia (p Z 0.003) and higher Pittsburgh bacteremia
score (p < 0.001) were associated with ENSKp bacteremia. The multivariate analysis showed that prior exposure to 4th generation cephalosporins (odds ratio [OR], 28.05; 95% confidence interval [CI], 2.92e269.85; p Z 0.004), COPD (OR, 21.38; 95% CI, 2.95e154.92; p Z 0.002) and higher Pittsburgh bacteremia score (OR, 1.35; 95% CI, 1.10e1.66; p Z 0.004) were independent factors for ENSKp bacteremia. ENSKp bacteremia had a higher14-day mortality rate than ESKp bacteremia (44.0% vs. 22.0%; p Z 0.049). The overall inhospital mortality rates for these two groups were 60.0% and 40.0% respectively (p Z 0.102).
ENSKp bacteremia had a poor outcome and the risk factors were prior exposure of 4th generation cephalosporins, COPD and higher Pittsburgh bacteremia score. Antibiotic stewardship may be the solution for the preventive strategy.
Bacteremia; Ertapenem nonsusceptible; Klebsiella pneumoniae