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Volume 45, Number 2, April 2012

Clinical characteristics of urosepsis caused by extended-spectrum beta-lactamase-producing
Escherichia coli or Klebsiella pneumonia and their emergence in the community


Jen-Chieh Lee, Nan-Yao Lee, Hsin-Chun Lee, Wei-Han Huang, Ko-Chung Tsui, Chia-Ming Chang, Ching-Chi Lee, Po-Lin Chen, Chi-Jung Wu, Po-Ren Hsueh*, Wen-Chien Ko


Received: April 29, 2011    Revised: June 6, 2011    Accepted: July 12, 2011   

 

Corresponding author:

Department of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
** Corresponding author. Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, 704, Tainan, Taiwan.
E-mail addresses: hsporen@ntu.edu.tw (P.-R. Hsueh), winston3415@gmail.com (W.-C. Ko).



 

Background and purpose: 

The purpose of this study is to delineate clinical characteristics of urosepsis caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) in different clinical settings, with an emphasis on community-acquired infections.



 

Methods:

A retrospective study was conducted at two medical centers in Taiwan. From May 2002 to August 2007, clinical data of adults with urosepsis caused by ESBL-EK were collected. Patients were categorized into three groups according to the place of acquisition. Baseline characteristics, microbiological data and clinical outcomes were compared.



 

Results:

Ninety-three cases of ESBL-EK urosepsis were included. Their mean age was 69.4 years, and 48.4% were men. Eleven (11.8%), 41 (44.1%), and 41 (44.1%) patients were categorized as having community-acquired, healthcare-associated, and hospital-acquired infections, respectively. Cases of ESBL-EK urosepsis from different settings shared similar characteristics in terms of age, gender, comorbidity and resistance profiles of bacterial strains. Of the bacterial isolates, 75% and 38.7% were resistant to fluoroquinolones and aminoglycosides, respectively. Cases of community-acquired urosepsis had a lower disease severity than those acquired in healthcare facilities or hospitals. Of note, there was no case fatality in 11 cases of community-acquired urosepsis and, in contrast, a crude mortality rate of 41.5% was found among adults with hospital-acquired urosepsis (p < 0.001).



 

Conclusion:

A limited number of adults with community-acquired urosepsis caused by ESBL-EK in
the present study had a favorable outcome. Nonetheless, clinicians should be cautious of the
emergence of urinary tract infections caused by ESBL-producers in the community setting.



 

Key words:

community-acquired bacteremia; extended-spectrum beta-lactamase; outcomes; UTI