Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum β-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence

Authors

Alexandre R. Marra, Virginia Commonwealth UniversityFollow
Sérgio B. Wey, Universidade Federal de São Paulo
Adauto Castelo, Universidade Federal de São Paulo
Ana Cristina Gales, Universidade Federal de São Paulo
Guilherme R. Cal, Hospital Israelita Albert Einstein
José R. do Carmo Filho, Universidade Federal de São Paulo
Michael B. Edmond, Virginia Commonwealth UniversityFollow
Carlos Alberto Pires Pereira, Universidade Federal de São Paulo

Document Type

Article

Original Publication Date

2006

Journal/Book/Conference Title

BMC Infectious Diseases

Volume

2006

DOI of Original Publication

10.1186/1471-2334-6-24

Comments

Originally published at http://dx.doi.org/10.1186/1471-2334-6-24

Date of Submission

September 2014

Abstract

Background The frequency of ESBL producing Klebsiella pneumoniae bloodstream infections (BSI) is high in Brazilian hospitals, however little is known regarding what role, if any, resistance plays in the expected outcome in hospitals with a high prevalence of these pathogens.

Methods From 1996 to 2001, hospital acquired K. pneumoniae BSI were evaluated retrospectively. Each patient was included only once at the time of BSI. ESBL producing strains were identified using the E-test method. The association of variables with the mortality related to bacteremia was included in a stepwise logistic regression model.

Results One hundred and eight hospital acquired K. pneumoniae BSI met criteria for inclusion. Fifty two percent were due to ESBL producing strains. The overall in-hospital mortality was 40.8%. Variables independently predicting death by multivariate analysis were the following: mechanical ventilation (p = 0.001), number of comorbidities (p = 0.003), antimicrobials prescribed before bacteremia (p = 0.01) and fatal underlying disease (p = 0.025).

Conclusion Bacteremia due to ESBL producing K. pneumoniae strains was not an independent predictor for death in patients with BSI. An increased mortality in hospital-acquired BSI by K. pneumoniae was related to the requirement for mechanical ventilation, more than two comorbidities, the previous use of two or more antibiotics, and the presence of a rapidly fatal disease.

Rights

© 2006 Marra et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Is Part Of

VCU Internal Medicine Publications