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

Alexandre R Marra; Sérgio B Wey; Adauto Castelo; Ana Cristina Gales; Ruy Guilherme R Cal; José R do Carmo Filho; Michael B Edmond; Carlos Alberto P Pereira

doi:10.1186/1471-2334-6-24

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

Journal article

Open access

Peer reviewed

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

Alexandre R Marra, Sérgio B Wey, Adauto Castelo, Ana Cristina Gales, Ruy Guilherme R Cal, José R do Carmo Filho, Michael B Edmond and Carlos Alberto P Pereira

BMC infectious diseases, Vol.6(1), 24

02/14/2006

DOI: 10.1186/1471-2334-6-24

PMCID: PMC1382232

PMID: 16478537

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Abstract

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. 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. 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). 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.

Brazil

Comorbidity

Multivariate Analysis

Klebsiella pneumoniae - isolation & purification

beta-Lactam Resistance

Humans

Middle Aged

Cross Infection - mortality

Child, Preschool

Bacteremia - mortality

Infant

Male

beta-Lactamases - biosynthesis

Bacteremia - microbiology

Anti-Bacterial Agents - therapeutic use

Klebsiella Infections - epidemiology

Adult

Female

Retrospective Studies

Klebsiella pneumoniae - metabolism

Child

Cross Infection - epidemiology

Risk Factors

Logistic Models

Klebsiella Infections - microbiology

Respiration, Artificial

Cross Infection - microbiology

Adolescent

Bacteremia - epidemiology

Klebsiella Infections - mortality

Aged

Details

Title: Subtitle: Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum beta-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence
Creators: Alexandre R Marra - Division of Infectious Diseases, Universidade Federal de São Paulo, Brasil (UNIFESP-EPM)/Hospital São Paulo (HSP), Brasil. a.marra@uol.com.br
Sérgio B Wey
Adauto Castelo
Ana Cristina Gales
Ruy Guilherme R Cal
José R do Carmo Filho
Michael B Edmond
Carlos Alberto P Pereira
Resource Type: Journal article
Publication Details: BMC infectious diseases, Vol.6(1), 24
DOI: 10.1186/1471-2334-6-24
PMID: 16478537
PMCID: PMC1382232
NLM abbreviation: BMC Infect Dis
ISSN: 1471-2334
eISSN: 1471-2334
Publisher: England
Language: English
Date published: 02/14/2006
Academic Unit: Internal Medicine
Record Identifier: 9983905522102771

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