Clinical significance and impact on mortality of extended-spectrum beta lactamase-producing Enterobacteriaceae isolates in nosocomial bacteremia.
During an 8-month period, 55 episodes of nosocomial bacteremia caused by Enterobacteriaceae species were identified in a tertiary medical center, of which 26 (47%) were caused by extended-spectrum beta lactamase (ESBL)-producing organisms. ESBL production was associated with resistance to aminoglycosides, fluoroquinolones, tetracycline and co-trimoxazole compared with non-ESBL-producing organisms (p < 0.01). By multivariate analysis, infection with ESBL-producing organisms was associated with previous antibiotic therapy and central venous catheter insertion and mortality was associated with heart failure, malignancy and a prolonged hospital stay. Nineteen (73%) patients infected with ESBL-producing organisms received adequate empirical antibiotic therapy and all 26 received adequate definitive therapy. The in-hospital mortality rate did not differ between patients infected with ESBL producers and those infected by non-ESBL-producing Enterobacteriaceae species [13/26 (50%) and 11/29 (38%), respectively] (p > 0.5).
Menashe
G
G
Infectious Disease Institute, Soroka Medical Center and the Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Borer
A
A
Yagupsky
P
P
Peled
N
N
Gilad
J
J
Fraser
D
D
Riesenberg
K
K
Schlaeffer
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D002405:Catheterization, Central Venous; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D001618:beta-Lactamases / Q000096:biosynthesis*
D000900:Anti-Bacterial Agents; D001618:beta-Lactamases