title: Clinical implications of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae bacteraemia.
abstract: To identify the clinical implications of extended-spectrum beta-lactamase (ESBL) production, 162 cases of Klebsiella pneumoniae bacteraemia in 154 adults were analysed. Of these cases, 44 (27.2%) were ESBL-producing (ESBLKP). Common sources of ESBLKP bacteraemia included primary bacteraemia (34.1%) and biliary infection (29.5%). The placement of a biliary drainage catheter, nosocomial acquisition, and prior antibiotic therapy were independently associated with ESBL production in multivariate analysis. More cases of ESBLKP than non-ESBLKP received inappropriate antibiotic therapy before culture results were reported (54.5 vs. 3.4%; P = 0.001). In 19 cases of ESBLKP, no significant difference in mortality was observed between patients who received appropriate empiric antibiotic therapy and those who did not (26.3 vs. 20.8%; P = 0.67). The mean length of hospital stay after the onset of bacteraemia was longer in the cases of ESBLKP than in the cases of non-ESBLKP (39.6 vs. 23.9 days; P = 0.008). Directly related mortality was not significantly different between the cases of ESBLKP and the cases of non-ESBLKP (23.3 vs. 20.0%; P = 0.65). None of the patients with biliary infection due to ESBLKP died (0/12; P = 0.03). In conclusion, ESBL production was not significantly associated with death but it had a considerable impact on patients with K. pneumoniae bacteraemia.
authors.affiliation: Division of Infectious Diseases, Asan Medical Center, Seoul, Korea. yskim@amc.seoul.kr
authors.forename: B-N
authors.initials: BN
authors.lastname: Kim
authors.forename: J-H
authors.initials: JH
authors.lastname: Woo
authors.forename: M-N
authors.initials: MN
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Ryu
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D007723:Korea / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases