title: Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome.
abstract: OBJECTIVE
  To study the risk factor for nosocomial bacteremia caused by Escherichia coli or Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL) and the influence on patient outcome.
  
  
  METHODS
  Retrospective, single-center study of consecutive bacteremic patients.
  
  
  METHODS
  A university-affiliated teaching hospital.
  
  
  METHODS
  A total of 85 patients with nosocomial bacteremia due to E. coli or K. pneumoniae were enrolled.
  
  
  METHODS
  None.
  
  
  RESULTS
  The demographic characteristics and clinical information including treatment were recorded upon review of patients' records. The primary end point was hospital mortality. Twenty-seven percent of isolates produced ESBLs. Previous treatment with 3rd-generation cephalosporins was the only independent risk factor for bacteremia due to ESBL-producing pathogens [odds ratio (OR) 4.146, P=0.008]. Antibiotic treatment was considered appropriate in 71 cases (83%), and failed in 23 patients (27%). Twenty-one patients (25%) died in the hospital. Antibiotic treatment failure was the only independent risk factor for hospital mortality (OR 15.376, P=0.001). Inappropriate antibiotic treatment might lead to significantly higher mortality rate (7/14 vs 14/71, P=0.016). Patients treated with imipenem were more likely to survive while those receiving cephalosporin treatment tended to have a poorer outcome (1/19 vs 14/40, P=0.023).
  
  
  CONCLUSIONS
  More judicious use of cephalosporins, especially 3rd-generation cephalosporins, may decrease ESBL-producing E. coli or K. pneumoniae bacteremia, and also improve patient outcome.
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing 100730, P R China. dubin98@yahoo.com
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.forename: Yun
authors.initials: Y
authors.lastname: Long
authors.forename: Hongzhong
authors.initials: H
authors.lastname: Liu
authors.forename: Dechang
authors.initials: D
authors.lastname: Chen
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
authors.forename: Yingchun
authors.initials: Y
authors.lastname: Xu
authors.forename: Xiuli
authors.initials: X
authors.lastname: Xie
mesh_terms: D018806:APACHE; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000201:enzymology*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases