Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases.
The prevalence of extended-spectrum beta -lactamase (ESBL) production by Klebsiella pneumonia approaches 50% in some countries, with particularly high rates in eastern Europe and Latin America. No randomized trials have ever been performed on treatment of bacteremia due to ESBL-producing organisms; existing data comes only from retrospective, single-institution studies. In a prospective study of 455 consecutive episodes of Klebsiella pneumoniae bacteremia in 12 hospitals in 7 countries, 85 episodes were due to an ESBL-producing organism. Failure to use an antibiotic active against ESBL-producing K. pneumoniae was associated with extremely high mortality. Use of a carbapenem (primarily imipenem) was associated with a significantly lower 14-day mortality than was use of other antibiotics active in vitro. Multivariate analysis including other predictors of mortality showed that use of a carbapenem during the 5-day period after onset of bacteremia due to an ESBL-producing organism was independently associated with lower mortality. Antibiotic choice is particularly important in seriously ill patients with infections due to ESBL-producing K. pneumoniae.
Paterson
David L
DL
Infectious Disease Section, VA Medical Center, Pittsburgh, Pennsylvania 15240, USA.
Ko
Wen-Chien
WC
Von Gottberg
Anne
A
Mohapatra
Sunita
S
Casellas
Jose Maria
JM
Goossens
Herman
H
Mulazimoglu
Lutfiye
L
Trenholme
Gordon
G
Klugman
Keith P
KP
Bonomo
Robert A
RA
Rice
Louis B
LB
Wagener
Marilyn M
MM
McCormack
Joseph G
JG
Yu
Victor L
VL
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000401:mortality; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology / Q000627:therapeutic use; D007710:Klebsiella Infections / Q000188:drug therapy / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008297:Male; D015999:Multivariate Analysis; D018440:beta-Lactam Resistance / Q000502:physiology*; D001618:beta-Lactamases / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D015378:Imipenem; D001618:beta-Lactamases