title: Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases.
abstract: 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.
authors.affiliation: Infectious Disease Section, VA Medical Center, Pittsburgh, Pennsylvania 15240, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
authors.forename: Anne
authors.initials: A
authors.lastname: Von Gottberg
authors.forename: Sunita
authors.initials: S
authors.lastname: Mohapatra
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Casellas
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Lutfiye
authors.initials: L
authors.lastname: Mulazimoglu
authors.forename: Gordon
authors.initials: G
authors.lastname: Trenholme
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.forename: Louis B
authors.initials: LB
authors.lastname: Rice
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Joseph G
authors.initials: JG
authors.lastname: McCormack
authors.forename: Victor L
authors.initials: VL
authors.lastname: Yu
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem; D001618:beta-Lactamases