Bacteremia due to extended-spectrum beta-lactamase-producing Enterobacteriaceae other than Escherichia coli and Klebsiella.
OBJECTIVE
Carbapenems are considered the drugs of choice for the treatment of serious infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella and Escherichia coli. However, controversy exists about the antibiotic choice for infections due to ESBL-producing organisms of other genera.


METHODS
This retrospective study evaluated the risk factors and outcomes of 54 adult patients with bacteremia due to ESBL-producing Enterobacteriaceae other than Klebsiella spp. or E. coli treated at a tertiary care hospital in northern Taiwan from January 2001-December 2003. Patients were categorized into carbapenem (n = 22) and non-carbapenem (n = 32) treatment groups. All patients had at least one positive blood culture together with fever or other clinical features compatible with systemic infection.


RESULTS
Higher Acute Physiology and Chronic Health Evaluation II score, glucocorticoid use, and presentation of septic shock were significant risk factors for mortality (p<0.05). Patients treated with a carbapenem had a better 14-day or overall survival rate (i.e., survived to discharge) than those treated with non-carbapenem antibiotics, although this difference was not significant. Among patients in the non-carbapenem group, the overall survival rates of ciprofloxacin, aminoglycoside, and ceftazidime were 70% (14/20), 62.5% (5/8), and 50% (2/4), respectively (p=0.877). The overall survival rates of the carbapenem (72.7%) and ciprofloxacin (70.0%) groups were similar.


CONCLUSIONS
The results suggest that ciprofloxacin, when indicated based on antimicrobial susceptibility testing, may serve as an alternative choice for infections caused by ESBL-producing Enterobacteriaceae other than E. coli or Klebsiella spp. and may not affect the clinical outcome at discharge.
Huang
Shie-Shian
SS
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Lee
Ming-Hsun
MH
Leu
Hsieh-Shong
HS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015780:Carbapenems / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004755:Enterobacteriaceae / Q000302:isolation & purification* / Q000378:metabolism; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000401:mortality; D004926:Escherichia coli / Q000302:isolation & purification* / Q000378:metabolism; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification* / Q000378:metabolism; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002939:Ciprofloxacin; D002442:Ceftazidime; D001618:beta-Lactamases