Mortality rate in neonates infected with extended-spectrum beta lactamase-producing Klebsiella species and selective empirical use of meropenem.
BACKGROUND
Infection with resistant gram-negative bacteria is a growing threat to hospitalised patients.


OBJECTIVE
To determine factors associated with mortality among infants infected by extended-spectrum beta-lactamase-producing Klebsiella species (Klebs-ESBL) and to assess whether selective empirical use of meropenem (MERO) is associated with high mortality.


METHODS
Medical records of neonates admitted from January 2002 to December 2003 who had positive blood and/or cerebrospinal fluid (CSF) culture with Klebs-ESBL were reviewed for clinical, management and outcome information. Univariate and multivariate logistic regression analyses were performed to determine factors associated with mortality among infants with culture-proven Klebs-ESBL.


RESULTS
A hundred patients had positive blood (n=97) and/or CSF cultures (n=9) owing to Klebs-ESBL. Overall mortality rate was 30%. The mortality rates among those who were empirically started on a combination of piperacillin-tazobactam and amikacin (Pip-Taz+Amik) (n=48), meropenem (MERO) (n=40) and in those not started on MERO or Pip-Taz+Amik) (n=12) were 25%, 32% and 42%, respectively. Non-survivors were younger (p=0.01), had cardio-respiratory compromise or required assisted ventilation at presentation (p<0.001), and were not started on antibiotics, MERO or Pip-Taz+Amik (p<0.001). On multivariate analysis, factors associated with mortality were vaginal delivery (OR -7.07, 95% CI 2.14-23.39), a need for assisted ventilation at onset of illness (OR -4.94, 95% CI 1.12-21.86) and not starting empirical MERO or Pip-Taz+Amik (OR -17.01, 95% CI 2.41-120.23).


CONCLUSIONS
While empirical use of carbapenems for nosocomial sepsis might be appropriate in areas where Klebs-ESBL is prevalent, their use can be restricted to those with cardio-respiratory compromise or severe sepsis without an increase in mortality.
Velaphi
S
S
Department of Paediatrics, Chris Hani Baragwanath Hospital (CHBH), PO Bertsham 2013, South Africa. Sithembiso.Velaphi@wits.ac.za
Wadula
J
J
Nakwa
F
F
D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007709:Klebsiella / Q000201:enzymology; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D008297:Male; D000077731:Meropenem; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013845:Thienamycins / Q000008:administration & dosage*; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077725:Piperacillin, Tazobactam Drug Combination; D000583:Amikacin; D010397:Penicillanic Acid; D001618:beta-Lactamases; D000077731:Meropenem; D010878:Piperacillin