Extended-spectrum beta-lactamase-producing phenotype signifies a poor prognosis for patients with cefpodoxime-resistant Escherichia coli or Klebsiella pneumoniae bacteremia.
OBJECTIVE
Bloodstream infections caused by multidrug-resistant Enterobacteriaceae are a major concern. This study explored the clinical impact of extended-spectrum beta-lactamase (ESBL) production among cefpodoxime-resistant Escherichia coli and Klebsiella pneumoniae bacteremia.


METHODS
The medical charts and microbiological results of patients with cefpodoxime-resistant E. coli or K. pneumoniae bacteremia in a tertiary hospital in southern Taiwan between June 2003 and December 2006 were retrospectively reviewed. The clinical characteristics, medical histories, and clinical outcomes were evaluated. ESBL production was indicated by the double-disk synergy test.


RESULTS
278 episodes of bacteremia caused by cefpodoxime-resistant K. pneumoniae or E. coli were identified, of which 115 (41%) were ESBL producing. Compared with non-ESBL-producing bacteremia, bacteremic episodes caused by ESBL producers were less often community acquired (4.3% vs 26.4%; p < 0.001). Underlying diabetes mellitus (48.7% vs 35.0%; p = 0.02), liver cirrhosis (22.6% vs 11.7%; p = 0.02), or uremia (21.7% vs 3.7%; p < 0.001) were more common in ESBL-producing bacteremia. In contrast, solid tumors were more frequent in non-ESBL-producing bacteremia (44.8% vs 27.8%; p = 0.004). Overall, patients with ESBL-producing bacteremia had higher disease severity indicated by a Pittsburgh bacteremia score > or = 4, longer duration of hospital stay (51.1 days vs 31.9 days; p = 0.007), more admission to intensive care units (19.1% vs 8.0%; p = 0.006), and a higher mortality rate at 28 days (34.8% vs 23.9%; p = 0.03).


CONCLUSIONS
ESBL production signifies a poor clinical outcome for patients with bacteremia caused by cefpodoxime-resistant E. coli or K. pneumoniae.
Lee
Chih I
CI
Department of Internal Medicine, National Cheng Kung University Hospital, 704 Tainan, Taiwan.
Lee
Nan Yao
NY
Yan
Jing Jou
JJ
Lee
Hsin Chun
HC
Ko
Nai Ying
NY
Chang
Chia Ming
CM
Wu
Chi Jung
CJ
Chen
Po Ling
PL
Wang
Li Rong
LR
Ko
Wen Chien
WC
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D015296:Ceftizoxime / Q000031:analogs & derivatives* / Q000494:pharmacology; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology; D004927:Escherichia coli Infections / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010641:Phenotype; D011379:Prognosis; D012720:Severity of Illness Index; D001618:beta-Lactamases / Q000096:biosynthesis*; D000097623:Cefpodoxime
D000900:Anti-Bacterial Agents; D015296:Ceftizoxime; D001618:beta-Lactamases; D000097623:Cefpodoxime