title: Impact of extended spectrum beta-lactamase producing Klebsiella pneumoniae infections in severely burned patients.
abstract: BACKGROUND
  Significantly higher mortality has been demonstrated in patients who suffer severe burns complicated by Klebsiella pneumoniae bacteremia. The specific virulence mechanisms associated with this organism in this population are unclear.
  
  
  METHODS
  Our study assessed the impact of the mechanism of antibiotic resistance, strain clonality, and other host factors on morbidity and mortality. All patients with thermal burns infected with K pneumoniae between January 1, 2004 and July 1, 2008 were included in the analysis.
  
  
  RESULTS
  Ninety-one patients had 111 episodes of K pneumoniae infections, with 59 isolates among the 91 patients producing extended spectrum beta-lactamase (ESBL). Patients with ESBL-producing strains were slightly younger, had higher Injury Severity Scores (ISS), and higher percent full thickness burns. Those who survived to discharge were younger (p < 0.001), had less burned surface area (p = 0.013), had fewer ventilator days (p = 0.016), and fewer infections with ESBL-producing isolates (p = 0.042). Logistic regression revealed that an infection with ESBL-producing K pneumoniae during the hospital stay was the factor most predictive of death, with a nearly 4-fold increased odds of dying. However, survival duration analysis of the population with and without ESBL-producing K pneumoniae using Kaplan-Meier technique showed no significant difference in the populations. Cox regression proportional hazards model revealed that only age (p = 0.01) and ventilator days (p < or = 0.01) were associated with time to death. No specific clonality of the strains tested or ESBL production resistance genes were associated with mortality or ESBL production.
  
  
  CONCLUSIONS
  These results suggest that infections caused by ESBL-producing K pneumoniae are predictive of death when occurring in an older, more badly burned population.
authors.affiliation: Walter Reed Army Institute of Research, Silver Spring MD, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Bennett
authors.forename: Janelle L
authors.initials: JL
authors.lastname: Robertson
authors.forename: Duane R
authors.initials: DR
authors.lastname: Hospenthal
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
authors.forename: Katrin
authors.initials: K
authors.lastname: Mende
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002056:Burns / Q000150:complications*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D053208:Kaplan-Meier Estimate; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases