title: Cefotaxime resistance and outcome of Klebsiella spp bloodstream infection.
abstract: We attempt to describe the epidemiology and outcome associated with cefotaxime-resistant (CTX-R) Klebsiella spp bacteraemia. Klebsiella spp bloodstream infection episodes prospectively collected through a blood culture surveillance programme from January 1991 to December 2008 in a single institution were analysed. A total of 910 monomicrobial episodes of Klebsiella spp bacteraemia were identified during the study period. The most important sources were from urinary tract infection, unknown sources, billiary focus and catheter related infection. There were 112 (12%) CTX-R isolates. Out of 112 isolates, 98 were CTX-R by Extended-Spectrum β-Lactamase production. Shock on presentation and mortality were significantly more frequent in CTX-R than in CTX susceptible isolates. Inappropriate empirical therapy was received in 50 (45%) cases in the CTX-R Klebsiella spp group (13 cases of death, 26%). Predictive factors associated with CTX-R Klebsiella spp isolate were: previous β-lactam therapy (OR = 4.16), nosocomial acquired bacteraemia (OR = 1.93), solid organ trasplantation (OR = 2.09) and shock (OR = 1.90). Independent risk factors associated with mortality in Klebsiella spp bacteraemia were: age (OR = 1.03), liver cirrhosis (OR = 2.63), ultimately or rapidly fatal prognosis of underlying disease (OR = 2.44), shock (OR = 8.60), pneumonia (OR = 4.96) or intraabdominal (OR = 3.85) source of bacteraemia and CTX-R isolate (OR = 4.63). Klebsiella spp is an important cause of bloodstream infection. CTX-R isolates have been increasing since 2000. CTX-R is an independent factor associated with mortality in Klebsiella spp bacteraemia.
authors.affiliation: Emergency Department and Infectious Diseases Unit, Hospital Clínic, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain. mortega@clinic.ub.es
authors.forename: M
authors.initials: M
authors.lastname: Ortega
authors.forename: F
authors.initials: F
authors.lastname: Marco
authors.forename: A
authors.initials: A
authors.lastname: Soriano
authors.forename: M
authors.initials: M
authors.lastname: Almela
authors.forename: J A
authors.initials: JA
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: López
authors.forename: C
authors.initials: C
authors.lastname: Pitart
authors.forename: J
authors.initials: J
authors.lastname: Mensa
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002439:Cefotaxime / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000187:drug effects* / Q000302:isolation & purification; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D002439:Cefotaxime