title: Clinical significance of infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae blood isolates with inducible AmpC β-lactamase.
abstract: Few studies have investigated the clinical features and outcomes for extended-spectrum β-lactamase (ESBL)-producing Enterobacter spp., Citrobacter spp., Serratia spp., and Morganella morganii (ECSM) bloodstream infections. This study was performed to investigate the clinical features and outcomes for ESBL-producing ECSM bloodstream infections. Patients with ECSM bloodstream infection were enrolled from October 2006 to March 2008. Of 124 patients with ECSM bacteremia, 30 cases (24.2%) were ESBL-producing isolates. Immunosuppressive drugs use within 30 days (p=0.028), indwelling device at the time of bacteremia (p=0.042) and antibiotics use within 3 months (p=0.022) were independently associated with ESBL production in multivariate analysis. Overall 30-day mortality rate was 19.4% (24/124). When the 30-day mortality rate was evaluated, no significant difference was found between the ESBL group (16.6%; 5/30) and non-ESBL group (20.2%; 19/94). Hospitalization was longer in the ESBL group than in the non-ESBL group (65.4±92.8 vs. 32.9±37.8 days, respectively; p=0.007). The recent use of antibiotics (especially broad-spectrum cephalosporins and other β-lactam antibiotics) was an important risk factor for ESBL among ECSM bacteremia. ESBL production of ECSM isolates was not significantly associated with mortality but ESBL-producing organisms have an important impact on the duration of hospital stay and subsequent medical cost.
authors.affiliation: Division of Infectious Diseases, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hae Suk
authors.initials: HS
authors.lastname: Cheong
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D001426:Bacterial Proteins / Q000235:genetics*; D015780:Carbapenems / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D004790:Enzyme Induction; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult; D018440:beta-Lactam Resistance / Q000187:drug effects / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D002511:Cephalosporins; D007166:Immunosuppressive Agents; C048795:AmpC beta-lactamases; D001618:beta-Lactamases