title: Clinical impact of extended-spectrum β-lactamase-producing Enterobacteriaceae in patients with biliary tract infection.
abstract: BACKGROUND
  Clinical outcomes associated with Gram-negative bacterial isolates with extended spectrum beta-lactamase (ESBL) in patients with biliary tract infection are largely unknown. The objective of the present study was to compare the demographics, risk factors, and clinical outcomes between patients with biliary tract infection caused by ESBL-producing and non-producing Klebsiella pneumoniae and Escherichia coli.
  
  
  METHODS
  Between February 2005 and August 2010, we collected 159 cases with biliary tract infection caused by K. pneumoniae and E. coli identified by blood or bile cultures obtained before endoscopic or surgical treatment performed at our institution. We also retrospectively collected the data of patients' demographic characteristics, co-morbid conditions, antimicrobial therapy, and clinical outcomes.
  
  
  RESULTS
  Among the 159 strains isolated, 21 strains (13.2 %) were positive for phenotypical ESBL-test. Sepsis was more common in ESBL-positive strains, but did not reach statistical significance (23.8 % for ESBL-positive strains and 9.4 % for ESBL-negative strains, P = 0.066). Thirty-day mortality was significantly higher in ESBL-positive strains (3/21, 14.3 %) compared to ESBL-negative strains (4/138, 2.9 %, P = 0.049). However, there were no significant differences in overall survival between ESBL-positive and ESBL-negative strains. By multivariate analysis, inadequate antimicrobial therapy (HR 4.06, 95 % CI 1.08-16.46, P = 0.049) and sepsis (HR 6.54, 95 % CI 1.26-33.85, P = 0.025) were independent and significant predictors of 30-day mortality.
  
  
  CONCLUSIONS
  ESBL status of bacterial isolates for patients with biliary tract infection caused by K. pneumoniae and E. coli has clinical impact, especially on the short-term outcomes of those patients.
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, Korea. hongjoo3.kim@samsung.com
authors.forename: Hong Joo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Park
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.forename: Chong Il
authors.initials: CI
authors.lastname: Sohn
authors.forename: Woo Kyu
authors.initials: WK
authors.lastname: Jeon
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001646:Bile / Q000382:microbiology; D001660:Biliary Tract Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases