title: Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome.
abstract: Escherichia coli and Klebsiella pneumoniae are main pathogens in neutropenic fever even if the proportion of Gram-positive cocci is increasing. Extended-spectrum β-lactamases (ESBL)-producing organisms are an emerging problem in nosocomial infection. Nevertheless, until now, information about risk factors for the acquisition and clinical outcomes of bacteremia due to ESBL-producing organisms is limited in neutropenic patients. From medical records collected between January 2007 and December 2008, we identified a total of 101 consecutive patients who developed bacteremia due to E. coli (n = 87) or K. pneumoniae (n = 14). Twenty-six (26 %) cases of bacteremia were caused by ESBL-producing organisms. A hospital stay of >2 weeks during the 3 months preceding bacteremia [adjusted odds ratio (OR), 5.887; 95 % confidence interval (CI), 1.572-22.041] and the use of broad-spectrum cephalosporins in the 4 weeks prior to bacteremia (adjusted OR, 6.186; 95 % CI, 1.616-23.683) were significantly related to the acquisition of ESBL. Twenty-four (92 %) of the ESBL-producing organisms were susceptible to either piperacillin-tazobactam or amikacin. Aminoglycosides (amikacin or isepamicin) were the main appropriate antimicrobial agents used against the ESBL-producing isolates during the initial empirical treatment (16/22, 73 %). However, the 30-day mortality rates for ESBL bacteremia and non-ESBL bacteremia were not significantly different (15 vs 5 %; p = 0.199). As alternatives to carbapenem, piperacillin-tazobactam plus amikacin or isepamicin combinations may be effective empirical therapeutic options for patients with neutropenic fever who are at high risk of developing bacteremia with ESBL-producing pathogens.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Si-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jae-Cheol
authors.initials: JC
authors.lastname: Kwon
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Choi
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Yoo
authors.forename: Byung-Sik
authors.initials: BS
authors.lastname: Cho
authors.forename: Ki-Seong
authors.initials: KS
authors.lastname: Eom
authors.forename: Yoo-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Hee-Je
authors.initials: HJ
authors.lastname: Kim
authors.forename: Seok
authors.initials: S
authors.lastname: Lee
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Seok-Goo
authors.initials: SG
authors.lastname: Cho
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Kim
authors.forename: Jong-Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D016470:Bacteremia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D003428:Cross Infection / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D004926:Escherichia coli / Q000254:growth & development; D004927:Escherichia coli Infections / Q000097:blood / Q000150:complications* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005334:Fever / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007710:Klebsiella Infections / Q000097:blood / Q000150:complications* / Q000209:etiology / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000254:growth & development; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000890:Anti-Infective Agents; D001618:beta-Lactamases