title: Risk factors for hospital-acquired bloodstream infections caused by extended-spectrum β-lactamase Klebsiella pneumoniae among cancer patients.
abstract: BACKGROUND
  Incidence of infection due to extended-spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) has increased rapidly in recent years. However, its prevalence in cancer patients is seldom reported.
  
  
  OBJECTIVE
  This study was designed to identify the risk factors for bloodstream infections (BSIs) with ESBL-KP, and to understand its susceptibility among cancer patients on antibiotics.
  
  
  METHODS
  We conducted a retrospective study with a total of 118 cancer patients between 2009 and 2011 with BSIs, among which 88 were infected with non-ESBL-KP and 30 with ESBL-KP. Patterns of susceptibility, clinical characteristics and mortality were investigated. Multivariate logistic regression model was used to unveil independent risk factors.
  
  
  RESULTS
  On multivariate analysis, length of stay (LOS) (p = 0.025), and prior exposure to cephalosporins (p = 0.006), fluoroquinolones (p = 0.011), macrolides (p = 0.007) and aminoglycosides (p = 0.008) were independent risk factors for BSIs of ESBL-KP. For mortality, there was no significant difference between ESBL-KP and non-ESBL-KP groups (p = 0.431). Moreover, compared with non-ESBL-KP, ESBL-KP displayed reduced sensitivity to aminoglycosides (p < 0.001, except amikacin), fluoroquinolones (p < 0.001), piperacillin-tazobactam (p = 0.005) and trimethoprim-sulfamethoxazole (p < 0.001), respectively.
  
  
  CONCLUSIONS
  ESBL-KP exhibited less susceptibility to various non-β-lactamase antibiotics, and infections due to these organisms were related to LOS and preexisting use of antibiotics. Thus, judicious use of all antibiotics should be underscored to reduce the infections caused by ESBL-KP.
authors.affiliation: Key Laboratory of Cancer Prevention and Therapy, Department of Clinical Laboratory, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China, lidingly@126.com.
authors.forename: D
authors.initials: D
authors.lastname: Li
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.forename: W
authors.initials: W
authors.lastname: Zhang
authors.forename: S
authors.initials: S
authors.lastname: Zheng
authors.forename: Q
authors.initials: Q
authors.lastname: Zhang
authors.forename: C
authors.initials: C
authors.lastname: Bai
authors.forename: P
authors.initials: P
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D002511:Cephalosporins / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007710:Klebsiella Infections / Q000150:complications* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000378:metabolism*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D001618:beta-Lactamases