title: Molecular epidemiology of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae from bloodstream infections and risk factors for mortality.
abstract: The prevalence of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae is growing worldwide. Infections with these bacteria are suspected to be related to increased mortality. We aimed to estimate the distribution of ESBL genotypes and to assess the impact on mortality associated with ESBL positivity in cases of bloodstream infection (BSI) due to K. pneumoniae. We performed a cohort study on patients with K. pneumoniae BSI between 2008 and 2011. Presence of ESBL genes was analyzed by PCR and sequencing. Risk factors for mortality were analyzed by Cox-proportional hazard regression. We identified 286 ESBL-negative (81%) and 66 (19%) ESBL-positive cases. 97% (n = 64) of the ESBL-positive isolates were susceptible for meropenem. The most common ESBL genotypes were CTX-M-15 (60%), SHV-5 (27%) and CTX-M-3 (5%). Significant risk factors for mortality were chronic pulmonary disease (HR 1.747) and moderate/severe renal disease (HR 2.572). ESBL positivity was not associated with increased mortality.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: stephan@guerntke.net.
authors.forename: Stephan
authors.initials: S
authors.lastname: Gürntke
authors.affiliation: Friedrich Löffler Institute of Medical Microbiology, Universitätsmedizin Greifswald, Martin-Luther-Str.6, 17475 Greifswald, Germany. Electronic address: kohlerc@uni-greifswald.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Kohler
authors.affiliation: Friedrich Löffler Institute of Medical Microbiology, Universitätsmedizin Greifswald, Martin-Luther-Str.6, 17475 Greifswald, Germany. Electronic address: steinmetz.ivo@uni-greifswald.de.
authors.forename: Ivo
authors.initials: I
authors.lastname: Steinmetz
authors.affiliation: Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, 38855 Wernigerode, Germany. Electronic address: pfeifery@rki.de.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Pfeifer
authors.affiliation: Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, 38855 Wernigerode, Germany. Electronic address: christoph.eller@uk-halle.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Eller
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: petra.gastmeier@charite.de.
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: frank.schwab@charite.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: rasmus.leistner@charite.de.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Leistner
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000382:microbiology*; D005260:Female; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D001618:beta-Lactamases
keywords: Bloodstream infection; ESBL; Klebsiella pneumoniae; Molecular epidemiology