Clinical and microbiologic characteristics of adult patients with recurrent bacteraemia caused by extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae.
The characteristics of patients with recurrent bacteraemia caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae (EK) are rarely described. Flomoxef belongs to the cephamycins group and demonstrates in vitro activity against ESBL-producing organisms. Whether flomoxef may be used for the treatment of such infections remains controversial. This retrospective case-control study enrolled adult patients who had bacteraemia caused by ESBL-EK during 2005-2011. Case patients were those who had more than one episode of ESBL-EK bacteraemia. Controls were those who were matched for age and interval time of blood sampling and had only one episode of ESBL-EK bacteraemia with subsequent bacteraemia episodes caused by other non-ESBL-EK bacteria. Pulsed-field gel electrophoresis and microbiologic profiles of the initial and subsequent ESBL-EK isolates were analysed. During the study period, 424 patients were found to have at least one positive blood culture after the first ESBL-EK bacteraemia episode, and 67 (15.8%) had a second episode of ESBL-EK bacteraemia. Bacteraemia resulting from vascular catheter-related infection (odds ratio, 3.24; 95% confidence interval, 1.31-8.05), and definitive therapy with flomoxef (odds ratio, 2.99; 95% confidence interval, 1.10-8.15) were both independent risk factors for the recurrence. Among the 56 patients with available ESBL-EK isolates for analysis, 38 (67.8%) were infected by genetically similar strains. In three of these 38 recurrent ESBL-EK bacteraemia cases caused by an identical strain, the minimum inhibitory concentrations of carbapenem for the subsequent K. pneumoniae isolates were fourfold or higher than the initial isolates. Recurrent bacteraemia was not uncommon in our patients with ESBL-EK bacteraemia, and most of the episodes were caused by identical strains.
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: lee900@adm.cgmh.org.tw.
C-H
CH
Lee
Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
L-H
LH
Su
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
F-J
FJ
Chen
Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Y-F
YF
Tang
Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
C-C
CC
Chien
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J-W
JW
Liu
D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology*; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000188:drug therapy; D002511:Cephalosporins / Q000627:therapeutic use; D004926:Escherichia coli / Q000145:classification / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007711:Klebsiella pneumoniae / Q000145:classification / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018440:beta-Lactam Resistance
D002511:Cephalosporins; C045693:flomoxef
Carbapenems; ESBL producers; Enterobacteriaceae; case–control study; cephamycins; risk factors