title: Fluoroquinolone therapy for bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae.
abstract: OBJECTIVE
  For extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infections, carbapenems are recommended as first line therapy, and clinical data on the therapeutic efficacy of fluoroquinolones (FQs) is limited. This study compares the efficacy of FQs and carbapenems for bloodstream infections caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae.
  
  
  METHODS
  Between 2008 and 2010, adults with ESBL-producing E. coli or K. pneumoniae bacteremia at two medical centers were reviewed. Adults receiving definitive FQ or carbapenem therapy were compared in a propensity score-matched analysis, and 30-day mortality was the primary endpoint.
  
  
  RESULTS
  A total of 299 patients were eligible. Patients receiving a FQ (n = 24), either ciprofloxacin or levofloxacin, had a lower 30-day mortality rate than those with carbapenem therapy (8.3%, 2/24 vs. 23.3%, 64/275; p = 0.12). Multivariate regression analysis revealed that a critical illness [Pitt bacteremia score ≥ 4 points; odds ratio (OR), 7.09; p < 0.001], rapidly fatal underlying disease (OR, 5.73; p < 0.001), and hospital-associated infection (OR, 2.57; p = 0.01) were independently associated with 30-day mortality. By contrast, FQ definitive therapy was a protective factor compared with carbapenems (OR, 0.18; p = 0.04). There were 72 matched cases with carbapenem therapy in a propensity score-matched analysis, and a difference in the 30-day mortality rate of two groups was noted (8.3% vs. 29.2%; p = 0.05).
  
  
  CONCLUSIONS
  For ESBL-producing E. coli or K. pneumoniae bacteremia, ciprofloxacin or levofloxacin, if active in vitro, can be considered as a carbapenem-sparing alternative.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainin, Taiwan.
authors.forename: Ching-Lung
authors.initials: CL
authors.lastname: Lo
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainin, Taiwan; Center of Infection Control, National Cheng Kung University Hospital, Tainin, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainin, Taiwan; Center of Infection Control, National Cheng Kung University Hospital, Tainin, Taiwan.
authors.forename: Chia-Wen
authors.initials: CW
authors.lastname: Li
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainin, Taiwan; Center of Infection Control, National Cheng Kung University Hospital, Tainin, Taiwan.
authors.forename: Ming-Chi
authors.initials: MC
authors.lastname: Li
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainin, Taiwan; Center of Infection Control, National Cheng Kung University Hospital, Tainin, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan. Electronic address: nanyao@mail.ncku.edu.tw.
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainin, Taiwan; Center of Infection Control, National Cheng Kung University Hospital, Tainin, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D015780:Carbapenems / Q000627:therapeutic use; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D024841:Fluoroquinolones; D001618:beta-Lactamases
keywords: ESBL; Enterobacteriaceae; bloodstream infections; carbapenem; fluoroquinolone