title: Should the patients colonized with extended-spectrum beta-lactamase-producing Gram-negative bacilli (E-GNB) coming to hospital from the community with pneumonia get anti-E-GNB active empirical treatment?
abstract: Extended-spectrum beta-lactamases are responsible for resistance of Gram-negative bacilli to several beta-lactam antibiotics, including those prescribed for treatment pneumonia. To evaluate the importance of colonization with E-GNB for the choice of empirical treatment we performed a retrospective case-control study including 156 patients, hospitalized for treatment of pneumonia from 2009 through 2013. Empirical treatment success and in-hospital survival were significantly lower in patients colonized with E-GNB compared to non-colonized (p = 0.002, p = 0.035). When comparing subgroups of colonized patients, treatment success was significantly lower in patients who were colonized with E-GNB resistant to empirical antibiotic (p = 0.010), but not in those colonized by E-GNB susceptible to empirically given antibiotic (p = 0.104). Difference in in-hospital mortality was insignificant in both subgroups (p = 0.056, p = 0.331). The results of study suggest that an anti-E-GNB active antibiotic should be used for empirical treatment of pneumonia in E-GNB colonized patients.
authors.affiliation: a Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.
authors.forename: Lara
authors.initials: L
authors.lastname: Peterlin
authors.affiliation: a Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.
authors.forename: Mateja
authors.initials: M
authors.lastname: Žagar
authors.affiliation: b Department of Infectious Diseases , University Medical Centre Ljubljana , Ljubljana , Slovenia.|c Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Lejko Zupanc
authors.affiliation: d Slovenian Railways , Ljubljana , Slovenia.
authors.forename: Marija
authors.initials: M
authors.lastname: Paladin
authors.affiliation: b Department of Infectious Diseases , University Medical Centre Ljubljana , Ljubljana , Slovenia.|c Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.
authors.forename: Bojana
authors.initials: B
authors.lastname: Beović
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003428:Cross Infection / Q000188:drug therapy*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006761:Hospitals; D006801:Humans; D007363:Intensive Care Units, Neonatal; D008297:Male; D011014:Pneumonia / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: Antibiotics; Empirical treatment; Extended-spectrum beta-lactamases; Pneumonia