1. Bacteremic pneumonia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Appropriateness of empirical treatment matters.
- Author
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Cheng WL, Hsueh PR, Lee CC, Li CW, Li MJ, Chang CM, Lee NY, and Ko WC
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Bacteremia complications, Escherichia coli enzymology, Escherichia coli Infections microbiology, Female, Humans, Klebsiella Infections microbiology, Klebsiella pneumoniae enzymology, Male, Middle Aged, Pneumonia, Bacterial complications, Retrospective Studies, Survival Analysis, Taiwan, Treatment Outcome, Young Adult, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Escherichia coli Infections drug therapy, Klebsiella Infections drug therapy, Pneumonia, Bacterial drug therapy, beta-Lactamases metabolism
- Abstract
Background: Clinical information about bacteremic pneumonia caused by extended-spectrum beta-lactamase (ESBL)-producing organism is limited., Methods: A retrospective study was conducted at two medical centers in Taiwan. From May 2002 to August 2010, clinical information and outcome of adults with bacteremic pneumonia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae were analyzed. The primary outcome is the 30-day mortality., Results: A total of 111 patients with bacteremic pneumonia caused by E. coli (37 patients, 33.3%) and K. pneumoniae (74, 66.7%) were identified. Their mean age was 69.2 years and 51.4% were male patients. Fifty-seven (51.3%) episodes were classified as hospital-acquired infections, 19 (17.1%) as health-care-associated infections, and four (3.6%) as community-acquired infections. Fifty-one (45.9%) patients received appropriate empiric antimicrobial therapy. The 30-day mortality rate was 40.5% (45 patients). In the multivariate analysis, several independent risk factors, including rapidly fatal underlying disease [odds ratio (OR), 5.75; 95% confidence interval (CI), 1.54-21.48; p = 0.009], severe sepsis (OR, 4.84; 95% CI, 1.55-15.14; p = 0.007), critical illness (OR, 4.28; 95% CI, 1.35-13.57; p = 0.013), and receipt of appropriate empirical therapy (OR, 0.19; 95% CI, 0.07-0.55; p = 0.002), were associated with 30-day mortality. The survival analysis consistently found that individuals with appropriate empiric therapy had a higher survival rate (log-rank test, p < 0.001)., Conclusion: ESBL-producing bacteremic pneumonia, especially health-care-associated infections, often occurred in adults with comorbidities. Appropriate empirical therapy was associated with a favorable outcome., (Copyright © 2014. Published by Elsevier B.V.)
- Published
- 2016
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