Carbapenem therapy for bacteremia due to extended-spectrum-β- lactamase-producing Escherichia coli or Klebsiella pneumoniae: Implications of ertapenem susceptibility
Journal
Antimicrobial Agents and Chemotherapy
Journal Volume
56
Journal Issue
6
Pages
2888-2893
Date Issued
2012
Author(s)
Abstract
A retrospective study was conducted at two medical centers in Taiwan to evaluate the clinical characteristics, outcomes, and risk factors for mortality among patients treated with a carbapenem for bacteremia caused by extended-spectrum-beta-lactamase (ESBL)-producing organisms. A total of 251 patients with bacteremia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates treated by a carbapenem were identified. Among these ESBL-producing isolates, rates of susceptibility to ertapenem (MICs ? 0.25 μg/ml) were 83.8% and 76.4%, respectively; those to meropenem were 100% and 99.3%, respectively; and those to imipenem were 100% and 97.9%, respectively. There were no significant differences in the critical illness rate (P = 0.1) or sepsis-related mortality rate (P = 0.2) for patients with bacteremia caused by ESBL-producing K. pneumoniae (140 isolates, 55.8%) and E. coli (111 isolates, 44.2%). Multivariate analysis of variables related to sepsis-related mortality revealed that the presence of severe sepsis (odds ratio [OR], 15.9; 95% confidence interval [CI], 5.84 to 43.34; P<0.001), hospital-onset bacteremia (OR, 4.65; 95% CI, 1.42 to 15.24; P = 0.01), and ertapenem-nonsusceptible isolates (OR, 5.12; 95% CI, 2.04 to 12.88; P = 0.001) were independent risk factors. The patients receiving inappropriate therapy had a higher sepsis-related mortality than those with appropriate therapy (P = 0.002), irrespective of ertapenem, imipenem, or meropenem therapy. Infections due to the ertapenem-susceptible isolates (MICs ? 0.25 μg/ml) were associated with a more favorable outcome than those due to ertapenem- nonsusceptible isolates (MICs > 0.25 μg/ml), if treated by a carbapenem. However, the mortality for patients with bacteremic episodes due to isolates with MICs of ? 0.5 μg/ml was similar to the mortality for those whose isolates had MICs of > 0.5 μg/ml (P = 0.8). Such a finding supports the rationale of the current CLSI 2011 criteria for carbapenems for Enterobacteriaceae. Copyright ? 2012, American Society for Microbiology. All Rights Reserved.
SDGs
Other Subjects
carbapenem; ertapenem; extended spectrum beta lactamase; imipenem; meropenem; aged; antibiotic resistance; antibiotic sensitivity; antibiotic therapy; article; bacteremia; bacterium isolate; disease severity; Escherichia coli; extended spectrum beta lactamase producing Enterobacteriaceae; female; hospital infection; human; in vitro study; Klebsiella pneumoniae; major clinical study; male; minimum inhibitory concentration; mortality; multivariate logistic regression analysis; nonhuman; outcome assessment; pneumonia; priority journal; retrospective study; risk factor; sepsis; survivor; Taiwan; treatment outcome; univariate analysis; Adult; Bacteremia; beta-Lactams; Escherichia coli; Escherichia coli Infections; Female; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Retrospective Studies; Thienamycins; Young Adult
Type
journal article