Bacteremic pneumonia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Appropriateness of empirical treatment matters

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• 作者：Wan-Ling Cheng^a ; ^b ; Po-Ren Hsueh^c ; ^d ; Ching-Chi Lee^a ; ^b ; Chia-Wen Li^a ; ^b ; Ming-Ji Li^a ; ^b ; Chia-Ming Chang^a ; ^b ; ^e ; Nan-Yao Lee^a ; ^b ; ^e ; ^{nanyao@mail.ncku.edu.tw" class="auth_mail" title="E-mail the corresponding author} ; Wen-Chien Ko^a ; ^b ; ^e ; ^{winston3415@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Bacteremic pneumonia ; Empirical therapy ; Extended-spectrum beta-lactamase
• 刊名：Journal of Microbiology, Immunology and Infection
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：49
• 期：2
• 页码：208-215
• 全文大小：386 K

文摘

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.