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J Infect Chemother. 2014 Dec;20(12):817-9. doi: 10.1016/j.jiac.2014.08.012. Epub 2014 Sep 13.

Molecular epidemiology of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae from bloodstream infections and risk factors for mortality.

Author information

1
Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: stephan@guerntke.net.
2
Friedrich Löffler Institute of Medical Microbiology, Universitätsmedizin Greifswald, Martin-Luther-Str.6, 17475 Greifswald, Germany. Electronic address: kohlerc@uni-greifswald.de.
3
Friedrich Löffler Institute of Medical Microbiology, Universitätsmedizin Greifswald, Martin-Luther-Str.6, 17475 Greifswald, Germany. Electronic address: steinmetz.ivo@uni-greifswald.de.
4
Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, 38855 Wernigerode, Germany. Electronic address: pfeifery@rki.de.
5
Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, 38855 Wernigerode, Germany. Electronic address: christoph.eller@uk-halle.de.
6
Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: petra.gastmeier@charite.de.
7
Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: frank.schwab@charite.de.
8
Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: rasmus.leistner@charite.de.

Abstract

The prevalence of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae is growing worldwide. Infections with these bacteria are suspected to be related to increased mortality. We aimed to estimate the distribution of ESBL genotypes and to assess the impact on mortality associated with ESBL positivity in cases of bloodstream infection (BSI) due to K. pneumoniae. We performed a cohort study on patients with K. pneumoniae BSI between 2008 and 2011. Presence of ESBL genes was analyzed by PCR and sequencing. Risk factors for mortality were analyzed by Cox-proportional hazard regression. We identified 286 ESBL-negative (81%) and 66 (19%) ESBL-positive cases. 97% (n = 64) of the ESBL-positive isolates were susceptible for meropenem. The most common ESBL genotypes were CTX-M-15 (60%), SHV-5 (27%) and CTX-M-3 (5%). Significant risk factors for mortality were chronic pulmonary disease (HR 1.747) and moderate/severe renal disease (HR 2.572). ESBL positivity was not associated with increased mortality.

KEYWORDS:

Bloodstream infection; ESBL; Klebsiella pneumoniae; Molecular epidemiology

PMID:
25224765
DOI:
10.1016/j.jiac.2014.08.012
[Indexed for MEDLINE]

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