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PLoS One. 2016 Jul 21;11(7):e0158039. doi: 10.1371/journal.pone.0158039. eCollection 2016.

Sepsis Caused by Extended-Spectrum Beta-Lactamase (ESBL)-Positive K. pneumoniae and E. coli: Comparison of Severity of Sepsis, Delay of Anti-Infective Therapy and ESBL Genotype.

Author information

1
Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
2
Friedrich Loffler Institute of Medical Microbiology, Universitaetsmedizin Greifswald, Martin-Luther-Str.6, 17475, Greifswald, Germany.
3
Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, 38855, Wernigerode, Germany.
4
Department of Anesthesiology and Intensive Care, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.

Abstract

Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are associated with increased mortality. Outcome differences due to various species of ESBL-E or ESBL genotypes are not well investigated. We conducted a cohort study to assess risk factors for mortality in cases of ESBL-E bacteremia (K. pneumoniae or E. coli) and the risk factors for sepsis with organ failure. All consecutive patients of our institution from 2008 to 2011 with bacteremia due to ESBL-E were included. Basic epidemiological data, underlying comorbidities, origin of bacteremia, severity of sepsis and delay of appropriate anti-infective treatment were collected. Isolates were PCR-screened for the presence of ESBL genes and plasmid-mediated AmpC β-lactamases. Cox proportional hazard regression on mortality and multivariable logistic regression on risk factors for sepsis with organ failure was conducted. 219 cases were included in the analysis: 73.1% due to E. coli, 26.9% due to K. pneumoniae. There was no significant difference in hospital mortality (ESBL-E. coli, 23.8% vs. ESBL-K. pneumoniae 27.1%, p = 0.724). However, the risk of sepsis with organ failure was associated in cases of K. pneumoniae bacteremia (OR 4.5, p<0.001) and patients with liver disease (OR 3.4, p = 0.004) or renal disease (OR 6.8, p<0.001). We found significant differences in clinical presentation of ESBL-E bacteremia due to K. pneumoniae compared to E. coli. As K. pneumoniae cases showed a more serious clinical presentation as E. coli cases and were associated with different risk factors, treatment and prevention strategies should be adjusted accordingly.

PMID:
27442425
PMCID:
PMC4956035
DOI:
10.1371/journal.pone.0158039
[Indexed for MEDLINE]
Free PMC Article

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