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題 名 | Outcomes and Characteristics of Ertapenem-Nonsusceptible Klebsiella pneumoniae Bacteremia at a University Hospital in Northern Taiwan: A Matched Case-Control Study |
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作 者 | Liu, Shi-wei; Chang, Hong-jyun; Chia, Ju-hsin; Kuo, An-jing; Wu, Tsu-lan; Lee, Ming-hsun; | 書刊名 | Journal of Microbiology, Immunology and Infection |
卷 期 | 45:2 2012.04[民101.04] |
頁 次 | 頁113-119 |
分類號 | 415.27 |
關鍵詞 | Bacteremia; Ertapenem nonsusceptible; Klebsiella pneumoniae; |
語 文 | 英文(English) |
英文摘要 | Background and purpose: Carbapenem-resistant Klebsiella pneumoniae is an emerging problem worldwide. The object of this study was to investigate the risk factors, characteristics and outcomes of ertapenem-nonsusceptible K pneumoniae (ENSKp) bacteremia. Methods: We conducted a 1:2 ratio matched case-control study. The controls were randomly selected among patients with ertapenem-susceptible K pneumoniae (ESKp) bacteremia and were matched with ENSKp cases for bacteremia. Results: Seventy-five patients were included in this study (25 cases and 50 controls). Bivariate analysis showed that prior exposure to either b-Lactam/b-Lactam-lactamase inhibitors (p Z 0.008) or 4th generation cephalosporins (p < 0.001), chronic obstructive pulmonary disease (COPD) (p Z 0.001), acute renal failure (p Z 0.021), chronic kidney disease without dialysis (p Z 0.021), recent hospital stay (p Z 0.016), intensive care unit stay (p Z 0.002), mechanical ventilation (p Z 0.003), central venous catheter placement (p Z 0.016), Foley indwelling (p Z 0.022), polymicrobial bacteremia (p Z 0.003) and higher Pittsburgh bacteremia score (p < 0.001) were associated with ENSKp bacteremia. The multivariate analysis showed that prior exposure to 4th generation cephalosporins (odds ratio [OR], 28.05; 95% confidence interval [CI], 2.92e269.85; p Z 0.004), COPD (OR, 21.38; 95% CI, 2.95e154.92; p Z 0.002) and higher Pittsburgh bacteremia score (OR, 1.35; 95% CI, 1.10e1.66;p Z 0.004) were independent factors for ENSKp bacteremia. ENSKp bacteremia had a higher 14-day mortality rate than ESKp bacteremia (44.0% vs. 22.0%; p Z 0.049). The overall inhospital mortality rates for these two groups were 60.0% and 40.0% respectively (p Z 0.102). Conclusion: ENSKp bacteremia had a poor outcome and the risk factors were prior exposure of 4th generation cephalosporins, COPD and higher Pittsburgh bacteremia score. Antibiotic stewardship may be the solution for the preventive strategy. |
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