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Risk Factors for and Outcomes of Bacteremia Caused by Extended-Spectrum ß-Lactamase-Producing Escherichia coli and Klebsiella Species at a Canadian Tertiary Care Hospital.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Nguyen, My-Linh Toye, Baldwin Kanji, Salmaan Zvonar, Rosemary K. |
| Copyright Year | 2015 |
| Abstract | BACKGROUND Antimicrobial resistance due to production of extended-spectrum ß-lactamases by Escherichia coli and Klebsiella species (ESBL-EK) is concerning. Previous studies have shown that bacteremia due to ESBL-producing organisms is associated with increases in length of stay and/or mortality rate. Rates of infection by ESBL-EK vary worldwide, and regional differences in the prevalence of risk factors are likely. Few Canadian studies assessing risk factors for ESBL-EK infections or the outcomes of empiric therapy have been published. OBJECTIVES To determine risk factors for and patient outcomes associated with ESBL-EK bacteremia. The appropriateness of empiric antibiotic therapy and the effect of inappropriate empiric therapy on these outcomes were also examined. METHODS In a retrospective, 1:1 case-control study conducted in a tertiary care hospital between 2005 and 2010, data for 40 patients with ESBL-EK bacteremia were compared with data for 40 patients who had non-ESBL-EK bacteremia. RESULTS Of all variables tested, only antibiotic use within the previous 3 months was found to be an independent risk factor for acquisition of ESBL-EK bacteremia (odds ratio 5.2, 95% confidence interval 1.6-16.9). A greater proportion of patients with non-ESBL-EK bacteremia received appropriate empiric therapy (88% [35/40] versus 15% [6/40], p < 0.001). Time to appropriate therapy was longer for those with ESBL-EK bacteremia (2.42 days versus 0.17 day, p < 0.001). Patient outcomes, including length of stay in hospital, admission to the intensive care unit (ICU), length of stay in the ICU (if applicable), and in-hospital mortality were not affected by the presence of ESBL-EK or the appropriateness of empiric therapy. CONCLUSIONS Previous antibiotic use was a significant, independent risk factor for acquiring ESBL-EK. Thus, prior antibiotic use is an important consideration in the selection of empiric antibiotic therapy and should increase the concern for resistant pathogens. |
| File Format | PDF HTM / HTML |
| DOI | 10.4212/cjhp.v68i2.1439 |
| PubMed reference number | 25964685 |
| Journal | Medline |
| Volume Number | 68 |
| Issue Number | 2 |
| Journal | The Canadian journal of hospital pharmacy |
| Alternate Webpage(s) | http://www.cjhp-online.ca/cshp/index.php/cjhp/article/download/1439/2102 |
| Alternate Webpage(s) | https://doi.org/10.4212/cjhp.v68i2.1439 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
