Comparison of Predictors and Mortality between Bloodstream Infections Caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae

Oded Scheuerman*, Vered Schechner, Yehuda Carmeli, Belen Gutiérrez-Gutiérrez, Esther Calbo, Benito Almirante, Pier Luigy Viale, Antonio Oliver, Patricia Ruiz-Garbajosa, Oriol Gasch, Monica Gozalo, Johann Pitout, Murat Akova, Carmen Peña, Jose Molina, Alicia Hernández-Torres, Mario Venditti, Nuria Prim, Julia Origüen, German BouEvelina Tacconelli, Maria Tumbarello, Axel Hamprecht, Ilias Karaiskos, Cristina De La Calle, Federico Pérez, Mitchell J. Schwaber, Joaquin Bermejo, Warren Lowman, Po Ren Hsueh, Carolina Navarro-San Francisco, Robert A. Bonomo, David L. Paterson, Alvaro Pascual, Jesus Rodríguez-Baño

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypesMETHODS As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.RESULTS The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non-CTX-M ESBLs were detected.CONCLUSIONS Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.

Original languageEnglish
Pages (from-to)660-667
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume39
Issue number6
DOIs
StatePublished - 1 Jun 2018

Funding

FundersFunder number
Spanish Network for Research in Infectious DiseasesRD16/0016/0001, REIPI DR12/0015/0010
Subdirección General de Redes y Centros de Investigación Cooperativa
European Society of Clinical Microbiology and Infectious Diseases
Instituto de Salud Carlos III
European Regional Development Fund
Ministerio de Economía, Industria y Competitividad, Gobierno de España

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