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

Published online by Cambridge University Press:  05 April 2018

Oded Scheuerman ,
Vered Schechner ,
Yehuda Carmeli ,
Belen Gutiérrez-Gutiérrez ,
Esther Calbo ,
Benito Almirante ,
Pier-Luigy Viale ,
Antonio Oliver ,
Patricia Ruiz-Garbajosa  and
Oriol Gasch
...Show all authors
Oded Scheuerman*
Affiliation:
Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Vered Schechner
Affiliation:
Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Yehuda Carmeli
Affiliation:
Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Belen Gutiérrez-Gutiérrez
Affiliation:
Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
Esther Calbo
Affiliation:
Hospital Universitari Mútua de Terrassa, Barcelona, Spain
Benito Almirante
Affiliation:
Hospital Universitari Vall d’Hebrón, Barcelona, Spain
Pier-Luigy Viale
Affiliation:
Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy
Antonio Oliver
Affiliation:
Hospital Universitario Son Espases, Palma de Mallorca, Spain
Patricia Ruiz-Garbajosa
Affiliation:
Hospital Ramón y Cajal, Madrid, Spain
Oriol Gasch
Affiliation:
Corporacio Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
Monica Gozalo
Affiliation:
Hospital Universitario Marqués de Valdecilla—IDIVAL, Santander, Spain
Johann Pitout
Affiliation:
Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
Murat Akova
Affiliation:
Hacettepe University School of Medicine, Ankara, Turkey
Carmen Peña
Affiliation:
Hospital Universitari de Bellvitge, Barcelona, Spain
Jose Molina
Affiliation:
Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, CSIC, University of Seville, Seville, Spain
Alicia Hernández-Torres
Affiliation:
Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
Mario Venditti
Affiliation:
Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
Nuria Prim
Affiliation:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Julia Origüen
Affiliation:
Hospital Universitario 12 de Octubre, Madrid, Spain
German Bou
Affiliation:
Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
Evelina Tacconelli
Affiliation:
Universitätsklinikum Tübingen, Tübingen, Germany
Maria Tumbarello
Affiliation:
Catholic University of the Sacred Heart, Rome, Italy
Axel Hamprecht
Affiliation:
Institut für Mikrobiologie, Immunologie und Hygiene Universitätsklinikum Köln, Cologne, Germany
Ilias Karaiskos
Affiliation:
Hygeia General Hospital, Athens,Greece
Cristina de la Calle
Affiliation:
Hospital Clinic, Barcelona, Spain
Federico Pérez
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
Mitchell J. Schwaber
Affiliation:
Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Joaquin Bermejo
Affiliation:
Hospital Español, Rosario, Argentina
Warren Lowman
Affiliation:
Wits Donald Gordon Medical Centre, Johannesburg, South Africa
Po-Ren Hsueh
Affiliation:
National Taiwan University Hospital, National Taiwan University Hospital College of Medicine, Taipei, Taiwan
Carolina Navarro-San Francisco
Affiliation:
Hospital Universitario La Paz, Madrid, Spain
Robert A. Bonomo
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
David L. Paterson
Affiliation:
University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia
Alvaro Pascual
Affiliation:
Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
Jesus Rodríguez-Baño
Affiliation:
Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
*
Address correspondence to O. Scheuerman, MD, Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center Tel Aviv and Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel ([email protected]).
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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 genotypes

METHODS

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.

CLINICAL TRIALS IDENTIFIER

ClinicalTrials.gov. Identifier: NCT01764490.

Infect Control Hosp Epidemiol 2018;39:660–667

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 6 , June 2018 , pp. 660 - 667
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Other investigators in the REIPI/ESGBIS/INCREMENT project: J. Guzmán Puche, University General Hospital Attikoni, Greece; M. Souli, Case Western Reserve University School of Medicine, Cleveland Ohio, United States; J. Gálvez, Hospital Universitario Virgen Macarena, Seville, Spain; M. Falcone and A. Russo, Policlinico Umberto I, Rome, Italy; G. Daikos, Laikon General Hospital, Athens, Greece; E. M. Trecarichi and A. R. Losito, Catholic University of the Sacred Heart, Rome, Italy; J. Gómez and E. García-Vázquez, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; E. Iosifidis and E. Roilides, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece; I. Karaiskos, Hygeia General Hospital, Athens, Greece; Y. Doi, University of Pittsburgh, Pittsburgh, Pennsylvania, United States; F. F. Tuon, Hospital da Universidade Federal do Paraná, Paraná, Brazil; J. A. Martínez, L. Morata and A. Soriano, Hospital Clinic, Barcelona, Spain; F. Navarro and B. Mirelis, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; R. San Juan and M. Fernández-Ruiz, Hospital 12 de Octubre, Madrid, Spain; N. Larrosa and M. Puig, Hospital Universitario Vall d’Hebrón, Barcelona, Spain; J. Molina and V. González, Hospital Universitario Virgen del Rocío, Seville, Spain; V. Rucci, Hospital Español, Rosario, Argentina; E. Ruiz de Gopegui and C. I. Marinescu, Hospital Universitario Son Espases, Palma de Mallorca, Spain; M. C. Fariñas, M. E. Cano, and M. Gozalo, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; J. R. Paño-Pardo and Marta Mora-Rillo, Hospital Universitario La Paz-IDIPAZ, Madrid, Spain; S. Gómez-Zorrilla and F. Tubau, Hospital de Bellvitge, Barcelona, Spain; S. Pournaras, A. Tsakris, and O. Zarkotou, University of Athens, Athens, Greece; Ö. K. Azap, Baskent University, Ankara, Turkey; M. Souli, A. Antoniadou, and G. Poulakou, University General Hospital Attikon, Chiadiri, Greece; D. Virmani, University of Calgary, Calgary, Canada; Á. Cano and J. Guzmán-Puche, Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain; Ö. Helvaci and A. O. Sahin, Hacettepe University, Ankara, Turkey; V. Pintado and R. Cantón, Hospital Ramón y Cajal, Madrid, Spain; M. Bartoletti and M. Giannella, Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy; S. Peter, Tübingen University Hospital, Tübingen, Germany; C. Badia and M. Xercavins, Hospital Universitario Mútua de Terrassa, Terrassa, Spain; D. Fontanals and E. Jové, Hospital Parc Taulí, Sabadell, Spain.

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