Prevalence and impact of extended-spectrum beta-lactamase production on clinical outcomes in cancer patients with Enterobacter species bacteremia.
10.3904/kjim.2014.29.5.637
- Author:
Sun Jong KIM
1
;
Ki Ho PARK
;
Jin Won CHUNG
;
Heungsup SUNG
;
Seong Ho CHOI
;
Sang Ho CHOI
Author Information
1. Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Enterobacter;
Neoplasms;
beta-Lactamases
- MeSH:
Adult;
Aged;
Anti-Bacterial Agents/therapeutic use;
Bacteremia/*complications/drug therapy/microbiology;
Child;
Cohort Studies;
Enterobacter/*enzymology/genetics;
Enterobacteriaceae Infections/*complications/drug therapy/microbiology;
Female;
Humans;
Infant;
Male;
Middle Aged;
Neoplasms/*complications;
Prospective Studies;
Treatment Outcome;
beta-Lactamases/*biosynthesis/genetics
- From:The Korean Journal of Internal Medicine
2014;29(5):637-646
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: We examined the prevalence of extended-spectrum beta-lactamase (ESBL) production and the impact of ESBL on clinical outcomes in cancer patients with Enterobacter spp. bacteremia. METHODS: Using prospective cohort data on Enterobacter bacteremia obtained between January 2005 and November 2008 from a tertiary care center, the prevalence and clinical impact of ESBL production were evaluated. RESULTS: Two-hundred and three episodes of Enterobacter spp. bacteremia were identified. Thirty-one blood isolates (15.3%, 31/203) scored positive by the double-disk synergy test. Among 17 isolates in which ESBL genes were detected by polymerase chain reaction and sequencing, CTX-M (n = 12), SHV-12 (n = 11), and TEM (n = 4) were the most prevalent ESBL types. Prior usage of antimicrobial agents (77.4% vs. 54.0%, p = 0.02) and inappropriate empirical antimicrobial therapy (22.6% vs. 3.0%, p < 0.001) were more commonly encountered in the ESBL-positive group than in the extended-spectrum cephalosporin-susceptible ESBL-negative group, respectively. Clinical outcomes did not differ significantly between the two groups (30-day mortality rate, 19.4% vs. 17.0%, p = 0.76; median length of hospital stay, 24.0 days vs. 30.5 days, p = 0.97). Initial presentation of severe sepsis/septic shock, pneumonia, and intra-abdominal infection were independently associated with 30-day mortality. CONCLUSIONS: The prevalence of ESBL-producing isolates was 15.3% in cancer patients with Enterobacter bacteremia. Although inappropriate empirical therapy was more common in the ESBL-positive group, ESBL production was not associated with poorer outcomes.
