Antibiotic therapy for Klebsiella pneumoniae bacteremia: Implications of production of extended-spectrum β-lactamases

David L. Paterson, Wen Chien Ko, Anne Von Gottberg, Sunita Mohapatra, Jose Maria Casellas, Herman Goossens, Lutfiye Mulazimoglu, Gordon Trenholme, Keith P. Klugman, Robert A. Bonomo, Louis B. Rice, Marilyn M. Wagener, Joseph G. McCormack, Victor L. Yu

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466 Citations (Scopus)


The prevalence of extended-spectrum β-lactamase (ESBL) production by Klebsiella pneumonia approaches 50% in some countries, with particularly high rates in eastern Europe and Latin America. No randomized trials have ever been performed on treatment of bacteremia due to ESBL-producing organisms; existing data comes only from retrospective, single-institution studies. In a prospective study of 455 consecutive episodes of Klebsiella pneumoniae bacteremia in 12 hospitals in 7 countries, 85 episodes were due to an ESBL-producing organism. Failure to use an antibiotic active against ESBL-producing K. pneumoniae was associated with extremely high mortality. Use of a carbapenem (primarily imipenem) was associated with a significantly lower 14-day mortality than was use of other antibiotics active in vitro. Multivariate analysis including other predictors of mortality showed that use of a carbapenem during the 5-day period after onset of bacteremia due to an ESBL-producing organism was independently associated with lower mortality. Antibiotic choice is particularly important in seriously ill patients with infections due to ESBL-producing K. pneumoniae.

Original languageEnglish
Pages (from-to)31-37
Number of pages7
JournalClinical Infectious Diseases
Issue number1
Publication statusPublished - 2004 Jul 1

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases


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