TY - JOUR
T1 - Antibiotic therapy for Klebsiella pneumoniae bacteremia
T2 - Implications of production of extended-spectrum β-lactamases
AU - Paterson, David L.
AU - Ko, Wen Chien
AU - Von Gottberg, Anne
AU - Mohapatra, Sunita
AU - Casellas, Jose Maria
AU - Goossens, Herman
AU - Mulazimoglu, Lutfiye
AU - Trenholme, Gordon
AU - Klugman, Keith P.
AU - Bonomo, Robert A.
AU - Rice, Louis B.
AU - Wagener, Marilyn M.
AU - McCormack, Joseph G.
AU - Yu, Victor L.
N1 - Funding Information:
1Infectious Disease Section, VA Medical Center, Pittsburgh, Pennsylvania; 2Department of Medicine, University of Queensland, Mater Adults Hospital, Brisbane, Australia; 3Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan; 4South African Institute of Medical Research, Johannesburg, South Africa; 5Section of Infectious Diseases, Rush Presbyterian St. Luke’s Medical Center, Chicago, Illinois; 6Departmento de Infectologia y Microbiologia, Sanatorio San Lucas, Buenos Aires, Argentina; 7Department of Microbiology, University Hospital, Antwerp, Belgium; 8Department of Microbiology, Marmara University, Istanbul, Turkey; and 9Infectious Diseases Section, Veterans Affairs Medical Center, Cleveland, Ohio
PY - 2004/7/1
Y1 - 2004/7/1
N2 - 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.
AB - 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.
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U2 - 10.1086/420816
DO - 10.1086/420816
M3 - Article
C2 - 15206050
AN - SCOPUS:3042706689
SN - 1058-4838
VL - 39
SP - 31
EP - 37
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -
