TITLE

Antibiotic Therapy for Klebsiella pneumoniae Bacteremia: Implications of Production of Extended-Spectrum Î’ -Lactamases

AUTHOR(S)
Paterson, David L.; Ko, Wen-Chien; Von Gottberg, Anne; Mohapatra, Sunita; Casellas, Jose Maria; Goossens, Herman; Mulazimoglu, Lutfiye; Trenholme, Gordon; Klugman, Keith P.; Bonomo, Robert A.; Rice, Louis B.; Wagener, Marilyn M.; McCormack, Joseph G.; Yu, Victor L.
PUB. DATE
July 2004
SOURCE
Clinical Infectious Diseases;7/1/2004, Vol. 39 Issue 1, p31
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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.
ACCESSION #
13602126

 

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