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Clinical and microbiological characteristics of adult patients with recurrent bacteraemia caused by extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae.
Clin Microbiol Infect. 2015 Aug 10;
Authors: Lee CH, Su LH, Chen FJ, Tang YF, Chien CC, Liu JW
Abstract
The characteristics of patients with recurrent bacteraemia caused by extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae (ESBL-EK) are rarely described. Flomoxef belongs to cephamycins demonstrates in-vitro activity against ESBL-producing organisms. Whether use flomoxef for the treatment of such infections remains controversial. This retrospective case-control study enrolled adult patients who had bacteraemia caused by ESBL-EK during 2005-2011. Case patients were those who had more than 1 episode of ESBL-EK bacteraemia. Controls were those who were matched for age and interval time of blood sampling and had only 1 episode of ESBL-EK bacteraemia with subsequent bacteraemia episodes caused by other non-ESBL-EK bacteria. Pulsed-field gel electrophoresis and microbiological profiles of the initial and subsequent ESBL-EK isolates were analyzed. During the study period, 424 patients were found to have at least 1 blood culture after the first ESBL-EK bacteraemia episode and 67 (15.8%) had a second episode of ESBL-EK bacteraemia. Bacteraemia secondary to vascular catheter-related infection (OR, 3.24; 95% CI, 1.31-8.05), and definitive therapy with flomoxef (OR, 2.99; 95% CI, 1.10-8.15) were both independent risk factors for the recurrence. Among the 56 patients with available ESBL-EK isolates for analysis, 38 (67.8%) were infected by genetically similar strains. In 3 of these 38 recurrent ESBL-EK bacteraemia caused by identical strain, the minimum inhibitory concentrations of carbapenem for the subsequent K. pneumoniae isolates were 4-fold or higher than the initial isolates. Recurrent bacteraemia was not uncommon in our patients with ESBL-EK bacteraemia and most of the episodes were caused by identical strains.
PMID: 26271718 [PubMed - as supplied by publisher]