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Risk factors for infection and treatment outcome of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumonia bacteremia in patients with hematologic malignancy

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Author(s)
류성열
Alternative Author(s)
Ryu, Seong Yeol
Publication Year
2012
Abstract
This study was performed to evaluate the impact
of extended-spectrum β-lactamase (ESBL)-producing bacteremia
on outcome in patients with hematologic malignancy.
We collected and analyzed data on 156 hematologic
malignancy patients with Escherichia coli or Klebsiella
pneumoniae bacteremia from the database of nationwide
surveillance studies for bacteremia. Thirty-seven of the 156
patients (23.7%) harbored ESBL-producing bacteremia. No
significant differences in underlying diseases were found in
either group. The multivariate analysis showed that signif-icant factors associated with ESBL-producing bacteremia
were ICU care (OR=7.03, 95% CI=1.79–27.6) and
nosocomial acquisition (OR=5.66, 95% CI=1.60–20.23).
There was an association between prior receipt of cephalosporins
and ESBL-producing bacteremia, although this
association was not statistically significant (OR=2.27, 95%
CI=0.99–5.23). The overall 30-day mortality rate of the
study population was 20.4% (29/142), and the 30-day
mortality rate for the ESBL group was significantly higher
than that for the non-ESBL group (44.8% vs. 14.2%,
P<0.001). Multivariate analysis showed that ESBLproducing
bacteremia was the most important risk factor
associated with 30-day mortality (OR, 5.64; 95% CI, 1.91–
16.67), along with ICU care (OR=4.35, 95% CI=1.16–16.26)
and higher Pitt bacteremia score (per 1-point increment) (OR=
1.50, 95% CI=1.18–1.92). In conclusion, ESBL-producing
bacteremia was the most important risk factor associated
with 30-day mortality in patients with hematologic malignancy,
along with ICU care and higher Pitt bacteremia score. Our
data suggest that determining the optimal empiric antimicrobial
therapy in patients with hematologic malignancy is
now becoming a challenge for clinicians in the era of
multidrug-resistant Gram-negative bacilli.
Keywords Gram-negative bacterial infections .
Bacteremia . Hematologic neoplasms . Treatment outcome .
Cephalosporin resistance
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine
Citation
Annals of Hematology, Vol.91(1) : 115-21, 2012
Type
Article
ISSN
0939-5555
DOI
10.1007/s00277-011-1247-7
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34973
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