Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T04:38:50.175Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Infection With Cephalosporin-Resistant Klebsiella pneumoniae Is Not Associated With Increased Mortality

Published online by Cambridge University Press:  21 June 2016

Cristiana C. Gomes ,
Evangelina Vormittag ,
Cleide R. Santos  and
Anna S. Levin
Cristiana C. Gomes
Affiliation:
Department of Infectious Diseases of the University of São Paulo, São Paulo, Brazil
Evangelina Vormittag
Affiliation:
Infection Control Department of Hospital das Clinicas, São Paulo, Brazil
Cleide R. Santos
Affiliation:
Infection Control Department of Hospital das Clinicas, São Paulo, Brazil
Anna S. Levin*
Affiliation:
Infection Control Department of Hospital das Clinicas, São Paulo, Brazil Department of Infectious Diseases of the University of São Paulo, São Paulo, Brazil
*
Rua Harmonia, 564/52, São Paulo-SP 05435–000, Brazil, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate whether resistance to third-generation cephalosporins and/or aztreonam was associated with a higher mortality rate among patients with nosocomial Klebsiella pneumoniae infections.

Design.

Retrospective cohort study.

Setting.

Tertiary care university hospital.

Methods.

A total of 143 patients with nosocomial infections due to K. pneumoniae were evaluated. Death within 21 days after diagnosis of infection was the outcome. Demographic data, invasive procedures, presence and severity of underlying conditions, infection diagnosis, anatomic site of isolation, and treatment of infection, as well as resistance to third-generation cephalosporins and/or aztreonam, were evaluated for association with the outcome.

Results.

The mortality associated with nosocomial K. pneumoniae infections was 22% in our study. Drug resistance was found in isolates from 48% of case patients. Multivariate analysis demonstrated that the severity of the patient's underlying condition (odds ratio, 12.50; P<.01) and isolation of the microorganism from the blood or from another usually sterile site (odds ratio, 2.94; P = .03) were associated with death. On the other hand, the presence of resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. When only the severe cases of infection were analyzed, the results were unchanged.

Conclusions.

Resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. The reasons for this are not clear. It is possible that the severity of the underlying disease and the patient's condition have a larger role than the K. pneumoniae infection in determining the outcome, and initially inadequate treatment may not have an impact sufficient to cause irreversible damage, allowing treatment to be changed to an effective drug.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 907 - 912
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Essack, SY. Laboratory detection of extended-spectrum beta-lactamses (ESBLs): the need for a reliable, reproducible method. Diagn Microbiol Infect Dis 2000; 37:293–295.CrossRefGoogle Scholar
2.Paterson, DL. Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs). Clin Microbiol Infect 2000; 6:460–463.CrossRefGoogle ScholarPubMed
3.Paterson, DL, Ko, W-C, Von Gottberg, A, et al. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum beta-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol 2001; 39:2206–2212.CrossRefGoogle ScholarPubMed
4.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988; 16:128–140.CrossRefGoogle ScholarPubMed
5.National Committee for Clinical Laboratory Standards (NCCLS). Performance for Antimicrobial Susceptibility Testing M100-S10 (M7). Wayne, PA: NCCLS, 1999.Google Scholar
6.Knaus, WA, Draper, EA, Wagner, DP, Zimmernab, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818–829.CrossRefGoogle ScholarPubMed
7.Pittet, D. Challenges, treatment strategies and clinical progression of MRSA bacteremia. Presse Med 2004; 33:2S10–2S17.Google ScholarPubMed
8.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003; 36:53–59.CrossRefGoogle ScholarPubMed
9.Hirakata, Y, Yamaguchi, T, Nakano, M, et al. Clinical and bacteriological characteristics of IMP-type metallo-beta-lactamase—producing Pseudomonas aeruginosa. Clin Infect Dis 2003; 37:26–32.CrossRefGoogle ScholarPubMed
10.Melzer, M, Eykyn, J, Grandsden, WR, Chinn, S. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus?. A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 2003; 37:1453–1460.CrossRefGoogle ScholarPubMed
11.Pelletier, SJ, Raymond, DP, Crabtree, TD, Gleason, TG, Priett, TL, Sawyer, R. Outcome analysis of intraabdominal infection with resistant gram-positive organisms. Surg Infect Larchmt 2002; 3:11–19.CrossRefGoogle ScholarPubMed
12.Kim, BN, Woo, JH, Ryu, J, Kim, YS. Resistance to extended-spectrum cephalosporins and mortality in patients with Citrobacter freundii bacteremia. Infection 2003; 31:202–207.CrossRefGoogle ScholarPubMed
13.Peres-Bota, D, Rodriguez, H, Dimopoulos, G, et al. Are infections due to resistant pathogens associated with a worse outcome in critically ill patients? J Infect 2003; 47:307–316.CrossRefGoogle ScholarPubMed
14.Paterson, DL, Ko, W-C, Von Gottberg, A, et al. Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases. Clin Infect Dis 2004; 39:31–37.CrossRefGoogle ScholarPubMed