DOI QR코드

DOI QR Code

Third-generation cephalosporin resistance of community-onset Escherichia coli and Klebsiella pneumoniae bacteremia in a secondary hospital

  • Lee, Shinwon (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Han, Seung Woo (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Kim, Kun Woo (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Song, Do Young (Department of Laboratory Medicine, Daegu Fatima Hospital) ;
  • Kwon, Ki Tae (Department of Internal Medicine, Daegu Fatima Hospital)
  • Received : 2012.11.22
  • Accepted : 2013.03.08
  • Published : 2014.01.01

Abstract

Background/Aims: To enable appropriate antimicrobial treatment for community-onset infections in emergency departments (EDs), data are needed on the resistance profiles of Escherichia coli and Klebsiella pneumoniae, which are the main pathogens of community-onset bacteremia. Methods: Records were reviewed of 734 patients with E. coli and K. pneumoniae bacteremia who visited the Daegu Fatima Hospital ED, Daegu, Korea between 2003 and 2009. We investigated the demographic data, clinical findings, and antimicrobial susceptibility patterns of the organisms. Results: Of 1,208 cases of community-onset bacteremia, 62.8% were caused by E. coli or K. pneumoniae in an ED of a secondary care hospital. Five hundred and forty-eight cases of E. coli (75%) and 183 cases of K. pneumoniae (25%) were analyzed. Urinary tract infection (43.1%) was most common, followed by intra-abdominal infection (39%) and pneumonia (7.2%). Trimethoprim/sulfamethoxazole, fluoroquinolone, third-generation cephalosporin (3GC) and amikacin resistance rates among E. coli and K. pneumoniae were 22.8%, 19.6%, 6.2%, and 1.3%, respectively. In 2009, the rate of 3GC resistance (10.6%) was significantly higher, compared to the annual averages of 2003 to 2008 (6.1%; p = 0.03). Previous exposure to antibiotics was an independent risk factor for 3GC resistance in multivariate logistic regression analysis. Conclusions: The rate of 3GC resistance increased in community-onset infections, and previous exposure to antibiotics was an independent risk factor. Despite the increased 3GC resistance in community-onset infections, an amikacin combination therapy could provide an option for treatment of bacteremic patients with previous antibiotic exposure in an ED.

Keywords

References

  1. Diekema DJ, Pfaller MA, Jones RN, et al. Survey of bloodstream infections due to gram-negative bacilli: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, and Latin America for the SENTRY Antimicrobial Surveillance Program, 1997. Clin Infect Dis 1999;29:595-607. https://doi.org/10.1086/598640
  2. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103-e120. https://doi.org/10.1093/cid/ciq257
  3. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010;50:133-164. https://doi.org/10.1086/649554
  4. Cheong HJ, Yoo CW, Sohn JW, Kim WJ, Kim MJ, Park SC. Bacteremia due to quinolone-resistant Escherichia coli in a teaching hospital in South Korea. Clin Infect Dis 2001;33:48-53. https://doi.org/10.1086/320873
  5. Ena J, Lopez-Perezagua MM, Martinez-Peinado C, Cia-Barrio MA, Ruiz-Lopez I. Emergence of ciprof loxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones. Diagn Microbiol Infect Dis 1998;30:103-107. https://doi.org/10.1016/S0732-8893(97)00216-2
  6. Lee H, Kim CK, Lee J, et al. Antimicrobial resistance of clinically important bacteria isolated from 12 hospitals in Korea in 2005 and 2006. Korean J Clin Microbiol 2007;10:59-69.
  7. Hawser SP, Bouchillon SK, Hoban DJ, Badal RE, Canton R, Baquero F. Incidence and antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae with extended-spectrum beta-lactamases in communityand hospital-associated intra-abdominal infections in Europe: results of the 2008 Study for Monitoring Antimicrobial Resistance Trends (SMART). Antimicrob Agents Chemother 2010;54:3043-3046. https://doi.org/10.1128/AAC.00265-10
  8. Pitout JD, Gregson DB, Church DL, Laupland KB. Population-based laboratory surveillance for AmpC beta-lactamase-producing Escherichia coli, Calgary. Emerg Infect Dis 2007;13:443-448. https://doi.org/10.3201/eid1303.060447
  9. Rodriguez-Bano J, Picon E, Gijon P, et al. Communityonset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis. Clin Infect Dis 2010;50:40-48. https://doi.org/10.1086/649537
  10. Kang CI, Song JH, Chung DR, et al. Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli. Int J Antimicrob Agents 2010;36:284-287. https://doi.org/10.1016/j.ijantimicag.2010.05.009
  11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383. https://doi.org/10.1016/0021-9681(87)90171-8
  12. Paterson DL, Ko WC, Von Gottberg A, et al. International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial Infections. Ann Intern Med 2004;140:26-32. https://doi.org/10.7326/0003-4819-140-1-200401060-00008
  13. Courpon-Claudinon A, Lefort A, Panhard X, et al. Bacteraemia caused by third-generation cephalosporin-resistant Escherichia coli in France: prevalence, molecular epidemiology and clinical features. Clin Microbiol Infect 2011;17:557-565. https://doi.org/10.1111/j.1469-0691.2010.03298.x
  14. Livermore DM, Hope R, Brick G, Lillie M, Reynolds R; BSAC Working Parties on Resistance Surveillance. Nonsusceptibility trends among Enterobacteriaceae from bacteraemias in the UK and Ireland, 2001-06. J Antimicrob Chemother 2008;62 Suppl 2:ii41-ii54. https://doi.org/10.1093/jac/dkn169
  15. Wang P, Hu F, Xiong Z, et al. Susceptibility of extended-spectrum-beta-lactamase-producing Enterobacteriaceae according to the new CLSI breakpoints. J Clin Microbiol 2011;49:3127-3131. https://doi.org/10.1128/JCM.00222-11
  16. Song W, Lee H, Lee K, et al. CTX-M-14 and CTX-M-15 enzymes are the dominant type of extended-spectrum beta-lactamase in clinical isolates of Escherichia coli from Korea. J Med Microbiol 2009;58(Pt 2):261-266. https://doi.org/10.1099/jmm.0.004507-0
  17. Kang CI, Kim SH, Kim DM, et al. Risk factors for and clinical outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2004;25:860-867. https://doi.org/10.1086/502310
  18. Kim YK, Pai H, Lee HJ, et al. Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 2002;46:1481-1491. https://doi.org/10.1128/AAC.46.5.1481-1491.2002
  19. Menashe G, Borer A, Yagupsky P, et al. Clinical significance and impact on mortality of extended-spectrum beta lactamase-producing Enterobacteriaceae isolates in nosocomial bacteremia. Scand J Infect Dis 2001;33:188-193. https://doi.org/10.1080/00365540151060806
  20. Schwaber MJ, Navon-Venezia S, Kaye KS, Ben-Ami R, Schwartz D, Carmeli Y. Clinical and economic impact of bacteremia with extended-spectrum-beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2006;50:1257-1262. https://doi.org/10.1128/AAC.50.4.1257-1262.2006
  21. Tumbarello M, Spanu T, Sanguinetti M, et al. Bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother 2006;50:498-504. https://doi.org/10.1128/AAC.50.2.498-504.2006
  22. Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657-686. https://doi.org/10.1128/CMR.18.4.657-686.2005
  23. Kang CI, Park SY, Chung DR, Peck KR, Song JH. Piperacillin- tazobactam as an initial empirical therapy of bacteremia caused by extended-spectrum ${\beta}$-lactamase-producing Escherichia coli and Klebsiella pneumoniae. J Infect 2012;64:533-534. https://doi.org/10.1016/j.jinf.2012.01.008
  24. Rodriguez-Bano J, Navarro MD, Retamar P, Picon E, Pascual A; Extended-Spectrum Beta-Lactamases-Red Espanola de Investigacion en Patología Infecciosa/Grupo de Estudio de Infeccion Hospitalaria Group. ${\beta}$-Lactam/${\beta}$-lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum ${\beta}$-lactamase-producing Escherichia coli: a post hoc analysis of prospective cohorts. Clin Infect Dis 2012;54:167-174. https://doi.org/10.1093/cid/cir790

Cited by

  1. Third-generation cephalosporin resistance in gram-negative bacteria in the community: a growing public health concern vol.29, pp.1, 2014, https://doi.org/10.3904/kjim.2014.29.1.27
  2. Bacteriology and Changes in Antibiotic Susceptibility in Adults with Community-Acquired Perforated Appendicitis vol.9, pp.10, 2014, https://doi.org/10.1371/journal.pone.0111144
  3. Analysis of the third‐ and fourth‐generation cephalosporin use for the treatment of infections caused by Gram‐negative bacteria in hospital settings vol.70, pp.12, 2014, https://doi.org/10.1111/ijcp.12911
  4. The Antimicrobial Susceptibility of Klebsiella pneumoniae from Community Settings in Taiwan, a Trend Analysis vol.6, pp.None, 2016, https://doi.org/10.1038/srep36280
  5. Microbiology and Antimicrobial Therapy for Diabetic Foot Infections vol.50, pp.1, 2014, https://doi.org/10.3947/ic.2018.50.1.11
  6. Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China vol.18, pp.None, 2014, https://doi.org/10.1186/s12879-018-3405-1
  7. Antimicrobial resistance surveillance among gram-negative bacterial isolates from patients in hospitals in Khartoum State, Sudan vol.8, pp.None, 2019, https://doi.org/10.12688/f1000research.17744.1
  8. Prevalence of and risk factor for community-onset third-generation cephalosporin-resistant Escherichia coli bacteremia at a medical center in Taiwan vol.19, pp.None, 2014, https://doi.org/10.1186/s12879-019-3880-z
  9. Aeromonas spp. Isolated from Pacific Abalone (Haliotis discus hannai) Marketed in Korea: Antimicrobial and Heavy-Metal Resistance Properties vol.77, pp.8, 2014, https://doi.org/10.1007/s00284-020-01982-9
  10. Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae : A Multicenter Study in China vol.17, pp.24, 2014, https://doi.org/10.3390/ijerph17249285
  11. Comparison of antimicrobial resistances and clinical features in community-onset Escherichia coli and Klebsiella pneumoniae bacteremia vol.36, pp.2, 2014, https://doi.org/10.3904/kjim.2019.272