The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Prevalence and impact of extended-spectrum ${\beta}$-lactamase production on clinical outcomes in cancer patients with Enterobacter species bacteremia

  • Kim, Sun Jong (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Park, Ki-Ho (Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Medical Center) ;
  • Chung, Jin-Won (Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital) ;
  • Sung, Heungsup (Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Seong-Ho (Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital) ;
  • Choi, Sang-Ho (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.03.08
  • Accepted : 2014.05.22
  • Published : 2014.09.01
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Abstract

Background/Aims: We examined the prevalence of extended-spectrum ${\beta}$-lactamase (ESBL) production and the impact of ESBL on clinical outcomes in cancer patients with Enterobacter spp. bacteremia. Methods: Using prospective cohort data on Enterobacter bacteremia obtained between January 2005 and November 2008 from a tertiary care center, the prevalence and clinical impact of ESBL production were evaluated. Results: Two-hundred and three episodes of Enterobacter spp. bacteremia were identified. Thirty-one blood isolates (15.3%, 31/203) scored positive by the double-disk synergy test. Among 17 isolates in which ESBL genes were detected by polymerase chain reaction and sequencing, CTX-M (n = 12), SHV-12 (n = 11), and TEM (n = 4) were the most prevalent ESBL types. Prior usage of antimicrobial agents (77.4% vs. 54.0%, p = 0.02) and inappropriate empirical antimicrobial therapy (22.6% vs. 3.0%, p < 0.001) were more commonly encountered in the ESBL-positive group than in the extended-spectrum cephalosporin-susceptible ESBL-negative group, respectively. Clinical outcomes did not differ significantly between the two groups (30-day mortality rate, 19.4% vs. 17.0%, p = 0.76; median length of hospital stay, 24.0 days vs. 30.5 days, p = 0.97). Initial presentation of severe sepsis/septic shock, pneumonia, and intra-abdominal infection were independently associated with 30-day mortality. Conclusions: The prevalence of ESBL-producing isolates was 15.3% in cancer patients with Enterobacter bacteremia. Although inappropriate empirical therapy was more common in the ESBL-positive group, ESBL production was not associated with poorer outcomes.

Keywords

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