Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae: Risk Factors for Infection and Impact of Resistance on Outcomes

The prevalence of antibiotic resistance among extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae has increased markedly in recent years. Thirty-three patients with infection due to ESBL-producing E. coli or K. pneumoniae (case patients) were compared with 66 ma...

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Bibliographic Details
Published in:	Clinical infectious diseases 2001-04, Vol.32 (8), p.1162-1171
Main Authors:	Lautenbach, Ebbing, Patel, Jean Baldus, Bilker, Warren B., Edelstein, Paul H., Fishman, Neil O.
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Aged Aged, 80 and over Antibacterial agents Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents Antimicrobials beta-Lactamases - biosynthesis Biological and medical sciences Case-Control Studies Drug Resistance, Microbial Escherichia coli Escherichia coli - drug effects Escherichia coli - enzymology Escherichia coli - genetics Escherichia coli - isolation & purification Escherichia coli Infections - complications Escherichia coli Infections - drug therapy Escherichia coli Infections - economics Escherichia coli Infections - microbiology Fees and Charges Female Health outcomes Hospital admissions Hospitalization Humans Infections Intensive care units Klebsiella Infections - complications Klebsiella Infections - drug therapy Klebsiella Infections - economics Klebsiella Infections - microbiology Klebsiella pneumoniae Klebsiella pneumoniae - drug effects Klebsiella pneumoniae - enzymology Klebsiella pneumoniae - genetics Klebsiella pneumoniae - isolation & purification Major Articles Male Medical sciences Microbial Sensitivity Tests Middle Aged Operating rooms Pharmacology. Drug treatments Predisposing factors Risk Factors
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Summary:	The prevalence of antibiotic resistance among extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae has increased markedly in recent years. Thirty-three patients with infection due to ESBL-producing E. coli or K. pneumoniae (case patients) were compared with 66 matched controls. Total prior antibiotic use was the only independent risk factor for ESBL-producing E. coli or K. pneumoniae infection (odds ratio, 1.10; 95% confidence interval, 1.03-1.18; P = .006). Case patients were treated with an effective antibiotic a median of 72 hours after infection was suspected, compared with a median of 11.5 hours after infection was suspected for controls (P < .001). ESBL-producing E. coli or K. pneumoniae infection was associated with a significantly longer duration of hospital stay and greater hospital charges (P = .01 and P < .001, respectively). Finally, many ESBL-producing E. coli and K. pneumoniae isolates were closely related. ESBL-producing E. coli and K. pneumoniae infections have a significant impact on several important clinical outcomes, and efforts to control outbreaks of infection with ESBL-producing E. coli and K. pneumoniae should emphasize judicious use of all antibiotics as well as barrier precautions to reduce spread.
ISSN:	1058-4838 1537-6591