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

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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 significant 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 ESBL-producing 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.

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Acknowledgments

This study was supported by a grant from the Korea Health 21 R & D Project funded by the Ministry of Health & Welfare, Republic of Korea (A102065).

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Authors and Affiliations

  1. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135–710, Republic of Korea

    Cheol-In Kang, Doo Ryeon Chung, Kyong Ran Peck & Jae-Hoon Song

  2. Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, South Korea

    Kwan Soo Ko

  3. Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, South Korea

    Kwan Soo Ko & Jae-Hoon Song

Authors
  1. Cheol-In Kang
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  2. Doo Ryeon Chung
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  4. Kyong Ran Peck
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  5. Jae-Hoon Song
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The Korean Network for Study of Infectious Diseases (KONSID)

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Correspondence to Jae-Hoon Song.

Additional information

KONSID members are as follows: Jae-Hoon Song, Cheol-In Kang, Doo Ryeon Chung, Kyong Ran Peck, Nam Yong Lee, and Yae Jean Kim (Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea), Kwan Soo Ko (Sungkyunkwan University School of Medicine, Suwon, Korea), Joon-Sup Yeom (Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea), Hyun Kyun Ki and Hae Suk Cheong (Konkuk University Hospital, Seoul, Korea), Jun Seong Son (Kyunghee University Hospital, Seoul, Korea), Choon Kwan Kim (Seoul Veterans Hospital, Seoul, Korea), Jin Seo Lee (Kangdong Sacred Heart Hospital, Seoul, Korea), Seung Soon Lee (Hallym University Sacred Heart Hospital, Seoul, Korea), Eun Seok Kim (Anyang Sam Hospital, Anyang, Korea), Yeon-Sook Kim (Chungnam National University Hospital, Daejon, Korea), Ji-Young Rhee (Dankook University Hospital, Cheonan, Korea), Sook-In Jung and Kyung Hwa Park (Chonnam National University Hospital, Gwangju, Korea), Shin-Woo Kim and Hyun-Ha Chang (Kyungpook National University Hospital, Daegu, Korea), Seong Yeol Ryu (Keimyung University Dongsan Medical Center, Daegu, Korea), Ki Tae Kwon (Daegu Fatima Hospital, Daegu, Korea), Hyuck Lee and Dong Sik Jung (Dong-A University Hospital, Busan, Korea), Chisook Moon (Inje University Busan Paik Hospital, Busan, Korea), Sang Taek Heo (Gyeongsang National University Hospital, Jinju, Korea), and Sang Yop Shin (Cheju National University Hospital, Jeju, Korea).

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Kang, CI., Chung, D.R., Ko, K.S. et al. Risk factors for infection and treatment outcome of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in patients with hematologic malignancy. Ann Hematol 91, 115–121 (2012). https://doi.org/10.1007/s00277-011-1247-7

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  • DOI: https://doi.org/10.1007/s00277-011-1247-7

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