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Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome

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Abstract

Escherichia coli and Klebsiella pneumoniae are main pathogens in neutropenic fever even if the proportion of Gram-positive cocci is increasing. Extended-spectrum β-lactamases (ESBL)-producing organisms are an emerging problem in nosocomial infection. Nevertheless, until now, information about risk factors for the acquisition and clinical outcomes of bacteremia due to ESBL-producing organisms is limited in neutropenic patients. From medical records collected between January 2007 and December 2008, we identified a total of 101 consecutive patients who developed bacteremia due to E. coli (n = 87) or K. pneumoniae (n = 14). Twenty-six (26 %) cases of bacteremia were caused by ESBL-producing organisms. A hospital stay of >2 weeks during the 3 months preceding bacteremia [adjusted odds ratio (OR), 5.887; 95 % confidence interval (CI), 1.572–22.041] and the use of broad-spectrum cephalosporins in the 4 weeks prior to bacteremia (adjusted OR, 6.186; 95 % CI, 1.616–23.683) were significantly related to the acquisition of ESBL. Twenty-four (92 %) of the ESBL-producing organisms were susceptible to either piperacillin–tazobactam or amikacin. Aminoglycosides (amikacin or isepamicin) were the main appropriate antimicrobial agents used against the ESBL-producing isolates during the initial empirical treatment (16/22, 73 %). However, the 30-day mortality rates for ESBL bacteremia and non-ESBL bacteremia were not significantly different (15 vs 5 %; p = 0.199). As alternatives to carbapenem, piperacillin–tazobactam plus amikacin or isepamicin combinations may be effective empirical therapeutic options for patients with neutropenic fever who are at high risk of developing bacteremia with ESBL-producing pathogens.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea

    Si-Hyun Kim

  2. Division of Infectious Diseases, Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea

    Jae-Cheol Kwon

  3. Division of Infectious Diseases, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, #62 Yeouido-Dong, Yeongdeungpo-Gu, Seoul, 150-173, South Korea

    Su-Mi Choi

  4. Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Dong-Gun Lee, Sun Hee Park, Jung-Hyun Choi & Jin-Hong Yoo

  5. Catholic Blood and Marrow Transplantation Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Dong-Gun Lee, Byung-Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Hee-Je Kim, Seok Lee, Chang-Ki Min, Seok-Goo Cho, Dong-Wook Kim, Jong-Wook Lee & Woo-Sung Min

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Correspondence to Su-Mi Choi.

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Kim, SH., Kwon, JC., Choi, SM. et al. Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome. Ann Hematol 92, 533–541 (2013). https://doi.org/10.1007/s00277-012-1631-y

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