Annals of Hematology

, Volume 91, Issue 1, pp 115–121 | Cite as

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

  • Cheol-In Kang
  • Doo Ryeon Chung
  • Kwan Soo Ko
  • Kyong Ran Peck
  • Jae-Hoon SongEmail author
  • The Korean Network for Study of Infectious Diseases (KONSID)
Original Article


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.


Gram-negative bacterial infections Bacteremia Hematologic neoplasms Treatment outcome Cephalosporin resistance 



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).

Conflicts of interest



  1. 1.
    Arnan M, Gudiol C, Calatayud L, Linares J, Dominguez MA, Batlle M, Ribera JM, Carratala J, Gudiol F (2011) Risk factors for, and clinical relevance of, faecal extended-spectrum beta-lactamase producing Escherichia coli (ESBL-EC) carriage in neutropenic patients with haematological malignancies. Eur J Clin Microbiol Infect Dis 30:355–360PubMedCrossRefGoogle Scholar
  2. 2.
    Blot S, Vandewoude K, De Bacquer D, Colardyn F (2002) Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clin Infect Dis 34:1600–1606PubMedCrossRefGoogle Scholar
  3. 3.
    Chong Y, Yakushiji H, Ito Y, Kamimura T (2010) Cefepime-resistant Gram-negative bacteremia in febrile neutropenic patients with hematological malignancies. Int J Infect Dis 14(Suppl 3):e171–e175PubMedCrossRefGoogle Scholar
  4. 4.
    Chow JW, Fine MJ, Shlaes DM, Quinn JP, Hooper DC, Johnson MP, Ramphal R, Wagener MM, Miyashiro DK, Yu VL (1991) Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 115:585–590PubMedGoogle Scholar
  5. 5.
    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Contr 16:128–140CrossRefGoogle Scholar
  6. 6.
    Gudiol C, Calatayud L, Garcia-Vidal C, Lora-Tamayo J, Cisnal M, Duarte R, Arnan M, Marin M, Carratala J, Gudiol F (2010) Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome. J Antimicrob Chemother 65:333–341PubMedCrossRefGoogle Scholar
  7. 7.
    Gudiol C, Tubau F, Calatayud L, Garcia-Vidal C, Cisnal M, Sanchez-Ortega I, Duarte R, Calvo M, Carratala J (2011) Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother 66:657–663PubMedCrossRefGoogle Scholar
  8. 8.
    Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Oh MD, Kim EC, Choe KW (2004) Bloodstream infections caused by Enterobacter species: predictors of 30-day mortality rate and impact of broad-spectrum cephalosporin resistance on outcome. Clin Infect Dis 39:812–818PubMedCrossRefGoogle Scholar
  9. 9.
    Kang CI, Ryeon Chung D, Peck KR, Song JH (2010) Hematologic malignancy as a risk factor for bacteremic skin and soft tissue infection caused by gram-negative bacilli. Ann Hematol 89:1171–1173PubMedCrossRefGoogle Scholar
  10. 10.
    Kang CI, Song JH, Chung DR, Peck KR, Ko KS, Yeom JS, Ki HK, Son JS, Lee SS, Kim YS, Jung SI, Kim SW, Chang HH, Ryu SY, Kwon KT, Lee H, Moon C (2011) Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia. J Infect 62:26–33PubMedCrossRefGoogle Scholar
  11. 11.
    Kang CI, Song JH, Chung DR, Peck KR, Ko KS, Yeom JS, Ki HK, Son JS, Lee SS, Kim YS, Jung SI, Kim SW, Chang HH, Ryu SY, Kwon KT, Lee H, Moon C, Shin SY (2010) Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli. Int J Antimicrob Agents 36:284–287PubMedCrossRefGoogle Scholar
  12. 12.
    Kim YK, Pai H, Lee HJ, Park SE, Choi EH, Kim J, Kim JH, Kim EC (2002) Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 46:1481–1491PubMedCrossRefGoogle Scholar
  13. 13.
    Knothe H, Shah P, Krcmery V, Antal M, Mitsuhashi S (1983) Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 11:315–317PubMedCrossRefGoogle Scholar
  14. 14.
    Schwaber MJ, Carmeli Y (2007) Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 60:913–920PubMedCrossRefGoogle Scholar
  15. 15.
    Son JS, Song JH, Ko KS, Yeom JS, Ki HK, Kim SW, Chang HH, Ryu SY, Kim YS, Jung SI, Shin SY, Oh HB, Lee YS, Chung DR, Lee NY, Peck KR (2010) Bloodstream infections and clinical significance of healthcare-associated bacteremia: a multicenter surveillance study in Korean hospitals. J Kor Med Sci 25:992–998CrossRefGoogle Scholar
  16. 16.
    Trecarichi EM, Tumbarello M, Spanu T, Caira M, Fianchi L, Chiusolo P, Fadda G, Leone G, Cauda R, Pagano L (2009) Incidence and clinical impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies. J Infect 58:299–307PubMedCrossRefGoogle Scholar
  17. 17.
    Tumbarello M, Spanu T, Sanguinetti M, Citton R, Montuori E, Leone F, Fadda G, Cauda R (2006) Bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother 50:498–504PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Cheol-In Kang
    • 1
  • Doo Ryeon Chung
    • 1
  • Kwan Soo Ko
    • 2
    • 3
  • Kyong Ran Peck
    • 1
  • Jae-Hoon Song
    • 1
    • 3
    Email author
  • The Korean Network for Study of Infectious Diseases (KONSID)
  1. 1.Division of Infectious Diseases, Samsung Medical CenterSungkyunkwan University School of MedicineGangnam-guRepublic of Korea
  2. 2.Department of Molecular Cell BiologySungkyunkwan University School of MedicineSuwonSouth Korea
  3. 3.Asia Pacific Foundation for Infectious Diseases (APFID)SeoulSouth Korea

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