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Impact of appropriateness of empiric therapy on outcomes in community-onset bacteremia by extended-spectrum-β-lactamase producing Escherichia coli and Klebisella pneumoniae definitively treated with carbapenems

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Abstract

Despite a significant increase of bloodstream infection caused by extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae in the community-setting, information regarding clinical outcomes of inappropriate empiric therapy (IAT) in patients with those infections is limited. A multicenter-retrospective cohort study was conducted in four hospitals. A total of 249 adults were identified to have community-onset bacteremia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae, and definitively treated with carbapenems. According to the appropriateness of empiric therapy, individuals were divided into an appropriate empiric therapy (AT) group (n = 106) and IAT group (n = 143). Patients who received AT showed more severe underlying conditions including underlying solid cancer, healthcare-association and intensive care unit (ICU) care, compared to the IAT group. Primary bacteremia was more commonly found in the AT group than in the IAT group, while urinary tract infection predominated more frequently in the IAT group than in the AT group. Multivariate analysis using propensity score analysis indicated that inappropriateness of empiric therapy was not an independent risk factor for 30-day death. ICU care, respiratory tract infection and underlying liver, renal and connective tissue diseases were significantly associated with mortality. In patients with bloodstream infections caused by ESBL-producing E. coli and K. pneumoniae in the community-setting, delay in appropriate therapy was not associated with an increased rate of death if the patients were definitively treated with carbapenems.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    E.-J. Joo

  2. Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea

    D. A. Park & N. R. Lee

  3. Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee Univeristy College of Medicine, Seoul, South Korea

    S.-y. Moon

  4. Department of Internal Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea

    J.-K. Choi

  5. Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    J.-H. Ko & K. R. Peck

Authors
  1. E.-J. Joo
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  2. D. A. Park
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  3. N. R. Lee
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  4. S.-y. Moon
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  5. J.-K. Choi
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  6. J.-H. Ko
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  7. K. R. Peck
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Corresponding author

Correspondence to K. R. Peck.

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Funding

This study was funded by the National Evidence-based Healthcare Collaborating Agency (NECA; project number NA2015–001).

Conflict of interest

All authors: none to declare.

Ethical approval

The study was approved by the institutional review board in each hospital.

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Informed consent was waived.

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Joo, EJ., Park, D.A., Lee, N.R. et al. Impact of appropriateness of empiric therapy on outcomes in community-onset bacteremia by extended-spectrum-β-lactamase producing Escherichia coli and Klebisella pneumoniae definitively treated with carbapenems. Eur J Clin Microbiol Infect Dis 36, 2093–2100 (2017). https://doi.org/10.1007/s10096-017-3031-7

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  • DOI: https://doi.org/10.1007/s10096-017-3031-7

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