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Clinical characteristics and outcomes of patients with extended-spectrum β-lactamase-producing bacteremias in the emergency department

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Abstract

Extended-spectrum β-lactamase (ESBL)-producing bacteria have been spreading from hospitals to communities. Despite this, there are limited emergency department (ED) patient-based studies about these bacteremias. A retrospective matched case–control study with a ratio of 1:3 was conducted at a university hospital. The case group consisted of patients aged >16 years with ESBL-producing bacteremias in the ED. Patients matched for age and sex with non-ESBL-producing bacteremias were sampled as the control group. Finally, 64 episodes of ESBL-producing Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis bacteremias were included in our study. The median age of case patients was 71 years, and 29 (45.3%) were males. The most common type of infection was urinary tract infection (71.9%), followed by intra-abdominal infection (12.5%). Inappropriate empirical antibiotics therapy was prescribed in 87.5% of case patients, which was significantly higher than the control group (13.0%; p < 0.001). Patients with inappropriate empirical antibiotics had a significantly longer hospital stay than those with appropriate empirical antibiotics (p < 0.001). Multivariate analysis showed that hospital-acquired infection, urinary catheterization, and previous antibiotics use were independent risk factors for the acquisition of ESBL-producing bacteremia. The 28-day mortality rate of case patients was 18.8%. Whether they received appropriate empirical antibiotics treatment or not, there was no statistical difference in the mortality of patients with ESBL-producing bacteremias (p = 0.167). To face these emerging multidrug-resistant bacteria and to guide the empirical antibiotics therapy, it is crucial for emergency physicians to recognize the characteristics and risk factors for ESBL-producing organisms.

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Acknowledgments

This study was funded in part by a grant from the E-Da Hospital (EDAHI-98001).

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Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan

    Jiun-Nong Lin

  2. Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung, 824, Taiwan

    Jiun-Nong Lin, Chung-Hsu Lai & Hsi-Hsun Lin

  3. Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Jiun-Nong Lin, Yen-Hsu Chen, Lin-Li Chang, Chung-Hsu Lai & Hsing-Lin Lin

  4. Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Tropical Medicine Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan

    Yen-Hsu Chen

  5. Department of Microbiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Lin-Li Chang

  6. Departments of Trauma and Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Hsing-Lin Lin

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  1. Jiun-Nong Lin
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Correspondence to Hsi-Hsun Lin.

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Lin, JN., Chen, YH., Chang, LL. et al. Clinical characteristics and outcomes of patients with extended-spectrum β-lactamase-producing bacteremias in the emergency department. Intern Emerg Med 6, 547–555 (2011). https://doi.org/10.1007/s11739-011-0707-3

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  • DOI: https://doi.org/10.1007/s11739-011-0707-3

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