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ABSTRACT: The characteristics of carbapenem-resistant P. aeruginosa (CRPA) isolates from Korea were investigated. Two major clones, CC235 and CC641, were identified. CC235, an important international clone, might have been imported recently in Korea as the clone displayed a homogeneous genotype, oprD mutation, and antimicrobial resistance profile. While 13 ST235 isolates harbored the blaIMP-6 gene, which conferred high-level meropenem resistance, CC641 isolates showed high biofilm-forming activity. CC235 and CC641 isolates showed distinct distribution of ferripyoverdine receptor type and virulence markers. While all CC235 isolates were the fpvAIIb type and exoS-/exoU+, CC641 isolates were exoS+/exoU-, and all but one showed the fpvAIII type. CC235 and CC641 isolates were also characterized by different extracellular protease activity; staphylolysin and elastase activities in CC235 and CC641, respectively. Two major CRPA clones in Korea seem to be predominant, reflecting their selective advantage by virtue of antimicrobial resistance, virulence, and biofilm-forming activity.
Journal of Medical Microbiology 04/2013; · 2.50 Impact Factor
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ABSTRACT: Background: Although extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has emerged as a significant pathogen, there is little information regarding treatment outcomes in community-onset bacteremia due to ESBL E. coli. The purpose of this study was to evaluate treatment outcomes of community-onset bacteremia caused by ESBL-producing E. coli and the factors associated with mortality. Methods: A retrospective cohort study was performed, including 92 adult patients with community-onset bacteremia caused by ESBL-producing E. coli. Results: The 30-day mortality rate was 10.9% (10/92). Independent risk factors for mortality were underlying liver disease and severity of illness (e.g., high Pitt bacteremia score, the presence of severe sepsis or septic shock; p < 0.05). Mortality in patients receiving inappropriate initial antimicrobial therapy was not significantly higher than mortality in those receiving appropriate empirical antimicrobial therapy (10.9 vs 10.7%; p = 0.975), if antimicrobial therapy was adjusted appropriately according to susceptibility results. Carbapenems, piperacillin/tazobactam, fluoroquinolones, and amikacin were the most effective antibiotics for community-onset bacteremia caused by ESBL-producing E. coli, although susceptibility profiles confirmed that alternatives to carbapenems are limited. Of 68 isolates in which the ESBLs and their molecular relationships were studied, all isolates produced ESBLs from the CTX-M family (CTX-M-14, 30 isolates; CTX-M-15, 22; and other CTX-M, 16). Conclusions: In patients with community-onset bacteremia caused by ESBL-producing E. coli, severe sepsis and underlying liver disease were significantly associated with mortality, and a delay in appropriate antimicrobial therapy was not associated with a higher mortality if therapy was adjusted appropriately according to the susceptibility results.
Scandinavian Journal of Infectious Diseases 03/2013; · 1.72 Impact Factor
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The Korean Journal of Internal Medicine 03/2013; 28(2):258-60.
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ABSTRACT: One hundred and twenty-one isolates of S. maltophilia complex were collected from seven Korean hospitals. Species and groups were identified using partial gyrB gene sequences and antimicrobial susceptibility testing was performed using a broth microdilution method. Based on partial gyrB gene sequences, 118 isolates were identified to belong to S. maltophilia complex including S. maltophilia, S. pavanii, Pseudomonas beteli, P. geniculata, and P. hibisciola. S. maltophilia were further divided into three groups, I to III. While S. maltophilia groups II and III were clustered into Clade A with S. pavanii and P. beteli, S. maltophilia group I was clustered into Clade B with P. geniculata and P. hibisciola. For all S. maltophilia complex isolates, resistance rate to trimethoprim/sulfamethoxazole (TMP/SMX) was very high (30.5%). Antimicrobial resistance rates were varied by species or groups of S. maltophilia complex. Isolates of Clade A showed significantly lower antimicrobial resistance rates than those of Clade B; while 25.0% of Clade A isolates were multidrug-resistant, 46.0% of Clade B isolates were multidrug-resistant (P 0.001). In this study, high antimicrobial resistance rates, particularly to TMP/SMX, were identified among S. maltophilia complex isolates from Korea. Distinct groups among S. maltophilia complex isolates were revealed and antimicrobial resistance rates differed among those groups. These data suggest consideration of alternative agents to TMP/SMX to treat S. maltophilia infections and warrant importance of accurate identification of appropriate selection of treatment option.
Journal of Medical Microbiology 02/2013; · 2.50 Impact Factor
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ABSTRACT: BACKGROUND: There are no available studies on the duration and risk factors of vancomycin-resistant enterococci (VRE) carriage after hospital discharge. In this study we investigated the duration of colonization with VRE and the risk factors for prolonged carriage in the outpatient clinic after discharge from the hospital. METHODS: The study took place from January 2008 to September 2009. Patients were included if they were identified as persistent VRE carriers by follow-up rectal swab or stool cultures in the outpatient setting, after discharge from the hospital without clearance of VRE. The probability of culture positivity and clearance was analyzed from the discharge date. Cox regression was performed to determine the risk factors for prolonged carriage. VRE clearance was defined as VRE-negative rectal (or stool) cultures on at least three consecutive occasions a minimum of 1 week apart. RESULTS: One hundred twenty-seven patients were included in this study. Follow-up cultures were conducted for a median of 8.86 weeks (range 1-90 weeks) after hospital discharge. The median duration of culture positivity of VRE was 5.57 weeks (range 0-50.14 weeks). Ninety-six out of 127 patients (75.6%) showed the first negative culture result at a median time of 4.86 weeks (range 0-66 weeks) after discharge. Among these patients, 15 were lost to follow-up after the first negative culture and eight were lost after the second negative culture. Sixty-eight patients (53.5%) were confirmed to have clearance of VRE during follow-up in the outpatient clinic. The median time to clearance after discharge was 8.86 weeks (range 2-90 weeks). In the cleared cases, the median time to the first negative VRE culture result was 4.71 weeks (range 0-66 weeks). Ninety percent of patients showed the first negative culture result at 25 weeks and VRE clearance at 30 weeks after discharge. Surgery or antibiotic use during admission (p=0.048 and p=0.001, respectively), dialysis (p=0.046), and discharge to a nursing home or other health care institution (p=0.025) were independently associated with prolonged colonization with VRE. CONCLUSIONS: The median duration of VRE colonization was 5.57 weeks after hospital discharge. In the cases with clearance during follow-up, the median time to clearance after discharge was 8.86 weeks. Risk factors for prolonged carriage were surgery, antibiotic use during admission, dialysis, and discharge to a nursing home or other health care institution. Therefore, patients with these risk factors should be managed more carefully to prevent transmission of VRE in the outpatient clinic.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 11/2012; · 2.17 Impact Factor
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Dae Won Park,
Byung Chul Chun,
June Myung Kim,
Jang Wook Sohn, Kyong Ran Peck,
Yang Soo Kim,
Young Hwa Choi,
Jun Yong Choi,
Sang Il Kim,
Joong Sik Eom,
Hyo Youl Kim,
Joon Young Song,
Young Goo Song,
Hee Jung Choi,
Min Ja Kim
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ABSTRACT: A prospective multicenter observational study was performed to investigate the epidemiology and outcomes of community-acquired severe sepsis and septic shock. Subjects included 1,192 adult patients admitted to the 22 participating intensive care units (ICUs) of 12 university hospitals in the Korean Sepsis Registry System from April, 2005 through February, 2009. Male accounted for 656 (55%) patients. Mean age was 65.0 ± 14.2 yr. Septic shock developed in 740 (62.1%) patients. Bacteremia was present in 422 (35.4%) patients. The 28-day and in-hospital mortality rates were 23.0% and 28.0%, respectively. Men were more likely to have comorbid illnesses and acute organ dysfunctions, and had higher mortality and clinical severity compared to women. While respiratory sources of sepsis were common in men, urinary sources were predominant in women. In the multivariate logistic regression analysis, cancer (odds ratio 1.89; 95% confidence interval 1.13-3.17), urinary tract infection (0.25; 0.13-0.46), APACHE II score (1.05; 1.02-1.09), SOFA score on day 1 (1.13; 1.06-1.21) and metabolic dysfunction (2.24, 1.45-3.45) were independent clinical factors for gender-related in-hospital mortality. This study provided epidemiological and clinical characteristics of community-acquired severe sepsis and septic shock in ICUs in Korea, and demonstrated the impact of clinical factors on gender difference in mortality.
Journal of Korean medical science 11/2012; 27(11):1308-14. · 0.84 Impact Factor
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ABSTRACT: The emergence of antimicrobial resistance threatens the successful treatment of pneumococcal infections. Here we report a case of bacteremic pneumonia caused by an extremely drug-resistant strain of Streptococcus pneumoniae, non-susceptible to at least one agent in all classes but vancomycin and linezolid, posing an important new public health threat in our region.
Journal of clinical microbiology 10/2012; · 4.16 Impact Factor
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Infection Control and Hospital Epidemiology 10/2012; 33(10):1053-5. · 3.67 Impact Factor
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Dae Won Park,
Byung-Chul Chun,
Soon-Sun Kwon,
Young Kyung Yoon,
Won Suk Choi,
Jang Wook Sohn, Kyong Ran Peck,
Yang Soo Kim,
Young Hwa Choi,
Jun Yong Choi,
Sang Il Kim,
Joong Sik Eom,
Hyo Youl Kim,
Hee Jin Cheong,
Young Goo Song,
Hee Jung Choi,
June Myung Kim,
Min Ja Kim
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ABSTRACT: OBJECTIVES:: To evaluate the effects of transfusions in patients with severe sepsis and septic shock on mortality. DESIGN:: Propensity-matched analysis of a prospective observational database (April 2005 to February 2009). SETTING:: Twenty-two medical and surgical intensive care units in 12 teaching hospitals in Korea. PATIENTS:: One thousand fifty-four patients with community-acquired severe sepsis and septic shock. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Of the 1,054 patients, 407 (38.6%) received a blood transfusion. The mean pretransfusion hemoglobin level was 7.7 ± 1.2 g/dL. Transfused patients had higher 28-day and in-hospital mortality rates (32.7% vs. 17.3%; p < .001, 41.3% vs. 20.3%; p < .001, respectively) and a longer duration of hospital stay (21 [interquartile range, 10-35] vs. 13 [interquartile range, 8-24] days; p < .001), but were more severely ill at admission (lower systolic blood pressure, higher Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score at admission). In 152 pairs matched according to the propensity score depending on patient transfusion status, transfused patients had a lower risk of 7-day (9.2% vs. 27.0%; p < .001), 28-day (24.3% vs. 38.8%; p = .007), and in-hospital mortality rates (31.6% vs. 42.8%; p = .044). After adjusting for blood transfusion as a time-dependent variable in multivariable analysis, blood transfusion was independently associated with lower risk of 7-day (hazard ratio 0.42, 95% confidence interval 0.19-0.50, p = .026), 28-day (hazard ratio 0.43, 95% confidence interval 0.29-0.62, p < .001), and in-hospital mortality (hazard ratio 0.51, 95% confidence interval 0.39-0.69, p < .001). CONCLUSIONS:: In this observational study of patients with community-acquired severe sepsis and septic shock, red blood cell transfusions were associated with lower risk of mortality.
Critical care medicine 09/2012; · 6.37 Impact Factor
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Antimicrobial Agents and Chemotherapy 09/2012; 56(9):4994-5; author reply 4996. · 4.84 Impact Factor
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Cheol-In Kang,
Jae-Hoon Song,
So Hyun Kim,
Doo Ryeon Chung, Kyong Ran Peck,
Visanu Thamlikitkul,
Hui Wang,
Thomas Man-Kit So,
Po-Ren Hsueh,
Rohani Md Yasin,
Celia C Carlos,
Pham Hung Van,
Jennifer Perera
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ABSTRACT: OBJECTIVE: This study was performed to identify risk factors for the development of bacteremic pneumonia and to evaluate the impact of bacteremia on the outcome of pneumococcal pneumonia. METHODS: Using a database from a surveillance study of community-acquired pneumococcal pneumonia, we compared data of the bacteremic group with that of the non-bacteremic group. RESULTS: Among 981 adult patients with pneumococcal pneumonia, 114 (11.6%) patients who had documented pneumococcal bacteremia were classified into the bacteremic group. In a multivariable analysis, use of immunosuppressant drugs, younger age (<65 years), and DM were independent risk factors associated with the development of bacteremic pneumonia among patients with pneumococcal pneumonia (all P < 0.05). The mortality rate was significantly higher in the bacteremic group than in the non-bacteremic group (28.6% vs. 8.5%; P < 0.001). The multivariable analysis revealed that concomitant bacteremia was one of the significant risk factors associated with mortality (OR, 2.57; 95% CI, 1.24-5.29), along with cerebrovascular disease and presentation with septic shock (all P < 0.05). CONCLUSIONS: Bacteremia was a common finding in pneumococcal pneumonia and was associated with a higher mortality rate. Several clinical variables may be useful for predicting bacteremic pneumonia among patients with pneumococcal pneumonia.
The Journal of infection 08/2012; · 4.13 Impact Factor
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ABSTRACT: BACKGROUND: Fusobacterium species are uncommon causes of osteomyelitis. These organisms are normal flora of the oral cavity. Therefore, they mostly cause osteomyelitis of the head and neck. Hematogenous osteomyelitis at distant sites other than the head and neck has rarely been reported in pediatric or immunocompromised patients. Here, we report the first case of osteomyelitis of a long bone combined with a muscle abscess due to Fusobacterium nucleatum in an otherwise healthy adult. CASE PRESENTATION: A 59-year-old Korean man was admitted for pain and swelling of the right lower leg, which had been persistent for two weeks. Magnetic resonance imaging showed osteomyelitis of the right fibula with a surrounding muscle abscess of the right lower leg. Incision and drainage was performed, and repetitive tissue cultures grew F. nucleatum. In this patient, it was presumed that recurrent periodontitis caused hematogenous seeding of F. nucleatum to a distant site leading to osteomyelitis with a muscle abscess. The patient was successfully treated with intravenous ampicillin-sulbactam for three weeks and oral amoxicillinclavulanate for eight weeks. He also underwent repeated surgical drainage. He has no evidence of recurrence after seven months of follow-up. CONCLUSIONS: Clinicians should be aware that F. nucleatum could be the etiologic agent of hematogenous osteomyelitis of a long bone in an immunocompetent patient.
BMC Infectious Diseases 07/2012; 12(1):161. · 3.12 Impact Factor
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Soo-Youn Moon, Kyong Ran Peck,
Hyun-Ha Chang,
Shin-Woo Kim,
Sang Taek Heo,
Jun Seong Son,
Seong Yeol Ryu,
Chisook Moon,
Sook-In Jung,
Sang Yop Shin,
Jeong-A Lee,
Mi-Kyong Joung,
Doo-Ryeon Chung,
Cheol-In Kang,
Jae-Hoon Song
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ABSTRACT: Background: Tigecycline has broad spectrum antimicrobial activity and is approved for complicated intra-abdominal infections, complicated skin and soft tissue infections, and community-acquired pneumonia. There are few data on clinical experience of tigecycline in hospital-acquired pneumonia (HAP) and Acinetobacter spp. infection. Methods: A retrospective study was performed at eight hospitals in Korea from May 2009 to January 2010. Adult patients treated with tigecycline regardless of their source of infection or pathogens were enrolled. Results: Tigecycline was administered in 108 patients. Pneumonia was the most common infection (43.5%), followed by skin and soft tissue infections (20.4%). Acinetobacter baumannii was isolated from 83 patients (76.9%) accounting for 50.3% of isolated pathogens, showing a resistance rate of 67.5% to carbapenems. Superinfection was identified in 32 patients (29.6%). Pseudomonas aeruginosa was most common microorganism causing superinfection (46.9%). Overall 30-day mortality rate was 52.9%. Thirty-day mortality rate of HAP and Acinetobacter spp. infection was 60.5% and 59.4%, respectively. Conclusion: Tigecycline can be considered as an alternative therapy in patients with HAP or infections caused by Acinetobacter spp., especially extensively drug-resistant A. baumannii.
Microbial drug resistance (Larchmont, N.Y.) 07/2012; · 1.99 Impact Factor
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ABSTRACT: Increasing multidrug resistance (MDR) among extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) is of a great concern, because the therapeutic options are severely limited. Thus, we performed a case-control study to evaluate risk factors for MDR among nosocomial bacteremia caused by ESBL-EK. All adult patients with ESBL-EK bacteremia from January 2009 through December 2010 were identified at our institution. MDR was defined as ESBL-EK that demonstrated in vitro resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolone (FQ), and gentamicin. Case patients were those with an MDR ESBL-EK isolate, and control patients were those with a non-MDR ESBL-EK isolate. Among a total of 123 ESBL-EK isolates (74 [60.2%] E. coli and 49 [39.8%] K. pneumoniae) causing nosocomial bacteremia, 33 (26.8%) cases were due to MDR ESBL-EK. In a univariate analysis, the factors significantly associated with acquisition of MDR ESBL-EK were neutropenia, immunosuppressant use, urinary tract infection, and prior use of antibiotics, especially FQ (all p<0.05). A multivariable analysis showed that a prior receipt of FQ (odds ratio [OR]=2.93; 95% confidence interval [CI]=1.07-8.01; p=0.036), percutaneous tube insertion (OR=4.04; 95% CI=1.56-10.75; p=0.005), and neutropenia (OR=4.22; 95% CI=1.56-11.45; p=0.005) were independent risk factors for MDR among ESBL-EK bacteremia in hospitalized patients. The CTX-M-15 enzyme was predominant in both the MDR ESBL-EK and non-MDR ESBL-EK groups (55% [11/20] vs. 55.6% [15/27]). Our data suggest that strategies designed to reduce MDR in ESBL-EK bacteremia should focus on limiting the use of FQ and minimizing invasive procedures such as tube insertion.
Microbial drug resistance (Larchmont, N.Y.) 06/2012; 18(5):518-24. · 1.99 Impact Factor
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So Yeon Park,
Seung Ji Kang,
Eun-Jeong Joo,
Young Eun Ha,
Jin Yang Baek,
Yu Mi Wi,
Cheol-In Kang,
Doo Ryeon Chung, Kyong Ran Peck,
Nam Young Lee,
Jae-Hoon Song
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ABSTRACT: We describe the first reported case of endocarditis due to Neisseria skkuensis. The organism from the blood cultures taken on admission day was identified initially as unidentified Gram-negative cocci by Vitek2. Finally, it was identified as Neisseria skkuensis by 16 rRNA gene sequence analysis.
Journal of clinical microbiology 06/2012; 50(8):2820-2. · 4.16 Impact Factor
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ABSTRACT: Schizophyllum commune, a basidiomycetous fungus, is a rare cause of mycotic disease in humans. We describe the first case of sino-orbital infection caused by S. commune in an immunocompetent woman who presented with maxillary sinusitis and inferior orbital tumor. Identification of the organism was confirmed by rRNA sequencing.
Diagnostic microbiology and infectious disease 06/2012; 73(4):376-7. · 2.45 Impact Factor
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ABSTRACT: Failure of vancomycin in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia has been reported despite full susceptibility of the organism to vancomycin. A retrospective observational cohort study including 137 patients with MRSA bacteraemia was performed at two centres in South Korea during 2009-2010. A total of 137 patients with MRSA bacteraemia receiving vancomycin therapy were enrolled during the study period. Isolates from 13 (9.5%) of the 137 patients had minimum inhibitory concentrations (MICs) ≥1 μg/mL. The 30-day cumulative survival was 53.8% for patients infected with isolates having a MIC≥1 μg/mL and 79.8% for patients infected with isolates having a MIC<1 μg/mL (log-rank test, P=0.026). Vancomycin MIC≥1 μg/mL [hazard ratio (HR)=7.0, 95% confidence interval (CI) 2.2-22.1; P=0.001], nosocomial acquisition of bacteraemia (HR=5.4, 95% CI 1.4-20.1; P=0.013), rapidly fatal underlying diseases (HR=20.5, 95% CI 3.9-106.4; P<0.001), presentation with septic shock (HR=8.4, 95% CI 3.0-23.3; P<0.001), presence of complicated infections (HR=5.6, 95% CI 2.0-15.8; P=0.001) and persistent MRSA bacteraemia for ≥3 days (HR=4.2, 95% CI 1.4-12.7; P=0.012) were independent predictors of 30-day mortality in patients with MRSA bacteraemia. In patients with high Pitt bacteraemia scores (Pitt score ≥2), the delay in initiation of vancomycin therapy was significantly different between non-survivors and survivors (2.4 days vs. 1.1 days; P=0.012). Vancomycin MIC≥1 μg/mL had a significant impact on mortality of patients with MRSA bacteraemia. These findings support early consideration of alternative anti-MRSA agents in patients with MRSA bacteraemia who have high vancomycin MICs as well as prompt initiation of anti-MRSA treatment in patients with MRSA bacteraemia, especially those with high Pitt scores.
International journal of antimicrobial agents 05/2012; 40(2):108-13. · 3.03 Impact Factor
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ABSTRACT: Vancomycin-intermediate resistance has not been previously reported among sequence type 72 (ST72) methicillin-resistant Staphylococcus aureus (MRSA) isolates of SCCmec type IV (ST72-MRSA-IV), which are distinctive community genotype strains in Korea. We report the first case of vancomycin treatment failure due to development of vancomycin-intermediate resistance in infection caused by an ST72-MRSA-IV isolate.
Journal of clinical microbiology 05/2012; 50(7):2513-4. · 4.16 Impact Factor
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ABSTRACT: The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After ≥ 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group and 71 (52.2%) in the ceftriaxone group were microbiologically evaluable. The mean duration of parenteral and total therapy, respectively, was 5.6 and 13.8 days for ertapenem and 5.8 and 13.8 days for ceftriaxone. The most common pathogen was Escherichia coli. At the primary efficacy endpoint 5-9 days after treatment, 58 (87.9%) patients in the ertapenem group and 63 (88.7%) in the ceftriaxone had a favorable microbiological response. When compared by stratum and severity, the outcomes in the two groups were equivalent. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. The results indicate that ertapenem is highly effective and safe for the treatment of APN and cUTIs.
Journal of Korean medical science 05/2012; 27(5):476-83. · 0.84 Impact Factor
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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.
KeywordsGram-negative bacterial infections–Bacteremia–Hematologic neoplasms–Treatment outcome–Cephalosporin resistance
Annals of Hematology 04/2012; 91(1):115-121. · 2.62 Impact Factor
