Bloodstream infections by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: Epidemiology and clinical outcome

Yun Kyung Kim, Hyunjoo Pai, Hoan Jong Lee, Su Eun Park, Eun Hwa Choi, Jungmin Kim, Je Hak Kim, Eui Chong Kim

Research output: Contribution to journalArticle

283 Citations (Scopus)

Abstract

To determine the epidemiologic features and clinical outcomes of bloodstream infections caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae isolates, cases of bacteremia caused by these organisms in children were analyzed retrospectively. Among the 157 blood isolates recovered from 1993 to 1998 at the Seoul National University Children's Hospital, the prevalence of ESBL production was 17.9% among the E. coli isolates and 52.9% among the K. pneumoniae isolates. The commonest ESBLs were SHV-2a and TEM-52. A novel ESBL, TEM-88, was identified. Pulsed-field gel electrophoresis analysis of the ESBL-producing organisms showed extensive diversity in clonality. The medical records of 142 episodes were reviewed. The risk factors for bloodstream infection with ESBL-producing organisms were prior hospitalization, prior use of oxyimino-cephalosporins, and admission to an intensive care unit within the previous month. There was no difference in clinical severity between patients infected with ESBL-producing strains (the ESBL group) and those infected with ESBL-nonproducing strains (the non-ESBL group) at the time of presentation. However, the overall fatality rate for the ESBL group was significantly higher than that for the non-ESBL group: 12 of 45 (26.7%) versus 5 of 87 (5.7%) (P = 0.001). In a subset analysis of patients treated with extended-spectrum cephalosporins with or without an aminoglycoside, favorable response rates were significantly higher in the non-ESBL group at the 3rd day (6 of 17 versus 33 of 51; P = 0.035), the 5th day (6 of 17 versus 36 of 50; P < 0.05), and the end of therapy (9 of 17 versus 47 of 50; P < 0.001). In conclusion, the ESBL production of the infecting organisms has a significant impact on the clinical course and survival of pediatric patients with bacteremia caused by E. coli and K. pneumoniae.

Original languageEnglish
Pages (from-to)1481-1491
Number of pages11
JournalAntimicrobial Agents and Chemotherapy
Volume46
Issue number5
DOIs
Publication statusPublished - 2002 May 2
Externally publishedYes

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Klebsiella pneumoniae
Epidemiology
Cephalosporins
Escherichia coli
Bacteremia
Infection
Pulsed Field Gel Electrophoresis
Aminoglycosides
Medical Records
Intensive Care Units
Hospitalization
Pediatrics
Survival
Therapeutics

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Bloodstream infections by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children : Epidemiology and clinical outcome. / Kim, Yun Kyung; Pai, Hyunjoo; Lee, Hoan Jong; Park, Su Eun; Choi, Eun Hwa; Kim, Jungmin; Kim, Je Hak; Kim, Eui Chong.

In: Antimicrobial Agents and Chemotherapy, Vol. 46, No. 5, 02.05.2002, p. 1481-1491.

Research output: Contribution to journalArticle

Kim, Yun Kyung ; Pai, Hyunjoo ; Lee, Hoan Jong ; Park, Su Eun ; Choi, Eun Hwa ; Kim, Jungmin ; Kim, Je Hak ; Kim, Eui Chong. / Bloodstream infections by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children : Epidemiology and clinical outcome. In: Antimicrobial Agents and Chemotherapy. 2002 ; Vol. 46, No. 5. pp. 1481-1491.
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abstract = "To determine the epidemiologic features and clinical outcomes of bloodstream infections caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae isolates, cases of bacteremia caused by these organisms in children were analyzed retrospectively. Among the 157 blood isolates recovered from 1993 to 1998 at the Seoul National University Children's Hospital, the prevalence of ESBL production was 17.9{\%} among the E. coli isolates and 52.9{\%} among the K. pneumoniae isolates. The commonest ESBLs were SHV-2a and TEM-52. A novel ESBL, TEM-88, was identified. Pulsed-field gel electrophoresis analysis of the ESBL-producing organisms showed extensive diversity in clonality. The medical records of 142 episodes were reviewed. The risk factors for bloodstream infection with ESBL-producing organisms were prior hospitalization, prior use of oxyimino-cephalosporins, and admission to an intensive care unit within the previous month. There was no difference in clinical severity between patients infected with ESBL-producing strains (the ESBL group) and those infected with ESBL-nonproducing strains (the non-ESBL group) at the time of presentation. However, the overall fatality rate for the ESBL group was significantly higher than that for the non-ESBL group: 12 of 45 (26.7{\%}) versus 5 of 87 (5.7{\%}) (P = 0.001). In a subset analysis of patients treated with extended-spectrum cephalosporins with or without an aminoglycoside, favorable response rates were significantly higher in the non-ESBL group at the 3rd day (6 of 17 versus 33 of 51; P = 0.035), the 5th day (6 of 17 versus 36 of 50; P < 0.05), and the end of therapy (9 of 17 versus 47 of 50; P < 0.001). In conclusion, the ESBL production of the infecting organisms has a significant impact on the clinical course and survival of pediatric patients with bacteremia caused by E. coli and K. pneumoniae.",
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