Korean J Intern Med.  2014 Sep;29(5):637-646. 10.3904/kjim.2014.29.5.637.

Prevalence and impact of extended-spectrum beta-lactamase production on clinical outcomes in cancer patients with Enterobacter species bacteremia

• Kim SJ
• Park KH
• Chung JW
• Sung H
• Choi SH
• Choi SH

• KMID: 1794629
• DOI: http://doi.org/10.3904/kjim.2014.29.5.637

Abstract

BACKGROUND/AIMS
We examined the prevalence of extended-spectrum beta-lactamase (ESBL) production and the impact of ESBL on clinical outcomes in cancer patients with Enterobacter spp. bacteremia.
METHODS
Using prospective cohort data on Enterobacter bacteremia obtained between January 2005 and November 2008 from a tertiary care center, the prevalence and clinical impact of ESBL production were evaluated.
RESULTS
Two-hundred and three episodes of Enterobacter spp. bacteremia were identified. Thirty-one blood isolates (15.3%, 31/203) scored positive by the double-disk synergy test. Among 17 isolates in which ESBL genes were detected by polymerase chain reaction and sequencing, CTX-M (n = 12), SHV-12 (n = 11), and TEM (n = 4) were the most prevalent ESBL types. Prior usage of antimicrobial agents (77.4% vs. 54.0%, p = 0.02) and inappropriate empirical antimicrobial therapy (22.6% vs. 3.0%, p < 0.001) were more commonly encountered in the ESBL-positive group than in the extended-spectrum cephalosporin-susceptible ESBL-negative group, respectively. Clinical outcomes did not differ significantly between the two groups (30-day mortality rate, 19.4% vs. 17.0%, p = 0.76; median length of hospital stay, 24.0 days vs. 30.5 days, p = 0.97). Initial presentation of severe sepsis/septic shock, pneumonia, and intra-abdominal infection were independently associated with 30-day mortality.
CONCLUSIONS
The prevalence of ESBL-producing isolates was 15.3% in cancer patients with Enterobacter bacteremia. Although inappropriate empirical therapy was more common in the ESBL-positive group, ESBL production was not associated with poorer outcomes.

Keyword

Enterobacter; Neoplasms; beta-Lactamases

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/therapeutic use
Bacteremia/*complications/drug therapy/microbiology
Child
Cohort Studies
Enterobacter/*enzymology/genetics
Enterobacteriaceae Infections/*complications/drug therapy/microbiology
Female
Humans
Infant
Male
Middle Aged
Neoplasms/*complications
Prospective Studies
Treatment Outcome
beta-Lactamases/*biosynthesis/genetics
Anti-Bacterial Agents
beta-Lactamases