Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil.
Braz J Infect Dis. 2011 Nov-Dec;15(6):594-8. doi: 10.1590/s1413-86702011000600016.
Extended spectrum β-lactamase (ESBL)-producing bacteria have become recognized as a problem in South America. The aim of this study was to evaluate risk factors and mortality rate in bacteremia caused by ESBL-producing Klebsiella pneumoniae in a Brazilian hospital.
A three-year retrospective cohort study with 104 cases of K. pneumoniae bacteremia (61 ESBL and 43 non-ESBL). Several clinical and laboratory variables were evaluated. The outcome of interest was 30-day mortality. The adequate treatment was evaluated according to antibiotic susceptibility.
Multivariable analysis showed that central venous catheter and mechanical ventilation were independent risk factors for ESBL. The duration of hospitalization before the bacteremia was not a risk factor. Mortality was similar in ESBL and non-ESBL and inadequate therapy was not shown to be a risk factor.
ESBL-producing Klebsiella bacteremia can occur early, suggesting that a carbapenem should be included in the initial empirical therapy for bacteremia in patients under mechanical ventilation and/or central venous catheter in our institution.
产Extended spectrum β-lactamase (ESBL)的细菌已被确认为南美的一个问题。本研究旨在评估巴西一家医院中产 ESBL 的肺炎克雷伯菌菌血症的危险因素和死亡率。
这是一项为期三年的回顾性队列研究，共纳入 104 例肺炎克雷伯菌菌血症（61 例产 ESBL，43 例非产 ESBL）。评估了多种临床和实验室变量。研究的主要结局为 30 天死亡率。根据抗生素敏感性评估了适当的治疗。
多变量分析显示，中心静脉导管和机械通气是 ESBL 的独立危险因素。菌血症发生前的住院时间不是危险因素。ESBL 和非 ESBL 组的死亡率相似，且不适当的治疗并未显示为危险因素。
产 ESBL 的肺炎克雷伯菌菌血症可能发生较早，提示在我们机构中，对于接受机械通气和/或中心静脉导管治疗的患者，初始经验性治疗应包括碳青霉烯类药物。
