Home⇛The PCMC Journal⇛vol. 8 no. 2 (2010)

Clinical Impact of and Risk Factors for Infections Caused by Extended-Spectrum SS-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae (ESBL-EK) Among Patients at the Philippine Children’s Medical Center

Leslie Gotos- Caguioa | Jaime A Santos | Ma. Patricia S. Austria

Discipline: medicine by specialism

 

Abstract:

Introduction: Extended-spectrum B-lactamase (ESBL)-producing infections caused by Escherichia coli and Klebsiella pneumoniae represent serious clinical problem as they are associated with high treatment failure and mortality rate. Objective: To identify the risk factors of ESBL- producing E. coli and Klebsiella pneumoniae (ESBL-EK) infections and to determine outcomes of ESBL-EK infections. Methodology: This was a case- control study conducted at Philippine Children’s Medical Center (PCMC) from August 2006 to August 2008. Eligible subjects were identified retrospectively through PCMC Clinical Microbiology Laboratory records. All cases were compared with 1:3 random sample of non- ESBL- EK control. Risk factors of cases and controls were analyzed as to demographic characteristics, co- morbid conditions, previous hospitalization and antibiotics used. Antibiotic resistance among the ESBL- EK isolates was determined as well as outcomes of both groups. Results: One hundred five ESBL- EK cases and 315 controls were enrolled. Patients with ESBL-EK were 2x younger (mean= 29.9 months) than controls. Patients admitted at the ICU were 2.5x more likely to acquire ESBL infection. Patients with renal disease were twice as likely to develop the infection. Analysis showed independent variables of ESBL-EK infection: age, co- morbid conditions, previous cephalosporin use, and invasive procedures. Carbapenem was the only antibiotic to which all isolates were susceptible. Piperacillin- tazobactam showed 10% resistance against ESBL- E. coli. Only 11.4% of cases received adequate empiric treatment. ESBL-EK- infected patients were 2.5 times more likely to die of the infection. Conclusion: Age, ICU admission, co- morbid conditions particularly renal diseases, previous hospitalizations and receipt of cephalosporins were associated with increased risk of acquiring ESBL infections. Rate of therapeutic failure and mortality was higher among children with ESBL-EK infections given inadequate or delayed use of appropriate antibiotics. The presence of ESBL-EK infection was also an independent predictor of outcome or mortality.



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