JAC Advance Access originally published online on September 1, 2006
Journal of Antimicrobial Chemotherapy 2006 58(5):1082-1085; doi:10.1093/jac/dkl367
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Prior use of carbapenems may be a significant risk factor for extended-spectrum ß-lactamase-producing Escherichia coli or Klebsiella spp. in patients with bacteraemia
1 Department of Infectious Diseases, Hospital Clínic, IDIBAPS—University of Barcelona Barcelona, Spain 2 Microbiology Laboratory, Hospital Clínic, IDIBAPS—University of Barcelona Barcelona, Spain
Received 7 June 2006; returned 5 July 2006; revised 14 August 2006; accepted 15 August 2006
*Corresponding author. Tel: +34-932272322; Fax: +34-934514438; E-mail: jamarti{at}clinic.ub.es
Background: The increasing prevalence of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae will probably trigger a rise in the use of carbapenems. The effect of these antibiotics on the risk of involvement of ESBL-producing organisms in serious infections is unclear.
Methods: Retrospective analysis of 2172 episodes of healthcare-associated bacteraemia diagnosed during a 3 year period in a teaching hospital. Putative risk factors included demographics, co-morbidities, previous isolation of an ESBL-producing organism and exposure to antibiotics. Univariate and multivariate analysis of the association of risk factors with ESBL-producing organisms was performed in the entire series of bacteraemic episodes and in those due to Escherichia coli or Klebsiella spp.
Results: In the entire series, prior isolation of an ESBL-producing organism [odds ratio (OR) 5.9 (3.02, 11.5)]; an ultimately/finally fatal co-morbidity [OR 2.8 (1.55, 4.95)]; renal transplantation [OR 4.3 (1.96, 9.63)]; a urinary source [OR 4.2 (2.22, 7.84)]; shock [OR 2.4 (1.35, 4.1)] and previous use of cephalosporins [OR 2.6 (1.54, 4.51)], carbapenems [OR 2.5 (1.24, 5.05)] and glycopeptides [OR 0.4 (0.13, 0.93)] were significantly associated with ESBL-producing E. coli or Klebsiella spp. by multivariate analysis. Prior isolation of an ESBL-producing organism, an ultimately/finally fatal co-morbidity, renal transplantation, and previous use of cephalosporins and carbapenems were also significant in the analysis restricted to episodes due to E. coli or Klebsiella spp.
Conclusions: In patients with healthcare-associated bacteraemia, prior use of carbapenems may be only second to cephalosporins as the most significant antibiotic exposure associated with the involvement of ESBL-producing organisms.
Keywords: imipenem , meropenem , hospital infections
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