Discrepancy between effects of carbapenems and flomoxef in treating nosocomial hemodialysis access-related bacteremia secondary to extended spectrum beta-lactamase producing Klebsiella pneumoniae in patients on maintenance hemodialysis.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968551 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2334 (Electronic) Linking ISSN: 14712334 NLM ISO Abbreviation: BMC Infect Dis Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Bacteremia/*drug therapy ; Carbapenems/*administration & dosage ; Cephalosporins/*administration & dosage ; Klebsiella Infections/*drug therapy ; Klebsiella pneumoniae/*enzymology ; Renal Dialysis/*adverse effects ; beta-Lactamases/*metabolism; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/administration & dosage ; Bacteremia/microbiology ; Bacteremia/mortality ; Cross Infection/drug therapy ; Cross Infection/mortality ; Female ; Humans ; Klebsiella Infections/microbiology ; Klebsiella Infections/mortality ; Klebsiella pneumoniae/isolation & purification ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

Background: Hemodialysis (HD) patients are susceptible to extended spectrum beta-lactamase (ESBL)-producing bacterial infections. Because the optimal treatment and clinical significance of ESBL-producing Klebsiella pneumoniae (ESBL-Kp) HD access-related bacteremia remain unclear, we conducted this retrospective study to determine the clinical outcomes of patients treated with either flomoxef or a carbapenem.
Methods: The eligibility criterion was fistula or graft- or catheter- related ESBL-Kp bacteremia in patients on maintenance HD. The clinical characteristics and antibiotic management were analyzed. Outcome was determined by mortality resulting from bacteremia during the 14-day period after the first positive blood culture for flomoxef-susceptible ESBL-Kp.
Results: The 57 patients studied were predominantly elderly, malnourished, with a history of severe illnesses and broad-spectrum antibiotic use before the onset of bacteremia, and with severe septicemia as determined by the Pitt bacteremia score (PBS). The study population comprised 7 fistula, 8 graft, and 42 HD catheter-related bacteremia (CRB) cases, and the mortality rate was high (36/57, 63.2%) in these 57 patients. Of 42 patients with CRB, those in the deceased group (27/42, 64.3%) had significantly lower levels of serum albumin, longer prior hospital stay and duration of catheter-dependent HD, and higher PBS than patients in the survived group. Failure to receive effective antibiotics (flomoxef or a carbapenem) within 5 days after onset of bacteremia and treatment with flomoxef both significantly contributed to higher mortality. Multivariate analyses revealed that flomoxef use, PBS, and catheter-dependent HD >30 days were independently associated with increased mortality (OR, 3.52; 95% CI, 1.19-58.17, OR, 2.92; 95% CI, 1.36-6.26 and OR, 5.73; 95% CI, 1.21-63.2, respectively).
Conclusions: Considering the high mortality rate, ESBL-Kp should be recognized as a possible pathogen in patients on maintenance HD at high risk of acquiring HD access infections associated with ESBL-producing bacteria. Carbapenems rather than flomoxef should be the therapy of choice in these critically vulnerable patients.

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0 (Anti-Bacterial Agents)
0 (Carbapenems)
0 (Cephalosporins)
EC 3.5.2.6 (beta-Lactamases)
V9E5U5XF42 (flomoxef)

Date Created: 20120906 Date Completed: 20130222 Latest Revision: 20220330

20240829

PMC3507710

10.1186/1471-2334-12-206

22947300