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Clinical outcome of empiric antimicrobial therapy of bacteremia due to extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae

Vikas P Chaubey1, Johann DD Pitout245, Bruce Dalton17, Terry Ross2, Deirdre L Church1, Daniel B Gregson125 and Kevin B Laupland1236*

Author Affiliations

1 Department of Medicine, University of Calgary, Calgary, Canada

2 Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada

3 Department of Critical Care Medicine, University of Calgary, Calgary, Canada

4 Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Canada

5 Calgary Laboratory Services, Alberta Health Services, Calgary, Canada

6 Centre for Anti-microbial Resistance, Alberta Health Services, Calgary, Canada

7 Department of Pharmacy Services, Alberta Health Services, Calgary, Canada

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BMC Research Notes 2010, 3:116  doi:10.1186/1756-0500-3-116

Published: 27 April 2010

Abstract

Background

Prompt administration of adequate empiric antimicrobial therapy is a major determinant influencing the outcome of serious infections. The objective of this study was to describe empiric antimicrobial therapy employed and assess its effect on the outcome of patients bacteremic with extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae.

Findings

A retrospective surveillance study of all patients with bacteremias caused by ESBL-producing E. coli and K. pneumoniae (EK-ESBL) from 2000-2007 in the Calgary Health Region was conducted. Data were available for 79 episodes of bacteremia among 76 patients. Forty-four (56%) were male, the median age was 70.0 yrs [interquartile range (IQR) 60.6-70.1 yrs], and 72 (91%) episodes were E. coli. Seventy-four episodes (94%) were treated with empiric therapy within the first 48 hours. A non-statistically significant increased mortality occurred in those treated empirically with a beta-lactam/beta-lactamase inhibitor combination (6/16; 38% vs. 10/53; 18%; p = 0.063) while empiric carbapenem therapy was associated with lower mortality (0/10 died vs. 16/53 (30%), p = 0.089). Only 42 (53%) episodes received adequate therapy within the first 48 hours. The median time to first adequate antibiotic therapy was 41.0 hours [IQR 5.8-59.5] (n = 75). The case-fatality rate was not different among those that received adequate compared to inadequate therapy by 48 hours as compared to inadequate empiric therapy (9/42; 21% vs. 7/37; 19%; p = 1.0).

Conclusion

Inadequate empiric therapy is common among patients with EK-ESBL bacteremia in our region but was not associated with adverse mortality outcome.