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Comparison of predictors and mortality between Bloodstream infections caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae

Scheuerman O, Schechner V,  Carmeli Y, Gutiérrez-Gutiérrez B, Calbo E, Almirante B, Viale PL, Oliver  A, Ruiz-Garbajosa P, Gasch O, Gozalo M, Pitout J, Akova M, Peña C,  Molina J, Hernández-Torres A, Venditti M, Prim N, Origüen J, Bou G, Tacconelli E,  Tumbarello M, Hamprecht A, Karaiskos I, de la Calle C, Pérez F,  Schwaber MJ, Bermejo J, Lowman W, Hsueh PR, Navarro-San Francisco C,  Bonomo RA, Paterson DL, Pascual A, Rodríguez-Baño J;  REIPI/ESGBIS/INCREMENT investigators.

Objective: To compare the epidemiology, clinical characteristics, and  mortality of patients with bloodstream infections (BSI) caused by  extended-spectrum β-lactamase (ESBL)-producing Escherichia coli  (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to  examine the differences in clinical characteristics and outcome between  BSIs caused by isolates with CTX-M versus other ESBL genotypes.

Methods: As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.

Results: The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non-CTX-M ESBLs were detected.

Conclusions: Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.

Clinical Trials Idenifier: Identifier: NCT01764490.Infect Control Hosp Epidemiol 2018;39:660-667.

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