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Phill, Eun, Su, Yeon, Yiel-Hea, and Yoon: Comparison of Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Bloodstream Infection Epidemiology
Original Article

J Nosocomial Infect Control 2013;19(2):45-51.

Published online: 3 May 2013

DOI: https://doi.org/10.14192/kjnic.2014.19.2.45

Comparison of Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Bloodstream Infection Epidemiology

Hoon Yoon Phill, Bin Cho Eun, Ji Kim Su, Hee Lee Yeon, Seo Yiel-Hea, Soo Park Yoon

Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea

Gachon University Gil Hospital, School of Medicine, Incheon, Korea

Department of Laboratory Medicine, Gachon University Gil Hospital, Incheon, Korea

Address reprint requests to Yoon Soo Park, Department of Internal Medicine, Gachon University, Gil Hospital, 24, Namdongdaero, 774 beon-gil, Namdong-gu, Incheon 405-760, Korea Tel: 032-460-8506, Fax: 032-469-4320 E-mail: yspark@gilhospital.com

Received 2 September 2014       Accepted 20 November 2014

Copyright © 2013, the Korean Thyroid Association. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae are main pathogens of bloodstream infection. We compared the epidemiology of ESBL-producing E. coli and K. pneumoniae.

Methods

From January 2003 through March 2007, we retrospectively investigated the clinical characteristics and comorbidities of patients with bloodstream infection by ESBL-producing E. coli and K. pneumoniae.

Results

During the study period, 79 patients (54 with E. coli and 25 with K. pneumoniae) with blood cultures positive for ESBL-producing E. coli or K. pneumoniae were studied. When comparing the source of bloodstream infections, urinary tract infections (UTIs) were more commonly caused by E. coli (24% vs. 0; P=0.007), and respiratory tract and soft tissue infection (36% vs. 15%; P=0.04, 12% vs. 0; P=0.03, respectively) were more commonly associated with K. pneumoniae. Among hospital-acquired bloodstream infection, third-generation cephalosporin was more commonly used in patients with E. coli than patients with K. pneumoniae (81% vs. 24%, Pä0.001). Medical devices (central venous catheter and urinary catheter) were more commonly used in patients with K. pneumoniae.

Conclusion

ESBL-producing E. coli bloodstream infection is more common in urinary tract infections. ESBL-producing K. pneumoniae is more common in respiratory tract infections and in skin and soft tissue infections. In hospital-acquired infections, ESBL-producing E. coli bloodstream infection is more common in biliary tract infection. ESBL-producing E. coli was more commonly associated with prior frequent antibiotics use and K. pneumoniae was more commonly associated with use of medical devices.

Keywords: Bloodstream infection, Epidemiology, ESBL, Escherichia coli, Klebsiella pneumoniae

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Table 1.
Comparative characteristics of bacteremia due to ESBL producing E. coli and K. pneumoniae
Covariate No. (%) of E. coli bacteremia(N=54) No. (%) of K. pneumoniae bacteremia (N=25) OR (95% CI) P
Type of infection        
Community acquired 12 (22) 2 (8)   0.2
Healthcare associated 11 (20) 6 (24)    
Hospital acquired 31 (57) 17 (68)    
Demographics        
Male 28 (52) 18 (72) 0.42 (0.15-1.17) 0.14
Age (yr, meanSD) 60 18 56 23   0.49
Comorbidity        
Diabetes mellitus 15 (28) 5 (20) 0.65 (0.2-2.05) 0.58
Malignancy 23 (43) 6 (24) 0.43 (0.15-1.23) 0.14
Renal insufficiency 3 (6) 1 (4) 0.71 (0.07-7.17) 1.0
(serum creatinineâ2 mg/dL)        
Dialysis 1 (2) 1 (4) 2.21 (0.13-36.8) 0.54
Heart failure 2 (4) 3 (12) 3.55 (0.55-22.7) 0.32
Chronic liver disease 15 (28) 3 (12) 0.36 (0.09-1.36) 0.16
Cerebrovascular accident 2 (4) 4 (16) 4.95 (0.84-29.1) 0.08
Charlson comorbidity index 3.8 2.5 2.8 2.3   0.1
(meanSD)        
Source of infection        
Primary 8 (15) 7 (28) 2.24 (0.71-7.07) 0.22
Urinary tract 13 (24) 0 (0)   0.007
Biliary tract 21 (39) 4 (16) 0.30 (0.09-0.10) 0.07
Intra-abdominal infection 5 (9) 2 (8) 0.85 (0.15-4.73) 1.0
Liver abscess 1 (2) 2 (8) 4.61 (0.40-53.4) 0.23
Respiratory tract 8 (15) 9 (36) 3.23 (1.07-9.81) 0.04
Skin and soft tissue 0 (0) 3 (12)   0.03
Pitt bacteremia score (meanSD) 2.5 3 3 3.5   0.5
Severe sepsis or septic shock 29 (54) 11 (44) 0.68 (0.26-1.76) 0.47
Mortality        
In hospital mortality 21 (39) 9 (36) 0.88 (0.33-2.36) 1.0
14-day mortality 16 (30) 8 (32) 1.12 (0.40-3.11) 1.0

Abbreviation: ESBL, Extended-spectrum β-lactamase.

Table 2.
Characteristics for hospital acquired bacteremia due to ESBL-producing E. coli and K. pneumoniae
Covariate No. (%) of E. coli bacteremia(N=31) No. (%) of K. pneumoniae bacteremia (N=17) OR (95% CI) P
Demographics        
Male 20 (65) 11 (65) 0.99 (0.29-3.42) 1.00
Age (yr, meanSD) 58 16 52 26   0.32
Comorbidity        
Diabetes mellitus 10 (32) 3 (18) 0.45 (0.1-1.93) 0.33
Malignancy 13 (42) 4 (24) 0.43 (0.11-1.61) 0.34
Renal insufficiency (serum creatinineâ2 mg/dL) 1 (6) 0 (0) 0.94 (0.85-1.03) 0.53
Dialysis 1 (3) 0 (0) 0.97 (0.91-1.03) 1.00
Heart failure 0 (0) 2 (12) 1.13 (0.95-1.35) 0.12
Chronic liver disease 11 (35) 3 (18) 0.39 (0.09-1.66) 0.32
Cerebrovascular accident 1 (3) 2 (12) 4.00 (0.34-47.7) 0.28
Charlson comorbidity index (meanSD) 4.1 2.3 2.9 2.4   0.2
Source of infection        
Primary 6 (19) 6 (35) 2.27 (0.60-8.64) 0.30
Urinary tract 3 (10) 0 (0)   0.54
Biliary tract 15 (48) 1 (6) 0.07 (0.008-0.57) 0.003
Intra-abdominal infection 3 (10) 2 (12) 1.24 (0.18-8.29) 1.00
Liver abscess 0 1 (6)   0.35
Respiratory tract 4 (13) 7 (41) 4.73 (1.13-19.68) 0.036
Skin and soft tissue 0 2 (12)   0.12
Pitt bacteremia score (meanSD) 2.9 3.1 3.6 3.2   0.34
Severe sepsis or septic shock 18 (58) 7 (41) 0.51 (0.15-1.68) 0.37
Previous antimicrobials 3r generation cephalosporin 25 (81) 4 (24)   ä.001
Previous device use        
Central venous catheter 13 (42) 15 (88) 10.39 (2.02-53.4) 0.002
Urinary catheter 8 (26) 13 (77) 9.3 (2.4-37.2) 0.001
Intubation 3 (10) 8 (47) 8.3 (1.8-38.1) 0.009
Mortality        
In hospital mortality 15 (48) 8 (47) 0.95 (0.290-3.10) 1.0
14-day mortality 12 (39) 7 (41) 1.10 (0.33-3.70) 1.0

Abbreviation: ESBL, Extended-spectrum β-lactamase.

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