Document Detail


Mortality rate in neonates infected with extended-spectrum beta lactamase-producing Klebsiella species and selective empirical use of meropenem.
MedLine Citation:
PMID:  19460263     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Infection with resistant gram-negative bacteria is a growing threat to hospitalised patients. AIM: To determine factors associated with mortality among infants infected by extended-spectrum beta-lactamase-producing Klebsiella species (Klebs-ESBL) and to assess whether selective empirical use of meropenem (MERO) is associated with high mortality. METHODS: Medical records of neonates admitted from January 2002 to December 2003 who had positive blood and/or cerebrospinal fluid (CSF) culture with Klebs-ESBL were reviewed for clinical, management and outcome information. Univariate and multivariate logistic regression analyses were performed to determine factors associated with mortality among infants with culture-proven Klebs-ESBL. RESULTS: A hundred patients had positive blood (n=97) and/or CSF cultures (n=9) owing to Klebs-ESBL. Overall mortality rate was 30%. The mortality rates among those who were empirically started on a combination of piperacillin-tazobactam and amikacin (Pip-Taz+Amik) (n=48), meropenem (MERO) (n=40) and in those not started on MERO or Pip-Taz+Amik) (n=12) were 25%, 32% and 42%, respectively. Non-survivors were younger (p=0.01), had cardio-respiratory compromise or required assisted ventilation at presentation (p<0.001), and were not started on antibiotics, MERO or Pip-Taz+Amik (p<0.001). On multivariate analysis, factors associated with mortality were vaginal delivery (OR -7.07, 95% CI 2.14-23.39), a need for assisted ventilation at onset of illness (OR -4.94, 95% CI 1.12-21.86) and not starting empirical MERO or Pip-Taz+Amik (OR -17.01, 95% CI 2.41-120.23). CONCLUSION: While empirical use of carbapenems for nosocomial sepsis might be appropriate in areas where Klebs-ESBL is prevalent, their use can be restricted to those with cardio-respiratory compromise or severe sepsis without an increase in mortality.
Authors:
S Velaphi; J Wadula; F Nakwa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of tropical paediatrics     Volume:  29     ISSN:  1465-3281     ISO Abbreviation:  Ann Trop Paediatr     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-22     Completed Date:  2009-07-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8210625     Medline TA:  Ann Trop Paediatr     Country:  England    
Other Details:
Languages:  eng     Pagination:  101-10     Citation Subset:  IM    
Affiliation:
Department of Paediatrics, Chris Hani Baragwanath Hospital (CHBH), PO Bertsham 2013, South Africa. Sithembiso.Velaphi@wits.ac.za
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MeSH Terms
Descriptor/Qualifier:
Amikacin / administration & dosage
Anti-Bacterial Agents / administration & dosage*
Cohort Studies
Drug Administration Schedule
Female
Humans
Infant, Newborn
Klebsiella / enzymology
Klebsiella Infections / drug therapy,  microbiology,  mortality*
Male
Penicillanic Acid / administration & dosage,  analogs & derivatives
Piperacillin / administration & dosage
Pregnancy
Regression Analysis
Retrospective Studies
Risk Factors
Survival Analysis
Thienamycins / administration & dosage*
beta-Lactam Resistance
beta-Lactamases / biosynthesis
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Thienamycins; 157044-21-8/piperacillin-tazobactam combination product; 37517-28-5/Amikacin; 61477-96-1/Piperacillin; 87-53-6/Penicillanic Acid; 96036-03-2/meropenem; EC 3.5.2.6/beta-Lactamases

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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