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      Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases.

      Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
      Anti-Bacterial Agents, pharmacology, therapeutic use, Bacteremia, drug therapy, mortality, Drug Resistance, Bacterial, Drug Utilization, Female, Humans, Imipenem, Klebsiella Infections, Klebsiella pneumoniae, drug effects, enzymology, Male, Multivariate Analysis, beta-Lactam Resistance, physiology, beta-Lactamases, metabolism

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          Abstract

          The prevalence of extended-spectrum beta -lactamase (ESBL) production by Klebsiella pneumonia approaches 50% in some countries, with particularly high rates in eastern Europe and Latin America. No randomized trials have ever been performed on treatment of bacteremia due to ESBL-producing organisms; existing data comes only from retrospective, single-institution studies. In a prospective study of 455 consecutive episodes of Klebsiella pneumoniae bacteremia in 12 hospitals in 7 countries, 85 episodes were due to an ESBL-producing organism. Failure to use an antibiotic active against ESBL-producing K. pneumoniae was associated with extremely high mortality. Use of a carbapenem (primarily imipenem) was associated with a significantly lower 14-day mortality than was use of other antibiotics active in vitro. Multivariate analysis including other predictors of mortality showed that use of a carbapenem during the 5-day period after onset of bacteremia due to an ESBL-producing organism was independently associated with lower mortality. Antibiotic choice is particularly important in seriously ill patients with infections due to ESBL-producing K. pneumoniae.

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