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Non-Respiratory Critical Care Infections


Monday, October 31, 2005

10:30 AM - 12:00 PM

EXTENDED-SPECTRUM BETA-LACTAMASES PRODUCING KLEBSIELLA PNEUMONIAE (ESBL-KP) INFECTION, RISK FACTORS, ANTIBIOTIC USE AND BACKGROUND

Frew H. Gebreab, MD*, Nasser Saad, RPh, Liziamma George, MD, Teena Abraham, PharmD, Imran Aurangzeb, MD, Elias Ashame, MD, Kelly Marion, RN and Suhail Raoof, MD

New York Methodist Hospital, Brooklyn, NY

PURPOSE: The development of multi-drug resistant bacterial infections is a serious problem in many hospitals. This study was conducted to identify the risk factors and antibiotic usage in medical intensive care and pulmonary step down patients who developed ESBL-KP infections at New York Methodist Hospital.

METHODS: Medical records of 47 patients who developed 50 ESBL-KP infections between January to December 2004 were reviewed. Data collection included demographics,admission diagnosis,and risk factors for development of ESBL-KP infections.

RESULTS: Of 47 patients; 74.5% (n=35)were females, and 25.5% (n= 12) were males in which 59.6% of them were admitted from home while the remaining 40.4% came from nursing facilities. Patients were admitted for sepsis (27.6%),acute respiratory failure (14.8%),pneumonia (17%),urinary tract infections (12.8%),acute renal failure (12.8 %), acute abdomen (8.5%), hepatic encephalopathy (4.3%) and malignancy (2.1%). All patients were treated with at least one broad spectrum antibiotic (Figure 1) for a mean duration of 14.5 days prior to the development of ESBL-KP infections. Ninety-eight percent of patients had at least 1 invasive procedure (Figure 2). The study identified that out of fifty ESBL-KP isolates; 52% (n=26) resulted in urinary tract, 24% (n=12) respiratory tract, 22% (n=11) blood stream, and 2% (n=1) surgical wound infection. Eighty four percent of isolates were sensitive to aminoglycosides whereas only 46% were sensitive to a carbapenem (Figure 3). The mean length of stay of ESBL-KP infections 46 days and all cause mortality was 32%.



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  		Figure 1. Antibiotic use in patients with ESBL-KP infection between January to December 2004 at New York Methodist Hospital

 


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  		Figure 2. Number and type of invasive procedure performed prior to the development of ESBL-KP infections between January to December 2004 at New York Methodist Hospital.

 
CONCLUSION: 1. There was no community acquired ESBL-KP infections. 2. Majority of ESBL-KP infections were sensitive to aminoglycosides. 3. Urinary tract was the most common site of infection 4. Majority of patients had invasive procedures and all were treated with broad spectrum antibiotics prior to ESBL-KP isolation.

CLINICAL IMPLICATIONS: Identification of possible risk factors for development infection with multi-drug resistant pathogen like ESBL-KP will be helpful in prevention, early detection and treatment of such infection.

DISCLOSURE: Frew Gebreab, None.






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