Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli

Teena Chopra, Dror Marchaim, Jennifer Veltman, Paul Johnson, Jing J. Zhao, Ryan Tansek, Dania Hatahet, Khawar Chaudhry, Jason M. Pogue, Hiro Rahbar, Ting Yi Chen, Thientu Truong, Victor Rodriguez, Joseph Ellsworth, Luigino Bernabela, Ashish Bhargava, Adnan Yousuf, George Alangaden, Keith S. Kaye

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Extended-spectrum-β-lactamase (ESBL)-producing pathogens are associated with extensive morbidity and mortality and rising health care costs. Scant data exist on the impact of antimicrobial therapy on clinical outcomes in patients with ESBL bloodstream infections (BSI), and no large studies have examined the impact of cefepime therapy. A retrospective 3-year study was performed at the Detroit Medical Center on adult patients with BSI due to ESBL-producing Klebsiella pneumoniae or Escherichia coli. Data were collected from the medical records of study patients at five hospitals between January 2005 and December 2007. Multivariate analysis was performed using logistic regression. One hundred forty-five patients with BSI due to ESBL-producing pathogens, including K. pneumoniae (83%) and E. coli (16.5%), were studied. The mean age of the patients was 66 years. Fifty-one percent of the patients were female, and 79.3% were African-American. Fifty-three patients (37%) died in the hospital, and 92 survived to discharge. In bivariate analysis, the variables associated with mortality (P<0.05) were presence of a rapidly fatal condition at the time of admission, use of gentamicin as a consolidative therapeutic agent, and presence of one or more of the following prior to culture date: mechanical ventilation, stay in the intensive care unit (ICU), and presence of a central venous catheter. In multivariate analysis, the predictors of in-hospital mortality included stay in the intensive care unit (odds ratio [OR], 2.17; 95% confidence interval [CI], 0.98 to 4.78), presence of a central-line catheter prior to positive culture (OR, 2.33; 95% CI, 0.77 to 7.03), presence of a rapidly fatal condition at the time of admission (OR, 5.13; 95% CI, 2.13 to 12.39), and recent prior hospitalization (OR, 1.92; 95% CI, 0.83 to 4.09). When carbapenems were added as empirical therapy to the predictor model, there was a trend between empirical carbapenem therapy and decreased mortality (OR, 0.61; 95% CI, 0.26 to 1.50). When added to the model, receipt of empirical cefepime alone (n = 43) was associated with increased mortality, although this association did not reach statistical significance (OR, 1.66; 95% CI, 0.71 to 3.87). The median length of hospital stay was shorter for patients receiving empirical cefepime than for those receiving empirical or consolidated carbapenem therapy. In multivariate analysis, empirical therapy with cefepime for BSI due to an ESBL-producing pathogen was associated with a trend toward an increased mortality risk and empirical carbapenem therapy was associated with a trend toward decreased mortality risk.

Original languageEnglish (US)
Pages (from-to)3936-3942
Number of pages7
JournalAntimicrobial Agents and Chemotherapy
Volume56
Issue number7
DOIs
StatePublished - Jul 2012

Fingerprint

Klebsiella pneumoniae
Escherichia coli
Carbapenems
Mortality
Odds Ratio
Confidence Intervals
Infection
Multivariate Analysis
Therapeutics
Intensive Care Units
Length of Stay
Central Venous Catheters
cefepime
Hospital Mortality
Gentamicins
Artificial Respiration
African Americans
Health Care Costs
Medical Records
Hospitalization

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology
  • Infectious Diseases

Cite this

Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli. / Chopra, Teena; Marchaim, Dror; Veltman, Jennifer; Johnson, Paul; Zhao, Jing J.; Tansek, Ryan; Hatahet, Dania; Chaudhry, Khawar; Pogue, Jason M.; Rahbar, Hiro; Chen, Ting Yi; Truong, Thientu; Rodriguez, Victor; Ellsworth, Joseph; Bernabela, Luigino; Bhargava, Ashish; Yousuf, Adnan; Alangaden, George; Kaye, Keith S.

In: Antimicrobial Agents and Chemotherapy, Vol. 56, No. 7, 07.2012, p. 3936-3942.

Research output: Contribution to journalArticle

Chopra, T, Marchaim, D, Veltman, J, Johnson, P, Zhao, JJ, Tansek, R, Hatahet, D, Chaudhry, K, Pogue, JM, Rahbar, H, Chen, TY, Truong, T, Rodriguez, V, Ellsworth, J, Bernabela, L, Bhargava, A, Yousuf, A, Alangaden, G & Kaye, KS 2012, 'Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli', Antimicrobial Agents and Chemotherapy, vol. 56, no. 7, pp. 3936-3942. https://doi.org/10.1128/AAC.05419-11
Chopra, Teena ; Marchaim, Dror ; Veltman, Jennifer ; Johnson, Paul ; Zhao, Jing J. ; Tansek, Ryan ; Hatahet, Dania ; Chaudhry, Khawar ; Pogue, Jason M. ; Rahbar, Hiro ; Chen, Ting Yi ; Truong, Thientu ; Rodriguez, Victor ; Ellsworth, Joseph ; Bernabela, Luigino ; Bhargava, Ashish ; Yousuf, Adnan ; Alangaden, George ; Kaye, Keith S. / Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli. In: Antimicrobial Agents and Chemotherapy. 2012 ; Vol. 56, No. 7. pp. 3936-3942.
@article{95cf53db45114092878175e531824fa1,
title = "Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli",
abstract = "Extended-spectrum-β-lactamase (ESBL)-producing pathogens are associated with extensive morbidity and mortality and rising health care costs. Scant data exist on the impact of antimicrobial therapy on clinical outcomes in patients with ESBL bloodstream infections (BSI), and no large studies have examined the impact of cefepime therapy. A retrospective 3-year study was performed at the Detroit Medical Center on adult patients with BSI due to ESBL-producing Klebsiella pneumoniae or Escherichia coli. Data were collected from the medical records of study patients at five hospitals between January 2005 and December 2007. Multivariate analysis was performed using logistic regression. One hundred forty-five patients with BSI due to ESBL-producing pathogens, including K. pneumoniae (83{\%}) and E. coli (16.5{\%}), were studied. The mean age of the patients was 66 years. Fifty-one percent of the patients were female, and 79.3{\%} were African-American. Fifty-three patients (37{\%}) died in the hospital, and 92 survived to discharge. In bivariate analysis, the variables associated with mortality (P<0.05) were presence of a rapidly fatal condition at the time of admission, use of gentamicin as a consolidative therapeutic agent, and presence of one or more of the following prior to culture date: mechanical ventilation, stay in the intensive care unit (ICU), and presence of a central venous catheter. In multivariate analysis, the predictors of in-hospital mortality included stay in the intensive care unit (odds ratio [OR], 2.17; 95{\%} confidence interval [CI], 0.98 to 4.78), presence of a central-line catheter prior to positive culture (OR, 2.33; 95{\%} CI, 0.77 to 7.03), presence of a rapidly fatal condition at the time of admission (OR, 5.13; 95{\%} CI, 2.13 to 12.39), and recent prior hospitalization (OR, 1.92; 95{\%} CI, 0.83 to 4.09). When carbapenems were added as empirical therapy to the predictor model, there was a trend between empirical carbapenem therapy and decreased mortality (OR, 0.61; 95{\%} CI, 0.26 to 1.50). When added to the model, receipt of empirical cefepime alone (n = 43) was associated with increased mortality, although this association did not reach statistical significance (OR, 1.66; 95{\%} CI, 0.71 to 3.87). The median length of hospital stay was shorter for patients receiving empirical cefepime than for those receiving empirical or consolidated carbapenem therapy. In multivariate analysis, empirical therapy with cefepime for BSI due to an ESBL-producing pathogen was associated with a trend toward an increased mortality risk and empirical carbapenem therapy was associated with a trend toward decreased mortality risk.",
author = "Teena Chopra and Dror Marchaim and Jennifer Veltman and Paul Johnson and Zhao, {Jing J.} and Ryan Tansek and Dania Hatahet and Khawar Chaudhry and Pogue, {Jason M.} and Hiro Rahbar and Chen, {Ting Yi} and Thientu Truong and Victor Rodriguez and Joseph Ellsworth and Luigino Bernabela and Ashish Bhargava and Adnan Yousuf and George Alangaden and Kaye, {Keith S.}",
year = "2012",
month = "7",
doi = "10.1128/AAC.05419-11",
language = "English (US)",
volume = "56",
pages = "3936--3942",
journal = "Antimicrobial Agents and Chemotherapy",
issn = "0066-4804",
publisher = "American Society for Microbiology",
number = "7",

}

TY - JOUR

T1 - Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli

AU - Chopra, Teena

AU - Marchaim, Dror

AU - Veltman, Jennifer

AU - Johnson, Paul

AU - Zhao, Jing J.

AU - Tansek, Ryan

AU - Hatahet, Dania

AU - Chaudhry, Khawar

AU - Pogue, Jason M.

AU - Rahbar, Hiro

AU - Chen, Ting Yi

AU - Truong, Thientu

AU - Rodriguez, Victor

AU - Ellsworth, Joseph

AU - Bernabela, Luigino

AU - Bhargava, Ashish

AU - Yousuf, Adnan

AU - Alangaden, George

AU - Kaye, Keith S.

PY - 2012/7

Y1 - 2012/7

N2 - Extended-spectrum-β-lactamase (ESBL)-producing pathogens are associated with extensive morbidity and mortality and rising health care costs. Scant data exist on the impact of antimicrobial therapy on clinical outcomes in patients with ESBL bloodstream infections (BSI), and no large studies have examined the impact of cefepime therapy. A retrospective 3-year study was performed at the Detroit Medical Center on adult patients with BSI due to ESBL-producing Klebsiella pneumoniae or Escherichia coli. Data were collected from the medical records of study patients at five hospitals between January 2005 and December 2007. Multivariate analysis was performed using logistic regression. One hundred forty-five patients with BSI due to ESBL-producing pathogens, including K. pneumoniae (83%) and E. coli (16.5%), were studied. The mean age of the patients was 66 years. Fifty-one percent of the patients were female, and 79.3% were African-American. Fifty-three patients (37%) died in the hospital, and 92 survived to discharge. In bivariate analysis, the variables associated with mortality (P<0.05) were presence of a rapidly fatal condition at the time of admission, use of gentamicin as a consolidative therapeutic agent, and presence of one or more of the following prior to culture date: mechanical ventilation, stay in the intensive care unit (ICU), and presence of a central venous catheter. In multivariate analysis, the predictors of in-hospital mortality included stay in the intensive care unit (odds ratio [OR], 2.17; 95% confidence interval [CI], 0.98 to 4.78), presence of a central-line catheter prior to positive culture (OR, 2.33; 95% CI, 0.77 to 7.03), presence of a rapidly fatal condition at the time of admission (OR, 5.13; 95% CI, 2.13 to 12.39), and recent prior hospitalization (OR, 1.92; 95% CI, 0.83 to 4.09). When carbapenems were added as empirical therapy to the predictor model, there was a trend between empirical carbapenem therapy and decreased mortality (OR, 0.61; 95% CI, 0.26 to 1.50). When added to the model, receipt of empirical cefepime alone (n = 43) was associated with increased mortality, although this association did not reach statistical significance (OR, 1.66; 95% CI, 0.71 to 3.87). The median length of hospital stay was shorter for patients receiving empirical cefepime than for those receiving empirical or consolidated carbapenem therapy. In multivariate analysis, empirical therapy with cefepime for BSI due to an ESBL-producing pathogen was associated with a trend toward an increased mortality risk and empirical carbapenem therapy was associated with a trend toward decreased mortality risk.

AB - Extended-spectrum-β-lactamase (ESBL)-producing pathogens are associated with extensive morbidity and mortality and rising health care costs. Scant data exist on the impact of antimicrobial therapy on clinical outcomes in patients with ESBL bloodstream infections (BSI), and no large studies have examined the impact of cefepime therapy. A retrospective 3-year study was performed at the Detroit Medical Center on adult patients with BSI due to ESBL-producing Klebsiella pneumoniae or Escherichia coli. Data were collected from the medical records of study patients at five hospitals between January 2005 and December 2007. Multivariate analysis was performed using logistic regression. One hundred forty-five patients with BSI due to ESBL-producing pathogens, including K. pneumoniae (83%) and E. coli (16.5%), were studied. The mean age of the patients was 66 years. Fifty-one percent of the patients were female, and 79.3% were African-American. Fifty-three patients (37%) died in the hospital, and 92 survived to discharge. In bivariate analysis, the variables associated with mortality (P<0.05) were presence of a rapidly fatal condition at the time of admission, use of gentamicin as a consolidative therapeutic agent, and presence of one or more of the following prior to culture date: mechanical ventilation, stay in the intensive care unit (ICU), and presence of a central venous catheter. In multivariate analysis, the predictors of in-hospital mortality included stay in the intensive care unit (odds ratio [OR], 2.17; 95% confidence interval [CI], 0.98 to 4.78), presence of a central-line catheter prior to positive culture (OR, 2.33; 95% CI, 0.77 to 7.03), presence of a rapidly fatal condition at the time of admission (OR, 5.13; 95% CI, 2.13 to 12.39), and recent prior hospitalization (OR, 1.92; 95% CI, 0.83 to 4.09). When carbapenems were added as empirical therapy to the predictor model, there was a trend between empirical carbapenem therapy and decreased mortality (OR, 0.61; 95% CI, 0.26 to 1.50). When added to the model, receipt of empirical cefepime alone (n = 43) was associated with increased mortality, although this association did not reach statistical significance (OR, 1.66; 95% CI, 0.71 to 3.87). The median length of hospital stay was shorter for patients receiving empirical cefepime than for those receiving empirical or consolidated carbapenem therapy. In multivariate analysis, empirical therapy with cefepime for BSI due to an ESBL-producing pathogen was associated with a trend toward an increased mortality risk and empirical carbapenem therapy was associated with a trend toward decreased mortality risk.

UR - http://www.scopus.com/inward/record.url?scp=84862573595&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862573595&partnerID=8YFLogxK

U2 - 10.1128/AAC.05419-11

DO - 10.1128/AAC.05419-11

M3 - Article

C2 - 22547616

AN - SCOPUS:84862573595

VL - 56

SP - 3936

EP - 3942

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

SN - 0066-4804

IS - 7

ER -