Stewardship antibióticos

Risk factors of community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae bacteremia in South Korea using National Health Insurance claims data.

Int J Antimicrob Agents. 2019 Sep 11;:

Authors: Lee Y, Kim YA, Kim D, Shin JH, Uh Y, Shin KS, Shin JH, Jeong SH, Park YS

Abstract
BACKGROUND: Although it is essential to know the particular causes of antibiotic-resistant infections in the community, there is lack of evidence regarding risk factors for community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteremia in South Korea. Herein, we aimed to identify risk factors for community-onset ESBL-KP bacteremia.
METHODS: From May 2016 to April 2017, patients with community-onset KP bloodstream infection (BSI) (N=408) from six sentinel hospitals participating in the Global Antimicrobial Surveillance System in South Korea were included. Risk factors of ESBL-KP BSI were assessed. PCR and sequencing to identify genes encoding ESBLs and multilocus sequence typing were performed.
RESULTS: Of the 408 patients with community-onset KP BSI, 70 (17%) were ESBL-KP BSI patients. Admission to a long-term-care hospital within the previous 3 months (OR, 5.7; 95% CI, 2.1-15.6; p=0.001), previous use of trimethoprim-sulfamethoxazole (TMP/SMT, OR, 11.5; 95% CI, 2.7-48.6; p=0.001) or extended-spectrum cephalosporin (OR, 2.2; 95% CI, 1.2-3.9; p=0.01), and previous urinary catheter use (OR, 2.3; 95% CI, 1.1-4.5; p=0.02) were independent risk factors for community-onset ESBL-KP BSI. ESBL-KP isolates most frequently carried the CTX-M-1-group ESBL (74%, n=52). The most prevalent sequence type (ST) among the ESBL-KP isolates was ST48 (14%, n=10). Among non-ESBL-KP isolates, ST23 was most prevalent (21%, n=70).
CONCLUSION: Previous admission to a long-term-care hospital, urinary catheter use, and previous antibiotic use of TMP/SMT and extended-spectrum cephalosporin within the previous three months were identified as risk factors for community-onset ESBL-KP BSI. Strict antibiotic stewardship and infection control measures for long-term-care hospitals are needed.

PMID: 31520781 [PubMed - as supplied by publisher]

Clinical effectiveness of oral antimicrobial therapy for acute pyelonephritis caused by extended-spectrum β-lactamase-producing Enterobacteriales.

Eur J Clin Microbiol Infect Dis. 2019 Sep 13;:

Authors: Kim SH, Lim KR, Lee H, Huh K, Cho SY, Kang CI, Chung DR, Peck KR

Abstract
Infections caused by extended-spectrum β-lactamase-producing Enterobacteriales (ESBL-PE) are commonly treated with intravenous antibiotics. This study investigated whether oral antimicrobial therapy (OAT) is as effective as intravenous antimicrobial therapy (IVT) for acute pyelonephritis (APN) caused by ESBL-PE. A retrospective cohort of patients with APN caused by ESBL-PE was studied at a tertiary-care hospital from January 2014 through December 2016. The OAT group comprised patients treated with an appropriate oral antimicrobial agent following 7 days or less of IVT. The primary endpoint was treatment failure defined as clinical and/or microbiological failure. The secondary endpoint was length of hospital stay and recurrences of APN within 2 months and within 1 year. Propensity score matching and multivariable Cox proportional hazard modeling were used to minimize bias. Among 238 eligible cases, Escherichia coli (83.6%) was the most common pathogen. Sixty patients received OAT after a median of four days of appropriate IVT, and 178 patients completed treatment with IVT. Fluoroquinolones (58.3%) were the most commonly prescribed OAT, followed by trimethoprim-sulfamethoxazole and amoxicillin-clavulanate. OAT was not associated with treatment failure (adjusted OR 0.66; 95% CI 0.18-2.44) and hospitalization length was shorter in the OAT group (6.2 days versus 10.7 days; P < 0.01). APN recurrence caused by ESBL-PE infection within 2 months was not associated with OAT (adjusted HR 0.56; 95% CI 0.16-2.00). OAT reduced hospital stay without adverse effects on treatment outcome. OAT could be safely applied as a carbapenem-saving option in treatment of APN.

PMID: 31520270 [PubMed - as supplied by publisher]