883. Epidemiology and Clinical Outcomes associated with Community Acquired Complicated Intra-abdominal Infections caused by Extended-Spectrum-BetaLactamase-producing Enterobacteriaceae
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
  • ID Week-FINAL.pdf (372.4 kB)
  • Background:

    The growing trend in multidrug resistant extended-spectrum-β-lactamase(ESBL)-producing organisms worldwide is posing a significant challenge in infection control among intra-abdominal infections (IAIs). The objective of our study was to compare clinical outcomes in patients with community acquired complicated IAIs caused by ESBL producing Enterobacteriaceae (ESBL-positive) to those with non-ESBL-producing (ESBL-negative) infections.


    A prospective, observational study of hospitalized adults with community acquired complicated IAIs was conducted at multiple sites in Portugal, Columbia, Thailand, Taiwan and Philippines. Samples were obtained during surgery or percutaneous drainage within 48 hours of admission and tested for ESBL production on site. Only patients with Escherichia coli or Klebsiella spp were enrolled. Species identification was conducted using the standard methods on site. ESBL-positive and ESBL-negative groups were compared for clinical outcomes at discharge and for length of hospital stay (LOS). Comparisons were made using Fischer exact test for clinical outcomes and non-parametric Wilcoxon-Sum-Rank test for LOS. 


    One hundred and eight patients were enrolled and analyzed from Columbia (5), Philippines (46), Portugal (13), Taiwan (26) and Thailand (18). Sixteen (15%) had ESBL-positive and 92 (85%) had ESBL-negative organisms. The mean age was 52 years in both groups. Escherichia coli was isolated in 73% of the infections.  A favorable clinical response defined as complete or partial resolution of symptoms, was observed in 14 (87.5%) ESBL-positive infections compared to 82 (89.1%) ESBL-negative infections [p= 0.6681].The median LOS was 8 days in ESBL-negative and 14 days in ESBL-positive infections [p= 0.0361]. There were 12 deaths overall in both groups, six were related to IAIs; 2 in ESBL-positive (12.5%) and 4 in ESBL-negative (4.3%) [p= 0.4545].


    Patients with community acquired, ESBL-positive IAIs required significantly longer duration of hospitalization than ESBL-negative IAIs. The clinical outcomes and the mortality in ESBL-positive infections did not vary much from those of ESBL-negative infections. These results however, were not statistically significant attributable to the small sample size.

    Yang Xie, PhD, MPH, Infectious Diseases, Merck & Co Inc; Global Health Outcomes, Whitehouse station, NJ, Vaishali Pawar, MPH, MBBS, Health Economics and Outcomes Research, Ernest Mario School of Pharmacy, Piscataway, NJ, Girish D. Prajapati, M.B.B.S., MPH, AllSource PPS, Huntington Beach,, CA, Dongmu Zhang, PhD, Merck & co Inc; Global Health Outcomes, Whitehouse station, NJ, Myrna Mendoza, MD, Philippines General Hospital, Manila, Philippines, Pattarachai Kiratisin, MD, PhD, Department of Microbiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand, Po Ren Hseuh, MD, Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Wen-Chien Ko, MD, Department of Medicine at National Cheng Kung University Medical College and Hospital, Tainan, Taiwan, Elmano Ramalheira, MD, Hospital Infante Dom Pedro - Aveiro/ Director of Clinical Pathology Department, Aveiro, Portugal, Ana Paula Castro, MD, Hospital Geral de Santo António/Medical Specialist at Clinical Pathology Department /Microbiology Service, Porto, Portugal and Fernando Rosso, MD, Infectious diseases, Fundación Valle del Lili, Cali, Colombia


    Y. Xie, Merck: Employee, Salary

    V. Pawar, None

    G. D. Prajapati, None

    D. Zhang, Merck: Employee, Salary

    M. Mendoza, None

    P. Kiratisin, None

    P. R. Hseuh, None

    W. C. Ko, None

    E. Ramalheira, None

    A. P. Castro, None

    F. Rosso, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.