1737. Clinical Implication and Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae Bacteremia in Patients with Cancer
Session: Poster Abstract Session: Treatment of Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Treatment of Klebsiella pneumoniae infection is often complicated by extended-spectrum beta-lactamase (ESBL)-producing strains. While patients with cancer almost always have multiple risk factors for ESBL-producing K. pneumoniae (ESBL-KP) infections, little is known regarding clinical characteristics and molecular epidemiology of ESBL-KP infections in this population.

Methods: We retrospectively reviewed 292 cancer patients with KP bacteremia. Clinical data of ESBL-KP bacteremia were compared with those of non-ESBL-KP. Characterization of ESBLs and multi-locus sequence typing (MLST) were performed in ESBL-KP isolates.

Results: Among 292 isolates, 51 (17.5%) were ESBL-KP. In multiple regression analysis, non-neutropenia, corticosteroid use, presence of percutaneous drainage tube, recent surgery, previous use of glycopeptides, longer hospital stay were independent risk factors for ESBL-KP bacteremia (all p<0.05). All-cause 14-day mortality rate was significantly higher in patients with ESBL-KP infection (16% vs. 6.2%, p=0.038). Compared to non-ESBL-KP bacteremia, ESBL-KP bacteremia resulted in higher mortality in patients with neutropenia (p=0.046), presence of central venous catheter (p=0.049), presence of percutaneous drainage (p=0.028), recent invasive procedure (p=0.039), and pancreatobiliary (p=0.006) or respiratory tract infection (p=0.031). Among 49 ESBL-KP isolates tested, 34 (69.4%) produced TEM-1 beta-lactamase; SHV types, 48 (98.0%); CTX-M types, 34 (69.4%). The most common CTX-M type ESBLs were CTX-M-15 and CTX-M-14. Among 32 isolates with MLST results, the most common sequence type (ST) were ST711 (n=6, 18.8%), followed by ST 307, ST 11 (n=4, 12.5% for both); and ST 15, ST 20, ST 1159 (n=3, 9.4% for all).

Conclusion: Risk factors for ESBL-KP bacteremia in patients with cancer were consistent with previously known risk factors. ESBL production affected adversely the outcomes of cancer patients with KP bacteremia, especially in patients with neutropenia, indwelling catheter, recent invasive procedure, pancreatobiliary or respiratory tract infection. Microbiologic analysis showed that CTX-M ESBLs and diverse clones have already disseminated in this unique group of cancer patients.

Kyungmin Huh, MD1, Cheol-In Kang, MD1, Woojoo Lee, MD2, Jaehoon Ko, MD2, Jungok Kim, MD1, Sun Young Cho, MD1, Young Eun Ha, MD1, Doo Ryeon Chung, MD1, Nam Yong Lee, MD3, Kyong Ran Peck, MD1 and Jae-Hoon Song, MD1, (1)Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, (2)Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, (3)Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

Disclosures:

K. Huh, None

C. I. Kang, None

W. Lee, None

J. Ko, None

J. Kim, None

S. Y. Cho, None

Y. E. Ha, None

D. R. Chung, None

N. Y. Lee, None

K. R. Peck, None

J. H. Song, None

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