PMID- 19460263
OWN - NLM
STAT- MEDLINE
DCOM- 20090717
LR  - 20181201
IS  - 1465-3281 (Electronic)
IS  - 0272-4936 (Linking)
VI  - 29
IP  - 2
DP  - 2009 Jun
TI  - Mortality rate in neonates infected with extended-spectrum beta 
      lactamase-producing Klebsiella species and selective empirical use of meropenem.
PG  - 101-10
LID - 10.1179/146532809X440716 [doi]
AB  - BACKGROUND: Infection with resistant gram-negative bacteria is a growing threat 
      to hospitalised patients. AIM: To determine factors associated with mortality 
      among infants infected by extended-spectrum beta-lactamase-producing Klebsiella 
      species (Klebs-ESBL) and to assess whether selective empirical use of meropenem 
      (MERO) is associated with high mortality. METHODS: Medical records of neonates 
      admitted from January 2002 to December 2003 who had positive blood and/or 
      cerebrospinal fluid (CSF) culture with Klebs-ESBL were reviewed for clinical, 
      management and outcome information. Univariate and multivariate logistic 
      regression analyses were performed to determine factors associated with mortality 
      among infants with culture-proven Klebs-ESBL. RESULTS: A hundred patients had 
      positive blood (n=97) and/or CSF cultures (n=9) owing to Klebs-ESBL. Overall 
      mortality rate was 30%. The mortality rates among those who were empirically 
      started on a combination of piperacillin-tazobactam and amikacin (Pip-Taz+Amik) 
      (n=48), meropenem (MERO) (n=40) and in those not started on MERO or Pip-Taz+Amik) 
      (n=12) were 25%, 32% and 42%, respectively. Non-survivors were younger (p=0.01), 
      had cardio-respiratory compromise or required assisted ventilation at 
      presentation (p<0.001), and were not started on antibiotics, MERO or Pip-Taz+Amik 
      (p<0.001). On multivariate analysis, factors associated with mortality were 
      vaginal delivery (OR -7.07, 95% CI 2.14-23.39), a need for assisted ventilation 
      at onset of illness (OR -4.94, 95% CI 1.12-21.86) and not starting empirical MERO 
      or Pip-Taz+Amik (OR -17.01, 95% CI 2.41-120.23). CONCLUSION: While empirical use 
      of carbapenems for nosocomial sepsis might be appropriate in areas where 
      Klebs-ESBL is prevalent, their use can be restricted to those with 
      cardio-respiratory compromise or severe sepsis without an increase in mortality.
FAU - Velaphi, S
AU  - Velaphi S
AD  - Department of Paediatrics, Chris Hani Baragwanath Hospital (CHBH), PO Bertsham 
      2013, South Africa. Sithembiso.Velaphi@wits.ac.za
FAU - Wadula, J
AU  - Wadula J
FAU - Nakwa, F
AU  - Nakwa F
LA  - eng
PT  - Journal Article
PL  - England
TA  - Ann Trop Paediatr
JT  - Annals of tropical paediatrics
JID - 8210625
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Thienamycins)
RN  - 157044-21-8 (Piperacillin, Tazobactam Drug Combination)
RN  - 84319SGC3C (Amikacin)
RN  - 87-53-6 (Penicillanic Acid)
RN  - EC 3.5.2.6 (beta-Lactamases)
RN  - FV9J3JU8B1 (Meropenem)
RN  - X00B0D5O0E (Piperacillin)
SB  - IM
MH  - Amikacin/administration & dosage
MH  - Anti-Bacterial Agents/*administration & dosage
MH  - Cohort Studies
MH  - Drug Administration Schedule
MH  - Female
MH  - Humans
MH  - Infant, Newborn
MH  - Klebsiella/enzymology
MH  - Klebsiella Infections/drug therapy/microbiology/*mortality
MH  - Male
MH  - Meropenem
MH  - Penicillanic Acid/administration & dosage/analogs & derivatives
MH  - Piperacillin/administration & dosage
MH  - Piperacillin, Tazobactam Drug Combination
MH  - Pregnancy
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Analysis
MH  - Thienamycins/*administration & dosage
MH  - beta-Lactam Resistance
MH  - beta-Lactamases/biosynthesis
EDAT- 2009/05/23 09:00
MHDA- 2009/07/18 09:00
CRDT- 2009/05/23 09:00
PHST- 2009/05/23 09:00 [entrez]
PHST- 2009/05/23 09:00 [pubmed]
PHST- 2009/07/18 09:00 [medline]
AID - 10.1179/146532809X440716 [doi]
PST - ppublish
SO  - Ann Trop Paediatr. 2009 Jun;29(2):101-10. doi: 10.1179/146532809X440716.