Extended-spectrum beta-lactamase-Producing Enterobacteriaceae in an Italian Intensive Care Unit: Clinical and Therapeutical Remarks

Carretto, E.; Emmi, V.; Barbarini, D.; Capra Marzani Federico,; Bolongaro, Antonia; Braschi, Antonio; Marone, P.

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In this study we evaluated the prevalence of Enterobacteriaceae and the epidemiology of ESBL+microorganisms in an ICU of our Institution over a 5-year period and analyzed the clinical features and outcomes of the infections caused by these microorganisms. The most frequent ESBL+ isolate was Proteus mirabilis (69 isolates, 58%); a high rate of positive results in the double-disk synergy test (DDS) was also recognized for Klebsiella pneumoniae (52 isolates, 51%), whereas this phenomenon was observed less frequently in other species. In 312 cases the isolated microorganism was considered to be the cause of infection; we documented 103 wound infections, 89 UTIs, 62 LRTIs, 30 primary bacteremias, 27 infections of indwelling catheters and 1 CNS infection. The overall mortality rate due to ESBL+ strains was 1%, compared with 10.6% rate caused by ESBL-negative Enterobacteriaceae. This could be explained because ESBL+ strains caused mostly localized infections (wound infections and UTIs), whereas systemic or severe infections were sustained by ESBL-negative strains, and therapy with carbapenems was started promptly after ESBL+ isolation (always within 24h after strain isolation).

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Titolo:	Extended-spectrum beta-lactamase-Producing Enterobacteriaceae in an Italian Intensive Care Unit: Clinical and Therapeutical Remarks
Autori:	Carretto E. Emmi V. Barbarini D. Capra Marzani Federico BOLONGARO, ANTONIA BRASCHI, ANTONIO Marone P. mostra contributor esterni nascondi contributor esterni
Data di pubblicazione:	2004
Rivista:	JOURNAL OF CHEMOTHERAPY
Abstract:	In this study we evaluated the prevalence of Enterobacteriaceae and the epidemiology of ESBL+microorganisms in an ICU of our Institution over a 5-year period and analyzed the clinical features and outcomes of the infections caused by these microorganisms. The most frequent ESBL+ isolate was Proteus mirabilis (69 isolates, 58%); a high rate of positive results in the double-disk synergy test (DDS) was also recognized for Klebsiella pneumoniae (52 isolates, 51%), whereas this phenomenon was observed less frequently in other species. In 312 cases the isolated microorganism was considered to be the cause of infection; we documented 103 wound infections, 89 UTIs, 62 LRTIs, 30 primary bacteremias, 27 infections of indwelling catheters and 1 CNS infection. The overall mortality rate due to ESBL+ strains was 1%, compared with 10.6% rate caused by ESBL-negative Enterobacteriaceae. This could be explained because ESBL+ strains caused mostly localized infections (wound infections and UTIs), whereas systemic or severe infections were sustained by ESBL-negative strains, and therapy with carbapenems was started promptly after ESBL+ isolation (always within 24h after strain isolation).
Handle:	http://hdl.handle.net/11571/19817
Appare nelle tipologie:	1.1 Articolo in rivista

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