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KMID : 0604020140290040257
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Korean Journal of Critical Care Medicine
2014 Volume.29 No. 4 p.257 ~ p.265
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Extended-Spectrum β-Lactamase and Multidrug Resistance in Urinary Sepsis Patients Admitted to the Intensive Care Unit
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Kim Bum-Joon
Kim Sung-Gyun
Lee Seung-Soon
Kim Tae-Seok
Hwang Yong-Il
Jang Seung-Hun
Kim Joo-Hee
Jung Ki-Suck
Park Sung-Hoon
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Abstract
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Background: The role of extended-spectrum β-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting.
Methods: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome.
Results: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95% confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production.
Conclusions: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.
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KEYWORD
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beta-lactamase, drug resistance, multiple, intensive care units, sepsis, urinary tract infections
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