Impact of extended spectrum beta-lactamase producing Klebsiella pneumoniae infections in severely burned patients

Jason W. Bennett, Janelle L. Robertson, Duane R. Hospenthal, Steven Wolf, Kevin K. Chung, Katrin Mende, Clinton K. Murray

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Significantly higher mortality has been demonstrated in patients who suffer severe burns complicated by Klebsiella pneumoniae bacteremia. The specific virulence mechanisms associated with this organism in this population are unclear. STUDY DESIGN: Our study assessed the impact of the mechanism of antibiotic resistance, strain clonality, and other host factors on morbidity and mortality. All patients with thermal burns infected with K pneumoniae between January 1, 2004 and July 1, 2008 were included in the analysis. RESULTS: Ninety-one patients had 111 episodes of K pneumoniae infections, with 59 isolates among the 91 patients producing extended spectrum beta-lactamase (ESBL). Patients with ESBL-producing strains were slightly younger, had higher Injury Severity Scores (ISS), and higher percent full thickness burns. Those who survived to discharge were younger (p < 0.001), had less burned surface area (p = 0.013), had fewer ventilator days (p = 0.016), and fewer infections with ESBL-producing isolates (p = 0.042). Logistic regression revealed that an infection with ESBL-producing K pneumoniae during the hospital stay was the factor most predictive of death, with a nearly 4-fold increased odds of dying. However, survival duration analysis of the population with and without ESBL-producing K pneumoniae using Kaplan-Meier technique showed no significant difference in the populations. Cox regression proportional hazards model revealed that only age (p = 0.01) and ventilator days (p ≤ 0.01) were associated with time to death. No specific clonality of the strains tested or ESBL production resistance genes were associated with mortality or ESBL production. CONCLUSIONS: These results suggest that infections caused by ESBL-producing K pneumoniae are predictive of death when occurring in an older, more badly burned population.

Original languageEnglish (US)
Pages (from-to)391-399
Number of pages9
JournalJournal of the American College of Surgeons
Volume211
Issue number3
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

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Klebsiella Infections
Klebsiella pneumoniae
beta-Lactamases
Pneumonia
Burns
Mechanical Ventilators
Infection
Population
Mortality
Injury Severity Score
Survival Analysis
Microbial Drug Resistance
Bacteremia
Proportional Hazards Models
Virulence
Length of Stay
Hot Temperature
Logistic Models
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Impact of extended spectrum beta-lactamase producing Klebsiella pneumoniae infections in severely burned patients. / Bennett, Jason W.; Robertson, Janelle L.; Hospenthal, Duane R.; Wolf, Steven; Chung, Kevin K.; Mende, Katrin; Murray, Clinton K.

In: Journal of the American College of Surgeons, Vol. 211, No. 3, 01.09.2010, p. 391-399.

Research output: Contribution to journalArticle

Bennett, Jason W. ; Robertson, Janelle L. ; Hospenthal, Duane R. ; Wolf, Steven ; Chung, Kevin K. ; Mende, Katrin ; Murray, Clinton K. / Impact of extended spectrum beta-lactamase producing Klebsiella pneumoniae infections in severely burned patients. In: Journal of the American College of Surgeons. 2010 ; Vol. 211, No. 3. pp. 391-399.
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N2 - BACKGROUND: Significantly higher mortality has been demonstrated in patients who suffer severe burns complicated by Klebsiella pneumoniae bacteremia. The specific virulence mechanisms associated with this organism in this population are unclear. STUDY DESIGN: Our study assessed the impact of the mechanism of antibiotic resistance, strain clonality, and other host factors on morbidity and mortality. All patients with thermal burns infected with K pneumoniae between January 1, 2004 and July 1, 2008 were included in the analysis. RESULTS: Ninety-one patients had 111 episodes of K pneumoniae infections, with 59 isolates among the 91 patients producing extended spectrum beta-lactamase (ESBL). Patients with ESBL-producing strains were slightly younger, had higher Injury Severity Scores (ISS), and higher percent full thickness burns. Those who survived to discharge were younger (p < 0.001), had less burned surface area (p = 0.013), had fewer ventilator days (p = 0.016), and fewer infections with ESBL-producing isolates (p = 0.042). Logistic regression revealed that an infection with ESBL-producing K pneumoniae during the hospital stay was the factor most predictive of death, with a nearly 4-fold increased odds of dying. However, survival duration analysis of the population with and without ESBL-producing K pneumoniae using Kaplan-Meier technique showed no significant difference in the populations. Cox regression proportional hazards model revealed that only age (p = 0.01) and ventilator days (p ≤ 0.01) were associated with time to death. No specific clonality of the strains tested or ESBL production resistance genes were associated with mortality or ESBL production. CONCLUSIONS: These results suggest that infections caused by ESBL-producing K pneumoniae are predictive of death when occurring in an older, more badly burned population.

AB - BACKGROUND: Significantly higher mortality has been demonstrated in patients who suffer severe burns complicated by Klebsiella pneumoniae bacteremia. The specific virulence mechanisms associated with this organism in this population are unclear. STUDY DESIGN: Our study assessed the impact of the mechanism of antibiotic resistance, strain clonality, and other host factors on morbidity and mortality. All patients with thermal burns infected with K pneumoniae between January 1, 2004 and July 1, 2008 were included in the analysis. RESULTS: Ninety-one patients had 111 episodes of K pneumoniae infections, with 59 isolates among the 91 patients producing extended spectrum beta-lactamase (ESBL). Patients with ESBL-producing strains were slightly younger, had higher Injury Severity Scores (ISS), and higher percent full thickness burns. Those who survived to discharge were younger (p < 0.001), had less burned surface area (p = 0.013), had fewer ventilator days (p = 0.016), and fewer infections with ESBL-producing isolates (p = 0.042). Logistic regression revealed that an infection with ESBL-producing K pneumoniae during the hospital stay was the factor most predictive of death, with a nearly 4-fold increased odds of dying. However, survival duration analysis of the population with and without ESBL-producing K pneumoniae using Kaplan-Meier technique showed no significant difference in the populations. Cox regression proportional hazards model revealed that only age (p = 0.01) and ventilator days (p ≤ 0.01) were associated with time to death. No specific clonality of the strains tested or ESBL production resistance genes were associated with mortality or ESBL production. CONCLUSIONS: These results suggest that infections caused by ESBL-producing K pneumoniae are predictive of death when occurring in an older, more badly burned population.

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