Abstract
BackgroundThe incidence of Proteus mirabilis antimicrobial resistance, especially that mediated by extended-spectrum β-lactamases (ESBLs), has increased. We investigated the impact of ESBL production on the mortality of patients with P. mirabilis bacteremia in Korea.MethodsPatients diagnosed with P. mirabilis bacteremia between November 2005 and December 2013 at a 2000-bed tertiary care center in South Korea were included in this study. Phenotypic and molecular analyses were performed to assess ESBL expression. Characteristics and treatment outcomes were investigated among ESBL-producing and non-ESBL-producing P. mirabilis bacteremia groups. A multivariate analysis of 28-day mortality rates was performed to evaluate the independent impact of ESBLs.ResultsAmong 62 P. mirabilis isolates from 62 patients, 14 expressed ESBLs (CTX-M, 2; TEM, 5; both, 6; other, 1), and the 28-day mortality rate of the 62 patients was 17.74%. No clinical factor was significantly associated with ESBL production. The 28-day mortality rate in the ESBL-producing group was significantly higher than that in the non-ESBL-producing group (50% vs. 8.3%, p = 0.001). A multivariate analysis showed that ESBL production (odds ratio [OR], 11.53, 95% confidence interval [CI], 2.11–63.05, p = 0.005) was independently associated with the 28-day mortality rate in patients with P. mirabilis bacteremia.ConclusionsESBL production is significantly associated with mortality in patients with bacteremia caused by P. mirabilis. Rapid detection of ESBL expression and prompt appropriate antimicrobial therapy are required to reduce mortality caused by P. mirabilis bacteremia.
Highlights
The incidence of Proteus mirabilis antimicrobial resistance, especially that mediated by extended-spectrum β-lactamases (ESBLs), has increased
Ahn et al BMC Infectious Diseases (2017) 17:327 the most frequent. [5, 9, 14] Previous studies reported that infections caused by MDR P. mirabilis strains are associated with higher rates of antibiotic treatment failure and mortality. [5, 8, 14] the treatment outcomes of MDR and non-MDR P. mirabilis infections are reported to be similar in several reports. [9, 15] The impact of MDR in P. mirabilis infections on treatment outcomes is unclear
The nonESBL-producing group showed higher rates of susceptibility to most β-lactam antibiotics than did the extendedspectrum β-lactamase (ESBL)-producing group; there was no significant difference in the rate of susceptibility to piperacillin/tazobactam between the two groups
Summary
The incidence of Proteus mirabilis antimicrobial resistance, especially that mediated by extended-spectrum β-lactamases (ESBLs), has increased. We investigated the impact of ESBL production on the mortality of patients with P. mirabilis bacteremia in Korea. [5, 9, 14] Previous studies reported that infections caused by MDR P. mirabilis strains are associated with higher rates of antibiotic treatment failure and mortality. [9, 15] The impact of MDR in P. mirabilis infections on treatment outcomes is unclear. [16,17,18] further study of the effects of MDR on clinical outcomes is needed To this end, we investigated the clinical characteristics and antimicrobial susceptibility profile of P. mirabilis bacteremia isolates in Korea. We evaluated the treatment outcomes of patients with ESBL-producing P. mirabilis bacteremia, in particular the impact of ESBL expression on the mortality rate of patients with P. mirabilis bacteremia
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