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. 2017 May 3;17(1):327.
doi: 10.1186/s12879-017-2431-8.

The impact of production of extended-spectrum β-lactamases on the 28-day mortality rate of patients with Proteus mirabilis bacteremia in Korea

Jin Young Ahn  1   2 , Hea Won Ann  2   3 , Yongduk Jeon  2   3 , Mi Young Ahn  2   3 , Dong Hyun Oh  2   3 , Yong Chan Kim  2   3 , Eun Jin Kim  2   3 , Je Eun Song  4 , In Young Jung  2   3 , Moo Hyun Kim  2 , Wooyoung Jeong  2 , Nam Su Ku  5   6   7 , Su Jin Jeong  2   3 , Jun Yong Choi  2   3 , Dongeun Yong  8 , Young Goo Song  2   3 , June Myung Kim  2   3
Affiliations

The impact of production of extended-spectrum β-lactamases on the 28-day mortality rate of patients with Proteus mirabilis bacteremia in Korea

Jin Young Ahn et al. BMC Infect Dis. .

Abstract

Background: 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.

Methods: Patients 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.

Results: Among 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.

Conclusions: ESBL 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.

Keywords: Bacteremia; Extended-spectrum β-lactamase; Mortality; Proteus Mirabilis.

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Figures

Fig. 1
Fig. 1
In vitro antimicrobial susceptibility tests for Proteus mirabilis isolates causing bacteremia
Fig. 2
Fig. 2
Kaplan-Meier survival estimates among patients with P. mirabilis bacteremia. ESBL, extended spectrum β-lactam
See this image and copyright information in PMC

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