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Enteric Gram-Negative Bacteremia at the Emergency Department: Risk Factors for Extended-Spectrum -Lactamase and Outcome

Adler, Amos MD*; Raveh, David MD†; Rudensky, Bernard PhD‡; Yinnon, Amos M. MD†; Benenson, Shmuel MD*

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31816613de
Original Articles

Objectives: To describe the risk factors for bacteremia due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE) isolated at the emergency department and the factors related to the outcome of these patients.

Methods: A prospective evaluation of cases of Enterobacteriaceae bacteremia isolated at the emergency department for 1 year for the risk factors for ESBLE was performed.

Results: Extended-spectrum β-lactamase-producing Enterobacteriaceae was isolated from 28 (21%) of 131 patients who had Enterobacteriaceae bacteremia. In multivariate analysis, risk factors for ESBLE were residency in a nursing home, recent treatment (previous 6 weeks) with cefuroxime, indwelling urinary catheter, and infection caused by Klebsiella pneumoniae (odds ratio = 5, 8, 5, and 20, respectively; P < 0.05). The empirical antimicrobial regimen was inadequate in 46 (36%) of the patients. In multivariate analysis, risk factors for inadequate empirical antimicrobial treatment were ESBLE and indwelling urinary catheter (odds ratio = 42 and 13, respectively; P ≤ 0.001). The overall in-hospital 30-day mortality rate was 16% (n = 21), and the only risk factor identified in multivariate analysis was a highly modified Acute Physiology and Chronic Health Evaluation III score. Extended-spectrum β-lactamase-producing Enterobacteriaceae or inadequate empirical antimicrobial treatments were not associated with increased mortality.

Conclusions: Our results suggest that although carbapenems should not be administered routinely in the emergency department, it should be considered for critically ill patients with risk factors for ESBLE.

Author Information

*Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; †Infectious Diseases Unit and ‡Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Jerusalem, affiliated with the Ben-Gurion Faculty of Medicine, Be'er Sheva, Israel.

Address correspondence and reprint requests to Amos Adler, MD, Section of Pediatric Infectious Diseases, The University of Chicago Hospitals, Chicago, IL 60637. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.