TABLE 1.
Clinical features and review of antimicrobial agent use by patients with respect to detection of ESBL-producing bacteremiaa
| Patient | Isolate | Age (yr) | Sex | Infection focus | Malignancy | Antibiotic used when bacteremia occurred | Antibiotic used after detection (timing after bacteremia)b | Outcome |
|---|---|---|---|---|---|---|---|---|
| P1 | kp1 | 14 | F | Catheter-related infection | Ewing's sarcoma | Cefazolin, amikacin, piperacillin, amphotericin B | No change | Died of Candida tropicalis fungemia on day 34 after K. pneumoniae kp2 bacteremia |
| kp2 (isolated 2 days after kp1 was isolated) | Cefmetazole, aztreonam, amphotericin B (within 1 day) | |||||||
| P2 | kp3 | 2 | M | FUO | AML | Piperacillin, cefazolin, amikacin | Imipenem, gentamicin, amphotericin B (within 1 day) | Recovered |
| P3 | kp4 | 1 | F | Urinary tract infection | Neuroblastoma | Nil | Cefazolin, amikacin, ceftazidime (2 days) | Recovered |
| P4 | kp5 | 9 | M | Catheter-related infection | ALL | Cefazolin, amikacin, piperacillin, ceftazidime | Vancomycin, amikacin, ceftazidime, amphotericin B (within 1 day) | Died of S. maltophilia infection on day 36 after K. pneumoniae kp5 bacteremia |
| P5 | kp6 | 6 | M | FUO | AML | Cefazolin, amikacin, ceftazidime, amphotericin B, vancomycin | Imipenem, cefmetazole, amphotericin B (1 day) | Died of S. maltophilia infection on day 74 after K. pneumoniae kp6 bacteremia |
| P6 | kp7 | 13 | M | FUO | Ewing's sarcoma | Amikin, piperacillin, amphotericin B, cefazolin | Imipenem, gentamicin (4 days) | Died of seizure and apnea on day 34 after K. pneumoniae kp7 bacteremia |
| P7 | kp8 | 16 | M | FUO | ALL | Cefazolin, ceftazidime, amikacin | Vancomycin, imipenem, ciprofloxacin (within 1 day) | Died on day 2 after K. pneumoniae bacteremia |
| P8 | kp9 | 13 | M | FUO | ALL | Cefazolin, netilmicin, piperacillin, amphotericin B | Imipenem, cefmetazole, amphotericin B (2 days) | Recovered |
| P9 | kp10 | 2 | F | FUO | AML | Cefazolin, ceftazidime, amikacin | Imipenem (3 days) | Died on day 2 after K. pneumoniae kp11 and Citrobacter freundii bacteremia (K. pneumoniae and C. freundii were isolated on 2 separate days) |
| kp11 (isolated 4 days after kp10 was isolated) | Imipenem | Imipenem, amphotericin B (within 1 day) | ||||||
| P10 | kp12 | 4 | M | FUO | AML | Cefazolin, amikacin, ceftazidime, amphotericin B | No change | Died on day of K. pneumoniae bacteremia |
| P11 | ec13 | 5 | F | FUO | ALL | Ceftazidime | Imipenem (1 day) | Recovered |
| ec14 (isolated 2 days after kp13 was isolated) | Imipenem | Imipenem, gentamicin (1 day) | ||||||
| P12 | ec15 | 3 | M | Urinary tract infection | ALL | Nil | Imipenem, amikacin (2 days) | Recovered |
| P13 | ec16 | 2 | M | FUO | AML | Nil | Cefazolin, piperacillin, and tobramycin (within 1 day) and then imipenem and vancomycin (3 days) | Died of sepsis caused by unidentified pathogen on day 116 after E. coli ec16 bacteremia |
a
Abbreviations: F, female; M, male; FUO, fever of unknown origin; AML, acute myeloid leukemia; ALL, acute lymphoid leukemia.
b
The antibiotics used after the detection of bacteremia, including the antibiotics used empirically and antibiotics used after the culture report became available. The timing of the change in antibiotic when antibiotics were adjusted on the day of bacteremia is presented as “within 1 day.”