Risk factors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli bacteremia - PubMed (original) (raw)

Risk factors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli bacteremia

Yoon Soo Park et al. Yonsei Med J. 2014 Mar.

Abstract

Purpose: Inadequate empirical therapy for severe infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital.

Materials and methods: A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined.

Results: Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95% CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95% CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95% CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum β-lactamase (ESBL) gene identified was blaCTX-M-15 (n=31) followed by blaCTX-M-14 (n=23).

Conclusion: The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.

Keywords: CTX-M; Escherichia coli; Risk factors; beta-lactamase.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1

Classification and regression trees analysis for predicting extended-spectrum β-lactamase (ESBL)-producing Escherichia coli bacteremia among adult patients who had a blood culture within 48 hours of admission to tertiary care hospital.

Fig. 2

Dendrogram based on _Xba_I-macrorestriction patterns of E. coli isolates producing CTX-M-1-type ESBLs. The dashed line indicates 80% similarity. E. coli isolates exhibiting similarities of <80% were considered unrelated. *_Xba_I-macrorestriction analysis yielded no DNA banding patterns due to the degeneration of the genomic DNA during preparation of the agarose plugs. ESBL, extended-spectrum β-lactamase.

Fig. 3

Dendrogram based on _Xba_I-macrorestriction patterns of E. coli isolates producing CTX-M-9-type and SHV ESBLs. The dashed line indicates 80% similarity. E. coli isolates exhibiting similarities of <80% were considered unrelated. *_Xba_I-macrorestriction analysis yielded no DNA banding patterns due to the degeneration of the genomic DNA during preparation of the agarose plugs. ESBL, extended-spectrum β-lactamase

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Risk factors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli bacteremia - PubMed (original) (raw)