BACKGROUND: There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality. METHODS: Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study. RESULTS: We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5-6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5-4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with beta-lactam/beta-lactam inhibitor combinations or carbapenems (8%-12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production. CONCLUSIONS: ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.
BACKGROUND: There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality. METHODS: Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study. RESULTS: We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5-6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5-4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with beta-lactam/beta-lactam inhibitor combinations or carbapenems (8%-12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production. CONCLUSIONS: ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.
Authors: Cheol-In Kang; Yu Mi Wi; Mi Young Lee; Kwan Soo Ko; Doo Ryeon Chung; Kyong Ran Peck; Nam Yong Lee; Jae-Hoon Song Journal: J Clin Microbiol Date: 2011-12-07 Impact factor: 5.948
Authors: Pilar Retamar; María M Portillo; María Dolores López-Prieto; Fernando Rodríguez-López; Marina de Cueto; María V García; María J Gómez; Alfonso Del Arco; Angel Muñoz; Antonio Sánchez-Porto; Manuel Torres-Tortosa; Andrés Martín-Aspas; Ascensión Arroyo; Carolina García-Figueras; Federico Acosta; Juan E Corzo; Laura León-Ruiz; Trinidad Escobar-Lara; Jesús Rodríguez-Baño Journal: Antimicrob Agents Chemother Date: 2011-10-17 Impact factor: 5.191
Authors: Z A Qureshi; D L Paterson; A Y Peleg; J M Adams-Haduch; K A Shutt; D L Pakstis; E Sordillo; B Polsky; G Sandkovsky; M K Bhussar; Y Doi Journal: Clin Microbiol Infect Date: 2011-09-26 Impact factor: 8.067
Authors: J T Freeman; D A Williamson; H Heffernan; M Smith; J E Bower; S A Roberts Journal: Eur J Clin Microbiol Infect Dis Date: 2012-01-23 Impact factor: 3.267
Authors: Mario Tumbarello; Enrico Maria Trecarichi; Matteo Bassetti; Francesco Giuseppe De Rosa; Teresa Spanu; Eugenia Di Meco; Angela Raffaella Losito; Andrea Parisini; Nicole Pagani; Roberto Cauda Journal: Antimicrob Agents Chemother Date: 2011-05-02 Impact factor: 5.191
Authors: Brad Spellberg; Martin Blaser; Robert J Guidos; Helen W Boucher; John S Bradley; Barry I Eisenstein; Dale Gerding; Ruth Lynfield; L Barth Reller; John Rex; David Schwartz; Edward Septimus; Fred C Tenover; David N Gilbert Journal: Clin Infect Dis Date: 2011-05 Impact factor: 9.079