Risk factors and clinical outcomes of extended spectrum beta-lactamase (ESBL)-producing Escherichia coli septicemia at Srinagarind University Hospital, Thailand.

Escherichia coli producing extended spectrum beta-lactamase (ESBL) has emerged as a worldwide, public health problem. The aims of this study were to determine the incidence of ESBL-producing E. coli septicemia and evaluate the factors associated with the infection and the clinical outcomes. We reviewed 145 cases of E. coli septicemia among adult patients admitted to Srinagarind University Hospital in northeastern Thailand between 2005 and 2006. The incidence of ESBL-producing E. coli septicemia was 9.9 cases per 10,000 hospital admissions. The factors significantly associated with ESBL-producing E. coli septicemia were: 1) hospital acquisition [odds ratio (OR) 6.46; 95% confidence interval (CI) 2.01-20.79], 2) previous use of a fluoroquinolone, (OR 19.14; 95% CI 5.82-62.96), and 3) use of a central venous catheter (OR, 8.59; 95% CI, 1.11-66.27). Seventy-two hours after receiving empiric treatment, a significantly greater proportion of patients with ESBL-producing E. coli septicemia had a worse clinical outcome than those with non-ESBL producing E. coli septicemia (p = 0.01). The overall mortality rate was significantly higher among the ESBL-producing E. coli septicemia group than the non-ESBL producing E. coli septicemia group (29% vs 11.5%, respectively, p = 0.02). A high APACHE II score, ESBL-producing E. coli septicemia, primary septicemia, and having a non-urinary tract infecting as a source of septicemia were significantly independent factors related to mortality among patients with E. coli septicemia. ESBL-producing E. coli septicemia is an important cause of nosocomial infection and is related to higher mortality risk, especially among those with primary septicemia and secondary septicemia due to a non-urinary tract infection.