BACKGROUND: Escherichia coli is one of the most common causes of healthcare-associated infections (HAIs); multidrug resistance reduces available options for antibiotic treatment. We examined factors associated with the spread of multidrug-resistant E. coli phenotypes responsible for device- and procedure-related HAIs from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities, using isolate and antimicrobial susceptibility data reported to the National Healthcare Safety Network during 2013-2017. METHODS: We used multivariable logistic regression to examine associations between co-resistant phenotypes, patient and healthcare facility characteristics, and time. We also examined the geographic distribution of co-resistant phenotypes each year by state and by hospital referral region to identify hot spots. RESULTS: A total of 96 672 E. coli isolates were included. Patient median age was 62 years, and 60% were female; more than half (54%) were reported from catheter-associated urinary tract infections. From 2013 to 2017, 35% of the isolates were nonsusceptible to fluoroquinolones (FQs), 17% to extended-spectrum cephalosporins (ESCs), and 13% to both ESCs and FQs. The proportion of isolates co-resistant to ESCs and FQs was higher in 2017 (14%) than in 2013 (11%) (P < .0001); overall prevalence and increases were heterogeneously distributed across healthcare referral regions. Co-resistance to FQs and ESCs was independently associated with male sex, central line-associated bloodstream infections, long-term acute care hospitals, and the 2016-2017 (vs 2013-2014) reporting period. CONCLUSIONS: Multidrug resistance among E. coli causing device- and procedure-related HAIs has increased in the United States. FQ and ESC co-resistant strains appear to be spreading heterogeneously across hospital referral regions. Published by Oxford University Press for the Infectious Diseases Society of America 2020.
BACKGROUND: Escherichia coli is one of the most common causes of healthcare-associated infections (HAIs); multidrug resistance reduces available options for antibiotic treatment. We examined factors associated with the spread of multidrug-resistant E. coli phenotypes responsible for device- and procedure-related HAIs from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities, using isolate and antimicrobial susceptibility data reported to the National Healthcare Safety Network during 2013-2017. METHODS: We used multivariable logistic regression to examine associations between co-resistant phenotypes, patient and healthcare facility characteristics, and time. We also examined the geographic distribution of co-resistant phenotypes each year by state and by hospital referral region to identify hot spots. RESULTS: A total of 96 672 E. coli isolates were included. Patient median age was 62 years, and 60% were female; more than half (54%) were reported from catheter-associated urinary tract infections. From 2013 to 2017, 35% of the isolates were nonsusceptible to fluoroquinolones (FQs), 17% to extended-spectrum cephalosporins (ESCs), and 13% to both ESCs and FQs. The proportion of isolates co-resistant to ESCs and FQs was higher in 2017 (14%) than in 2013 (11%) (P < .0001); overall prevalence and increases were heterogeneously distributed across healthcare referral regions. Co-resistance to FQs and ESCs was independently associated with male sex, central line-associated bloodstream infections, long-term acute care hospitals, and the 2016-2017 (vs 2013-2014) reporting period. CONCLUSIONS: Multidrug resistance among E. coli causing device- and procedure-related HAIs has increased in the United States. FQ and ESC co-resistant strains appear to be spreading heterogeneously across hospital referral regions. Published by Oxford University Press for the Infectious Diseases Society of America 2020.
Entities:
Keywords:
zzm321990 E. colizzm321990 ; antibiotic resistance; healthcare-associated infections; multi-resistance
Authors: James A Karlowsky; Daryl J Hoban; Melanie R Decorby; Nancy M Laing; George G Zhanel Journal: Antimicrob Agents Chemother Date: 2006-06 Impact factor: 5.191
Authors: Kalpana Gupta; Thomas M Hooton; Kurt G Naber; Björn Wullt; Richard Colgan; Loren G Miller; Gregory J Moran; Lindsay E Nicolle; Raul Raz; Anthony J Schaeffer; David E Soper Journal: Clin Infect Dis Date: 2011-03-01 Impact factor: 9.079
Authors: Deborah A Williamson; Sally A Roberts; David L Paterson; Hanna Sidjabat; Anna Silvey; Jonathan Masters; Michael Rice; Joshua T Freeman Journal: Clin Infect Dis Date: 2012-03-14 Impact factor: 9.079
Authors: Veronika L Tchesnokova; Elena Rechkina; Lydia Larson; Kendra Ferrier; Jamie Lee Weaver; David W Schroeder; Rosemary She; Susan M Butler-Wu; Maria E Aguero-Rosenfeld; Danielle Zerr; Ferric C Fang; James Ralston; Kim Riddell; Delia Scholes; Scott Weissman; Kaveri Parker; Brad Spellberg; James R Johnson; Evgeni V Sokurenko Journal: Clin Infect Dis Date: 2019-01-07 Impact factor: 9.079
Authors: Lance B Price; James R Johnson; Maliha Aziz; Connie Clabots; Brian Johnston; Veronika Tchesnokova; Lora Nordstrom; Maria Billig; Sujay Chattopadhyay; Marc Stegger; Paal S Andersen; Talima Pearson; Kim Riddell; Peggy Rogers; Delia Scholes; Barbara Kahl; Paul Keim; Evgeni V Sokurenko Journal: mBio Date: 2013-12-17 Impact factor: 7.867