Hospitals with long-term participation in an infection control network decreased rates of significant HAIs by approximately 50%, decreased costs, and saved lives.

e Extended-spectrum-␤-lactamase (ESBL)-producing organisms are increasingly prevalent. We determined the characteristics of 66 consecutive ESBL-producing isolates from six community hospitals in North Carolina and Virginia from 2010 to 2012. Fiftythree (80%) ESBL-producing isolates contained CTX-M enzymes; CTX-M-15 was found in 68% of Escherichia coli and 73% of Klebsiella isolates. Sequence type 131 (ST131) was the commonest type of E. coli, accounting for 48% of CTX-M-15-producing and 66% of CTX-M-14-producing isolates. In conclusion, the CTX-M genotype and ST131 E. coli were common among ESBL isolates from U.S. community hospitals. Infections associated with extended-spectrum-␤-lactamase (ESBL)-producing organisms are increasing worldwide (1, 2). The emergence of ESBL-producing organisms in the United States has been partially driven by the dissemination of the CTX-M family of ESBL enzymes, which are commonly associated with additional virulence factors and resistance determinants that confer selection advantages. We previously reported an increase in ESBL-producing E. coli infections among 16 community hospitals in the southeastern region of the United States from 2006 to 2008 (3). We hypothesized that CTX-M-producing organisms were widely disseminated and represented the majority of organisms with the ESBL phenotype in the community setting. Therefore, we conducted the current study to determine the clinical and molecular epidemiology of infections due to ESBL-producing organisms among community hospitals.Six community hospitals affiliated with the Duke Infection Control Outreach Network (DICON) in North Carolina and Virginia provided 66 consecutive phenotypically confirmed ESBL isolates for analysis from July 2010 to February 2012 (4, 5). Escherichia coli isolates were the most common (67%), followed by Klebsiella pneumoniae (29%), Klebsiella oxytoca (3%), and Enterobacter cloacae (2%). The patients' demographic and clinical characteristics are summarized in Table 1. Thirty-seven (56%) of these ESBL-producing isolates were detected from a urinary source; 63% of these urinary tract infections occurred in the absence of a urinary catheter.Using standard epidemiological definitions, 35 (65%) of these ESBL infections were categorized as community onset, health care associated, 10 (19%) were categorized as community acquired, and only 9 (17%) were categorized as hospital-onset ESBL infections (6, 7).Molecular epidemiology studies showed that 53 (80%) of these ESBL-producing isolates carried a CTX-M ␤-lactamase, including 37 (84%) isolates of E. coli, 15 (71%) Klebsiella isolates, and the single isolate of E. cloacae. Overall, 25 (68%) E. coli ESBL isolates had CTX-M-15 and 6 (16%) had CTX-M-14. One E. coli isolate (3%) had CTX-M-107. Of the 15 Klebsiella isolates that had CTX-M ␤-lactamase, 11 (73%) isolates were found to have CTX-M-15.Multilocus sequence typing (MLST) of E. coli isolates showed that sequence type 131 (ST131) was the predominant sequence type (8). Clonal analysis with pulsed-field gel electroph...

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