Community Infections Caused by Extended-Spectrum β-Lactamase–Producing Escherichia coli

Abstract

Background: Extended-spectrum ␤-lactamase (ESBL)producing Escherichia coli is an increasingly important group of community pathogens worldwide. These organisms are frequently resistant to many of the antimicrobial agents usually recommended for the treatment of infections caused by E coli, such as penicillins, cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Data concerning risk factors, clinical features, and therapeutic options for such infections are scarce. Methods: A case-control study was performed to investigate the risk factors for all types of community-acquired infections caused by ESBL-producing E coli in 11 Spanish hospitals from February 2002 to May 2003. Controls were randomly chosen from among outpatients with a clinical sample not yielding ESBL-producing E coli. The clinical features of these infections were investigated in the case patients. The efficacy of fosfomycin tromethamine and amoxicillin-clavulanate potassium was observationally studied in patients with cystitis. Results: A total of 122 cases were included. Risk factors selected by multivariate analysis included the fol-Author Affiliations are listed at the end of this article.

Factores asociados a infecciones urinarias producidas por enterobacterias productoras de β-lactamasas de espectro extendido: una cohorte prospectiva

“…Por lo anterior, se ha tratado de identificar factores de riesgo de presentar ITU por microorganismos productores de BLEE provenientes de la comunidad, describiéndose la enfermedad prostática, la infección urinaria recurrente 15 , la edad avanzada, diabetes mellitus, el uso de catéter vesical, ITU recurrente 13 y el uso previo de antimicrobianos, como b-lactámicos 15 , cefuroxima oral 18 , aminopenicilinas, fluorquinolonas y cefalosporinas 13 .…”

“…Esta diferencia observada puede ser explicada por las diferencias geográficas de ambos estudios y las diferencias en el diseño de los estudios. El uso de fluorquinolonas también se ha identificado como factor de riesgo independiente de producir sepsis por E. coli productoras de BLEE 13 . El fuerte impacto de las quinolonas sobre la microbiota intestinal facultativa de bacilos gramnegativos, podría jugar un rol en la selección de microorganismos productores de BLEE mediante mecanismos no del todo conocidos 25 .…”

Validation of the mutant selection window hypothesis with fosfomycin against Escherichia coli and Pseudomonas aeruginosa: an in vitro and in vivo comparative study

“…In a case-control study including 113 patients with E. coli UTIs, no resistance to fosfomycin was detected and clinical cure rates were high (93%). 27 In contrast, the emergence of resistance to fosfomycin …”

Ventriculitis Associated with Extended Spectrum Beta-Lactamase Producing Klebsiella pneumoniae after Acupuncture

“…Critical Care Research and Practice 3 Risk factors for acquiring community-associated ESBL infection [17] include: (i) recurrent UTI, (ii) previous antibiotic usage, (iii) diabetes mellitus, (iv) prior instrumentation to urinary tract, (v) female sex, (vi) age (over 65 years).…”