Epidemiology and Clinical Features of Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Nonhospitalized Patients

Abstract

Infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) in nonhospitalized patients seem to be emerging in different countries. Their incidence, epidemiology, and clinical impact in the community have not been studied. We describe the epidemiology and clinical features of infections caused by ESBLEC in nonhospitalized patients in Spain and the results of a case-control study performed to investigate the risk factors associated with the acquisition of these organisms. The clonal relatedness of the organisms was assessed by repetitive extragenic palindromic sequence PCR. The ESBLs and the genes encoding the ESBLs were initially characterized by isoelectric focusing and PCR, respectively. Forty-nine patients (76% with urinary tract infections, 22% with asymptomatic bacteriuria, and 2% with acute cholangitis) were included. Six patients were bacteremic. Diabetes mellitus (odds ratio, 5.5; 95% confidence interval, 1.6 to 18.7), previous fluoroquinolone use (odds ratio, 7.6; 95% confidence interval, 1.9 to 30.1), recurrent urinary tract infections (odds ratio, 4.5; 95% confidence interval, 1.3 to 15.1), a previous hospital admission (odds ratio, 18.2; 95% confidence interval, 5.3 to 61.1), and older age in male patients (odds ratio per year, 1.03; 95% confidence interval, 1.03 to 1.05) were identified as risk factors by multivariate analysis. The ESBLEC isolates were not clonally related. The ESBLs were characterized as members of the CTX-M-9 group, the SHV group, and the TEM group in 64, 18, and 18% of the isolates, respectively. ESBLEC is an emergent cause of urinary tract infections in nonhospitalized patients. There was no evidence of horizontal transmission of ESBLEC strains. Avoidance of fluoroquinolone use in high-risk patients should be considered whenever possible in order to avoid the selection of these organisms.Extended-spectrum beta-lactamase (ESBL)-producing members of the family Enterobacteriaceae are resistant to penicillins, narrow-and extended-spectrum cephalosporins, and aztreonam (4). ESBL-producing organisms are also frequently resistant to aminoglycosides, trimethoprim-sulfamethoxazole, and quinolones.Until recently, most infections caused by ESBL-producing Escherichia coli (ESBLEC) or Klebsiella pneumoniae had mostly been described as nosocomially acquired (4) or nursing home related (32). However, some recent data suggest that infections due to ESBL-producing organisms might be an emergent problem in outpatients in different countries (1,8,9,11,14,15), but detailed epidemiological data were not collected in most of those studies. Moreover, the clinical relevance and the epidemiology of these infections outside nursing homes have not been studied.In a recent nationwide study of ESBL-producing organisms in Spain, 93% of ESBL-producing K. pneumoniae strains were isolated from inpatients, while 51% of ESBL-producing E. coli (ESBLEC) strains were isolated from outpatients (13) Consequently, we conducted the study described in this report, in which we describe an...

The continuing challenge of ESBLs

“…In Spain, the clonal spread of E. coli harboring CTX-M-15 has occurred as well, but the situation appears more complex [25]. Rodriguez-Bano et al, [26], described 49 patients in the region of Sevilla with communityacquired ESBL producing E. coli, 64% of which carried CTX-M-9. All the strains were clonally unrelated.…”

Caracterización clínica de infecciones de vías urinarias producidas por enterobacterias productoras de betalactamasas de espectro extendido en Duitama (Colombia), durante 2010-2015

“…Respecto a las condiciones previas de exposición, el 61,6% de los pacientes había sido hospitalizado en el último año por IVU, hecho que resalta la asociación entre las hospitalizaciones previas por IVU con la infección por cepas resistentes expuesta en estudios previos 7,8,13 . Llama la atención que en el presente estudio el 25% de los pacientes presentara uso previo de antibióticos, teniendo en cuenta la fuerte asociación existente entre el tratamiento previo con antibióticos y la infección por microorganismos BLEE, como cefuroxima (OR 21,42; IC 95%: 5,38-85,22) 14 y fluoroquinolonas (OR 12,8; IC 95%: 4,4-37,2) 15 . En lo referente al tratamiento que recibieron los pacientes, a pesar del desarrollo de guías locales, hay errores en la prescripción de antibióticos, ya que solo el 10,7% de los pacientes recibió nitrofurantoína, la cual es recomendada como la primera línea de tratamiento empírico para IVU en Colombia 11 , y el 29,6% recibió ciprofloxacino, el cual presenta alta resistencia en nuestro medio con cifras desde el 31,4% en Bogotá hasta el 57,9% en Cartagena 16,17 .…”

Antimicrobial Potential of Momordica charantia L. against Multiresistant Standard Species and Clinical Isolates

“…These microorganisms are one of the most common causes of nosocomial infections and community infections with high morbidity and mortality. 3,4 Systemic infections caused by methicillin-resistant S. aureus (MRSA) infections are increasingly common in the hospital environment 7 and infections caused by extendedspectrum E. coli Beta-lactamase productors (ESBL) appear to increase in outpatients in different countries. 3 It is also worth mentioning the results against Candida species.…”

“…3,4 Systemic infections caused by methicillin-resistant S. aureus (MRSA) infections are increasingly common in the hospital environment 7 and infections caused by extendedspectrum E. coli Beta-lactamase productors (ESBL) appear to increase in outpatients in different countries. 3 It is also worth mentioning the results against Candida species. Despite being part of the normal flora of the oral cavity, they are considered important pathogens, especially C. albicans, C. tropicalis, C. parapsilosis, C. krusei, C. glabata, C. guillermond.…”

“…1 Hospital infections, as well as community-acquired infections, especially caused by bacteria, such as Pseudomonas euruginosa, Proteus mirabilis, Providencia rettgeri, Staphylococcus aureus and Escherichia coli are worrisome conditions, due to the high morbidity and mortality, [2][3][4] plus the associated antibiotic resistance. 3,[5][6][7] Other infections, such as those caused by Candida species are also a concern in healthcare. The most suitable drugs for their treatment are the azoles (fluconazole, itraconazole and miconazole) and polyene (amphotericin B and nystatin).…”