Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum β-lactamase-producing Escherichia coli

Kang, Cheol-In; Song, Jae-Hoon; Chung, Doo Ryeon; Peck, Kyong Ran; Ko, Kwan Soo; Yeom, Joon‐Sup; Ki, Hyun Kyun; Son, Jun Seong; Lee, Seung Soon; Kim, So Hyun; Jung, Sook-In; Kim, Shin‐Woo; Chang, Hyun‐Ha; Ryu, Seong Yeol; Kwon, Ki Tae; Lee, Hyuck; Moon, Chisook; Shin, Sohee

doi:10.1016/j.ijantimicag.2010.05.009

Cited by 85 publications

(76 citation statements)

References 8 publications

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“…ESBLproducing E. coli has emerged in recent years as a cause of community-acquired infections worldwide (3,12,22,23). Several studies attempted to identify risk factors for ESBL-producing E. coli among community onset infections (2,4,12,16,22). An association with health care and previous use of antimicrobials were a Central venous catheterization and prior use of cephalosporins (P Ͻ 0.1) were included in the multivariate logistic model predicting ESBL-producing E. coli.…”

Section: Discussionmentioning

confidence: 99%

“…The sites of infection were determined by the patients' physicians on the basis of clinical evaluation and the isolation of E. coli from the presumed portal of entry (7,12). Community onset infection was defined as an infection diagnosed within the first 48 h of hospitalization.…”

Section: Methodsmentioning

confidence: 99%

“…Because many cases of infections that are present or incubating upon admission to the hospital are nonetheless health care associated (HCA), nonnosocomial bacteremia is referred to as community onset rather than community-acquired bacteremia. Episodes of community onset bacteremia were further classified as HCA if any of the following criteria were present: a history of a Ͼ48-h hospital admission in the previous 90 days, hemodialysis, intravenous medication, home wound care in the previous 30 days, or residence in a nursing home or long-term care facility (6,12). Cases that did not meet these criteria were considered to be community associated (CA).…”

Section: Methodsmentioning

confidence: 99%

“…Subsequently, ESBL-producing E. coli has gained worldwide recognition as a significant group of community-acquired pathogens (3,22). Although most patients with community onset infections caused by these organisms have urinary tract infections (UTIs), some patients present with intra-abdominal infections and concomitant bacteremia (12,23). Nevertheless, there is still limited information about the clinical epidemiology of community onset ESBLproducing E. coli infections.…”

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Epidemiology and Risk Factors of Community Onset Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli Strains

Kang

Lee

et al. 2012

J Clin Microbiol

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Limited clinical information is available regarding community onset infections caused by extended-spectrum ␤-lactamase (ESBL)-producing Escherichia coli. A case-control study was performed to evaluate the epidemiology and risk factors of these types of infections. A case patient was defined as a person whose clinical sample yielded ESBL-producing E. coli. For each case patient, one control was randomly chosen from a group of outpatients from whom non-ESBL-producing E. coli had been isolated and for whom a clinical sample had been sent to the same laboratory for culturing during the following week. Of 108 cases of ESBL-producing E. coli, 56 (51.9%) were classified as health care associated (HCA). Univariate analysis showed male gender, HCA infection, severe underlying illness, and a prior receipt of antibiotics to be associated with ESBL-producing E. coli. In the multivariate analysis, HCA infection (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.67 to 6.06; P < 0.001) and previous use of antibiotics (OR, 4.88; 95% CI, 2.08 to 11.48; P < 0.001) were found to be significantly associated with the ESBL group. In a multivariate analysis that included each antibiotic, previous use of fluoroquinolone (OR, 7.32; 95% CI, 1.58 to 34.01; P ‫؍‬ 0.011) was significantly associated with ESBL-producing E. coli. Of 101 isolates in which ESBLs and their molecular relationships were studied, all isolates produced ESBLs from the CTX-M family (CTX-M-14, 40 isolates; CTX-M-15, 39 isolates; and other members of the CTX-M family, 22 isolates). In conclusion, this study confirms that ESBL-producing E. coli strains are a notable cause of community onset infections in predisposed patients. HCA infection and previous use of fluoroquinolone were significant factors associated with ESBL-producing E. coli in community onset infections. During the past 2 decades, antimicrobial-resistant strains that produce extended-spectrum ␤-lactamases (ESBLs) have emerged among Enterobacteriaceae, predominantly among Escherichia coli and Klebsiella pneumoniae (5,20,21). Subsequently, ESBL-producing E. coli has gained worldwide recognition as a significant group of community-acquired pathogens (3, 22). Although most patients with community onset infections caused by these organisms have urinary tract infections (UTIs), some patients present with intra-abdominal infections and concomitant bacteremia (12, 23). Nevertheless, there is still limited information about the clinical epidemiology of community onset ESBLproducing E. coli infections. Previous studies describing the clinical and microbiological epidemiology of ESBL-producing E. coli infections have focused mainly on UTIs (2, 4, 16, 22).Because ESBL-producing organisms are frequently resistant to multiple antimicrobial agents, therapeutic options for these infections are limited (18). At present, carbapenems are recommended for the treatment of serious infections caused by ESBL-producing organisms. Given the increasing incidence and pathogenic significance of ESBL-producing E. coli in community ...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Epidemiology and Risk Factors of Community Onset Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli Strains

Kang

Lee

et al. 2012

J Clin Microbiol

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“…Por otro lado, las sepsis producidas por estos microorganismos presentan mayor mortalidad que las producidas por cepas no productoras de BLEE 9,10 , describiéndose el inicio tardío de un antimicrobiano adecuado como el principal factor de riesgo relacionado con la mortalidad 11 .…”

Section: Introductionunclassified

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

Avilés

Betancour

Velasco

et al. 2016

Rev. chil. infectol.

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Risk factors for infection and treatment outcome of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in patients with hematologic malignancy

et al. 2011

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This study was performed to evaluate the impact of extended-spectrum β-lactamase (ESBL)-producing bacteremia on outcome in patients with hematologic malignancy. We collected and analyzed data on 156 hematologic malignancy patients with Escherichia coli or Klebsiella pneumoniae bacteremia from the database of nationwide surveillance studies for bacteremia. Thirty-seven of the 156 patients (23.7%) harbored ESBL-producing bacteremia. No significant differences in underlying diseases were found in either group. The multivariate analysis showed that significant factors associated with ESBL-producing bacteremia were ICU care (OR = 7.03, 95% CI = 1.79-27.6) and nosocomial acquisition (OR = 5.66, 95% CI = 1.60-20.23). There was an association between prior receipt of cephalosporins and ESBL-producing bacteremia, although this association was not statistically significant (OR = 2.27, 95% CI = 0.99-5.23). The overall 30-day mortality rate of the study population was 20.4% (29/142), and the 30-day mortality rate for the ESBL group was significantly higher than that for the non-ESBL group (44.8% vs. 14.2%, P < 0.001). Multivariate analysis showed that ESBL-producing bacteremia was the most important risk factor associated with 30-day mortality (OR, 5.64; 95% CI, 1.91-16.67), along with ICU care (OR = 4.35, 95% CI = 1.16-16.26) and higher Pitt bacteremia score (per 1-point increment) (OR = 1.50, 95% CI = 1.18-1.92). In conclusion, ESBL-producing bacteremia was the most important risk factor associated with 30-day mortality in patients with hematologic malignancy, along with ICU care and higher Pitt bacteremia score. Our data suggest that determining the optimal empiric antimicrobial therapy in patients with hematologic malignancy is now becoming a challenge for clinicians in the era of multidrug-resistant Gram-negative bacilli.

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Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum β-lactamase-producing Escherichia coli

Cited by 85 publications

References 8 publications

Epidemiology and Risk Factors of Community Onset Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli Strains

Epidemiology and Risk Factors of Community Onset Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli Strains

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

Risk factors for infection and treatment outcome of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in patients with hematologic malignancy

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Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum β-lactamase-producing Escherichia coli

Cited by 85 publications

References 8 publications

Epidemiology and Risk Factors of Community Onset Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli Strains

Epidemiology and Risk Factors of Community Onset Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli Strains

Factores asociados a infecciones urinarias producidas por enterobacterias productoras de &#946;-lactamasas de espectro extendido: una cohorte prospectiva

Risk factors for infection and treatment outcome of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in patients with hematologic malignancy

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