Community-Acquired, Extended-Spectrum β-Lactamase-Producing and Extensively Drug-Resistant Escherichia coli in a 28-Year-Old Pyelonephritis Patient Lacking Risk Factors

Abstract

While Escherichia coli is a common cause of urinary tract infections and pyelonephritis, there are few documented cases of extended-spectrum β-lactamase (ESBL)-producing and extensively drug-resistant (XDR) isolates from the community resulting in infection requiring hospitalization, especially in individuals lacking risk factors. In the United States, exposure to ESBL-producing E. coli is typically nosocomial, whereas patients from developing countries often encounter ESBL-producing E. coli in the community through the consumption of contaminated food or water. Considering the rarity at which XDR E. coli isolates are encountered, there is also a scarcity of literature describing the successful treatment of ESBL-producing XDR E. coli. Here we present a case of an otherwise healthy 28-year-old female delicatessen worker infected with ESBL-producing and XDR E. coli without recent travel, antibiotic use, or healthcare contact, who required admission to the intensive care unit (ICU) with pyelonephritis and septic shock. Treatment with intravenous meropenem through a peripherally inserted central catheter (PICC) line at home was curative and follow up thereafter unremarkable. Given the patient’s lack of obvious exposure to and risk factors for an ESBL-producing XDR E. coli infection and the specific lack of risk factors for severe pyelonephritis requiring hospitalization, this case represents a unique addition to the literature and is of value to clinicians by describing successful treatment.

Prevalence of extended spectrum beta-lactamase (ESBL) Escherichia coli recovered from ICU and non-ICU at dr. Zainoel Abidin General Hospital

“…In the present study, both ESBL and non-ESBL E. coli displayed nearly equivalent prevalence rates among patients receiving treatment in both the Intensive Care Unit (ICU) and non-ICU settings, constituting 67% of the total cases, as indicated in Figure 3. Although the prevalence of extended-spectrum beta-lactamase (ESBL)-producing E. coli is notably higher within Intensive Care Units (ICUs), it is important to acknowledge that non-ICU patients are also exposed to significant risks of colonization or infection, especially individuals residing in long-term care facilities (LTCFs) or those with a history of recurrent hospitalizations [8,22,23]. These non-ICU patients may exhibit similar risk factors as their ICU counterparts, including prolonged hospital stays and extensive antibiotic exposure [8,22,23].…”

“…Although the prevalence of extended-spectrum beta-lactamase (ESBL)-producing E. coli is notably higher within Intensive Care Units (ICUs), it is important to acknowledge that non-ICU patients are also exposed to significant risks of colonization or infection, especially individuals residing in long-term care facilities (LTCFs) or those with a history of recurrent hospitalizations [8,22,23]. These non-ICU patients may exhibit similar risk factors as their ICU counterparts, including prolonged hospital stays and extensive antibiotic exposure [8,22,23]. In LTCFs, the proximity of patients and frequent utilization of antibiotics can contribute to the dissemination and selection of ESBL-producing strains [23,24].…”

“…These non-ICU patients may exhibit similar risk factors as their ICU counterparts, including prolonged hospital stays and extensive antibiotic exposure [8,22,23]. In LTCFs, the proximity of patients and frequent utilization of antibiotics can contribute to the dissemination and selection of ESBL-producing strains [23,24]. Additionally, recurrent hospitalization can heighten the susceptibility to ESBL-producing E. coli colonization or infection [25].…”

Hospital water as the source of healthcare-associated infection and antimicrobial-resistant organisms

“…AMR species can proliferate in biofilms found at the outlet in response to the widespread use of antimicrobials used in hospitals creating an environment of selective pressure [62,63]. Currently, the US CDC does not consider contaminated water to be a source of ESBL-producing Enterobacteria infection in the United States because of a lack of data [64]. However, an epidemiological study conducted in France during a 3-year outbreak of ESBL-producing E. cloacae, found 17 environmental isolates in patient sink and shower drains, six of which had identical pulsotypes to clinical strains.…”