Community-Associated Escherichia coli Harboring CTX-M β-Lactamases from Urine Cultures from Pediatric Patients

Microbiologic and Clinical Comparison of Patients Harboring <i>Escherichia coli</i> Blood Isolates with and without Extended-Spectrum <i>β</i>-Lactamases

“…We and others have previously documented CTX-M enzymes in patients from hospitals, associated long-term care facilities, community-associated, and the pediatric population which were predominantly from urinary tract isolates [4][5][6]9]. This study records the preponderance of such enzymes, most notably CTX-M-15, in blood isolates from hospitalized and community-onset patients which was similar to the findings of others [9,12].…”

“…Other investigations have also reported such results [9,10]. An additional and significant finding was the isolation of a CTX-M-15 harboring E. coli from the blood in an 18 month-old patient and may be a growing trend in this previously under recognized population [6,13]. We have recently reported an increase in community-associated ESBL-positive urine cultures from pediatric patients in our area and mentioned the possibility of progression to more serious disease [6,14].…”

“…An additional and significant finding was the isolation of a CTX-M-15 harboring E. coli from the blood in an 18 month-old patient and may be a growing trend in this previously under recognized population [6,13]. We have recently reported an increase in community-associated ESBL-positive urine cultures from pediatric patients in our area and mentioned the possibility of progression to more serious disease [6,14]. The presence of ESBLpositive E. coli blood isolates in the pediatric population is of great concern and continued surveillance is warranted [13].…”

“…While E. coli bloodstream infections were traditionally treated with late generation cephalosporins, increased identification of ESBL positive isolates has led to therapeutic dilemmas since such isolates often contain plasmid carrying genes which confer resistance to additional classes of antimicrobials [1,3]. E. coli possessing CTX-M β-lactamases are a relatively new type of ESBL which we and others have recently identified among hospitalized patients, residents of long-term care facilities, pediatric patients, and patients from the community, predominantly from urinary tract isolates [1,[4][5][6]. This retrospective investi-gation was conducted to determine if such isolates are present in patients with bacteremia in our setting.…”

Identification of Extended-Spectrum-β-Lactamase-Positive Klebsiella pneumoniae Urinary Tract Isolates Harboring KPC and CTX-M β-Lactamases in Nonhospitalized Patients

“…However, empirical treatment with trimethoprim-sulfamethoxazole, quinolones, and fosfomycin can no longer be considered reliable. Dissemination of MDR K. pneumoniae urinary tract isolates may be occurring in the community because of a lack of surveillance, a lack of physician awareness, and/or failure of routine detection of CTX-M and KPC enzymes by clinical microbiology laboratories as was observed in E. coli harboring CTX-M ␤-lactamases isolated from urine in the pediatric population (19). Since carriers of …”