Community‐Onset Bacteremia Due to Extended‐Spectrum β‐Lactamase–Producing<i>Escherichia coli:</i>Risk Factors and Prognosis

Rodríguez-Baño, Jesús; Picón, Encarnación; Gijón, Paloma; Hernández, José Ramón; Ruiz, María Antonia Carmona; Peña, Carmen; Almela, Manuel; Almirante, Benito; Grill, Fabio; Colomina, Javier; Giménez, Monserrat; Oliver, Antonio; Horcajada, Juan Pablo; Navarro, Gemma; Coloma, Ana; Pascual, Álvaro

doi:10.1086/649537

Cited by 301 publications

(267 citation statements)

References 36 publications

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“…CTX-M enzymes were the predominant enzymes found in the community isolates. 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).…”

Section: Discussionmentioning

confidence: 99%

“…Even though HCA infections were associated with an increased risk of ESBL-producing E. coli, a high percentage of cases were exposed to no risk factors or to only one. Because rectal colonization with virulent strains of ESBL-producing E. coli is increasing among healthy individuals, it can be hypothesized that these infections may increasingly occur among patients with no specific risk factors (22)(23)(24).…”

Section: Discussionmentioning

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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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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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: Discussionmentioning

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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“…The main risk factors for the development of MR bacterial infections in the general population are current or recent hospitalization, healthcare contact (i.e., hemodyalisis) and prior exposure to β-lactams or quinolones [33][34][35][36][37] . The same risk factors have been reported in cirrhosis.…”

Section: Infectionsmentioning

confidence: 99%

Multiresistant bacterial infections in liver cirrhosis: Clinical impact and new empirical antibiotic treatment policies

Acevedo

2015

WJH

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Recently, important changes have been reported regarding the epidemiology of bacterial infections in liver cirrhosis. There is an emergence of multiresistant bacteria in many European countries and also worldwide, including the United States and South Korea. The classic empirical antibiotic treatment (third-generation cephalosporins, e.g. , ceftriaxone, cefotaxime or amoxicillin-clavulanic acid) is still effective in infections acquired in the community, but its failure rate in hospital acquired infections and in some health-care associated infections is high enough to ban its use in these settings. The current editorial focuses on the different epidemiology of bacterial infections in cirrhosis across countries and on its therapeutic implications.

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“…Esto confi rma lo sugerido por la literatura tanto en estudios realizados en población general y en adultos 14,15,[17][18][19] , como en estudio pediá-tricos 2,8,9 , donde se establece la misma conclusión. En estos y otros estudios, además, se establece una asociación estadística con el uso previo de otros antibióticos 20 , situación que nosotros no estudiamos en este trabajo.…”

Section: Discussionunclassified

Antibióticos y expresión de betalactamasas de espectro extendido (BLEE) en agentes bacterémicos

et al. 2011

Rev. chil. pediatr.

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Community‐Onset Bacteremia Due to Extended‐Spectrum β‐Lactamase–ProducingEscherichia coli:Risk Factors and Prognosis

Abstract: ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

Cited by 301 publications

References 36 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

Multiresistant bacterial infections in liver cirrhosis: Clinical impact and new empirical antibiotic treatment policies

Antibióticos y expresión de betalactamasas de espectro extendido (BLEE) en agentes bacterémicos

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