Risk Factors and Molecular Epidemiology of Community-Onset Extended-Spectrum beta-Lactamase-Producing Escherichia coli Bacteremia.
10.3349/ymj.2014.55.2.467
- Author:
Yoon Soo PARK
1
;
Il Kwon BAE
;
Juwon KIM
;
Seok Hoon JEONG
;
Seung Sik HWANG
;
Yiel Hea SEO
;
Yong Kyun CHO
;
Kyungwon LEE
;
June Myung KIM
Author Information
1. Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea. karmacho@gilhospital.com
- Publication Type:Original Article
- Keywords:
Risk factors;
beta-lactamase;
Escherichia coli;
CTX-M
- MeSH:
Bacteremia*;
beta-Lactamases;
Carbapenems;
Case-Control Studies;
Causality;
Confidence Intervals;
Decision Trees;
Escherichia coli*;
Escherichia*;
Humans;
Korea;
Methods;
Molecular Epidemiology*;
Outpatients;
Risk Factors*;
Shock;
Tertiary Healthcare;
Urinary Tract Infections
- From:Yonsei Medical Journal
2014;55(2):467-475
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Inadequate empirical therapy for severe infections caused by extended-spectrum beta-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. MATERIALS AND METHODS: A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. RESULTS: Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95% CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95% CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95% CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum beta-lactamase (ESBL) gene identified was bla(CTX-M-15) (n=31) followed by bla(CTX-M-14) (n=23). CONCLUSION: The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.
