Journal Article

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

Jesuús Rodríguez-Baño, Encarnación Picón, Paloma Gijón, José Ramón Hernández, Maite Ruíz, Carmen Peña, Manuel Almela, Benito Almirante, Fabio Grill, Javier Colomina, Monserrat Giménez, Antonio Oliver, Juan Pablo Horcajada, Gemma Navarro, Ana Coloma and Alvaro Pascual

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 1, pages 40-48
Published in print January 2010 | ISSN: 1058-4838
Published online January 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/649537
Community-Onset Bacteremia Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli: Risk Factors and Prognosis

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Background

There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality.

Methods

Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study.

Results

We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2–3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5–6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5–4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with β-lactam/β-lactam inhibitor combinations or carbapenems (8%–12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production.

Conclusions

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.

Journal Article.  5457 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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