Extended-spectrum beta-lactamase-producing Enterobacteriaceae strains in community-acquired bacteremia in Southern Israel.
BACKGROUND
In recent years, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have emerged in many hospitals worldwide. The increasing dissemination and long-term carriage of these organisms within the community carry tremendous implications on the empirical therapy of community-acquired infection.


METHODS
To evaluate the prevalence and clinical features of community-acquired bacteremia involving ESBL-producing Enterobacteriaceae in southern Israel (ESBL-P) we retrospectively studied all Enterobacteriaceae bacteremias during an 8-month period in the Negev region using medical and laboratory records. Antibiotic susceptibility was determined using the disk-diffusion method. ESBL production was determined using an E-test ESBL strip. Cases involving ESBL-P were compared to those involving non-producing strains (ESBL-NP) using the chi-square test.


RESULTS
In all, 187 Enterobacteriaceae bacteremias were detected, of which 119 were community-acquired (63.6%). ESBL-P were found in six cases (5%) which are described herein in greater detail. Patients with ESBL-P bacteremia were older, and were more likely to stay in the intensive-care unit. Urinary catheterization and bed-ridden conditions were significant risk factors for ESBL-P. ESBL-P strains were significantly resistant to nearly all antibiotic agents except for imipienem and piperacillin-tazobactam as opposing to ESBL-NP. Patients with ESBL-P bacteremia were more likely to suffer from complications and had a higher mortality.


CONCLUSIONS
This paper is the first to describe community-acquired Enterobacteriaceae bacteremia involving ESBL-P strains in Israel. Although the exact prevalence of these organisms in Israel is currently unknown, our findings suggest that ESBL-producers have already begun to disseminate in our community.
Borer
Abraham
A
Infectious Disease Institute, Soroka University Medical Center and the Ben-Gurion University of the Negev, Beer-Sheva, Israel. giladk@hotmail.com
Gilad
Jacob
J
Menashe
Galia
G
Peled
Nechama
N
Riesenberg
Klaris
K
Schlaeffer
Francisc
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000097:blood / Q000201:enzymology*; D004755:Enterobacteriaceae / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000097:blood / Q000201:enzymology*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D001618:beta-Lactamases / Q000096:biosynthesis*
D001618:beta-Lactamases