title: Clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase-producing Escherichia coli infections in Thailand: a case-case-control study.
abstract: BACKGROUND
  Extended-spectrum beta-lactamase (ESBL)-producing organisms, first identified in Germany in 1983, are now widely recognized as clinically relevant causes of infections in community.
  
  
  METHODS
  Our objective was to evaluate the clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase (CO-ESBL)-producing Escherichia coli infections. We used a case-case-control study undertaken in a 450-bed, tertiary care hospital. Patients included case group (CG) I, which had confirmed CO-ESBL-producing E coli infections (n=46). Case group (CG) II (n=46) included patients with CO-non-ESBL-producing E coli infections. Controls (n=138) were patients without infections.
  
  
  RESULTS
  By multivariate analysis, diabetes (95% confidence interval [CI]: 1.9-13.2, P< .001), prior ESBL E coli colonization (<90 days) (95% CI: 1.2-67.8, P< .001), recent receipt of antibiotics (<90 days) (95% CI: 4.2-44.2, P= .004), and previous exposure to third-generation cephalosporins (95% CI: 2.2-16.4, P= .001) and fluoroquinolones (95% CI: 1.4-18.3; P= .003) were associated risks among CG I. Diabetes (95% CI: 1.6-15.4, P= .005), stroke (95% CI: 1.5-17.1, P= .001), and diarrhea (95% CI: 3.8-65.8, P= .001) were risks among CG II. Patients with CO-ESBL in CG I versus controls were more likely to die (30% vs 0%, respectively; P< .001), had prolonged hospital length of stay (8 vs 5 days, respectively; P< .001), and had higher hospitalization costs (median, US $528 vs $108, respectively; P< .001). The plasmid carrying the CTX-M-15 gene was identified in 13 of 25 (52%) available CO-ESBL-producing E coli isolates.
  
  
  CONCLUSIONS
  CO-ESBL-producing E coli is an emerging multidrug-resistant microorganism in Thailand. Patients with prior ESBL colonization and recent antibiotic exposures, especially to third-generation cephalosporins and fluoroquinolones, were at risk for CO-ESBL-producing E coli infection.
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hosptial, Pratumthani, Thailand. ananpisarn@yahoo.com
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Patarachai
authors.initials: P
authors.lastname: Kiratisin
authors.forename: Piyawan
authors.initials: P
authors.lastname: Saifon
authors.forename: Rungrueng
authors.initials: R
authors.lastname: Kitphati
authors.forename: Surang
authors.initials: S
authors.lastname: Dejsirilert
authors.forename: Linda M
authors.initials: LM
authors.lastname: Mundy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State; D016022:Case-Control Studies; D002511:Cephalosporins / Q000009:adverse effects; D017714:Community-Acquired Infections / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000235:genetics; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D015995:Prevalence; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D002511:Cephalosporins; D024841:Fluoroquinolones; D001618:beta-Lactamases