title: Extended-spectrum beta-lactamase (ESBL)-producing enterobacteria: factors associated with infection in the community setting, Auckland, New Zealand.
abstract: We aimed to document the epidemiology of extended-spectrum beta-lactamase (ESBL)-producing enterobacteria in the Auckland community and identify factors associated with infection using a case-control study design. ESBL-producing enterobacteria were isolated from 107 infected patients, for which demographic and clinical data were available for 98 cases (92%). Escherichia coli was the predominant organism (82%), with urine as the commonest source (97%). Compared with a control group infected with ESBL-negative enterobacteria, factors significantly associated with infection on univariate analysis were: living in a residential care home (RCH); recent admission to hospital 'M'; recent antibiotic use; older age (>75 years); presence of a urinary catheter; and a history of comorbid chronic obstructive pulmonary disease (COPD), cardiovascular disease, neurological disease or recurrent urinary tract infection. On multivariate analysis, residence in RCH and COPD remained significant associations. Pulsed-field gel electrophoresis typing of the ESBL-producing E. coli identified a common strain. We concluded that residence in RCH and a history of COPD are significant associations with ESBL-producing enterobacterial infection in the Auckland community. Several spatial clusters in RCHs and a common strain suggest point-source outbreaks. A substantial number of community cases did not live in an RCH nor had been recently hospitalised, suggesting the independent generation of ESBL-producing enterobacteria in the broader community.
authors: Auckland Regional Public Health Service, Auckland, New Zealand.
authors: C T
authors: CT
authors: Moor
authors: S A
authors: SA
authors: Roberts
authors: G
authors: G
authors: Simmons
authors: S
authors: S
authors: Briggs
authors: A J
authors: AJ
authors: Morris
authors: J
authors: J
authors: Smith
authors: H
authors: H
authors: Heffernan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000201:enzymology / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012112:Residential Facilities; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014556:Urine / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases