title: Community-onset extended-spectrum beta-lactamase (ESBL) producing Escherichia coli: importance of international travel.
abstract: OBJECTIVE
  Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli have emerged as significant causes of community-onset disease. We sought to identify risk factors for acquiring community-onset ESBL-producing E. coli.
  
  
  METHODS
  Prospective, population-based surveillance for ESBL-producing E. coli was performed in the Calgary Health Region (population 1.2 million), Canada during a two-year period.
  
  
  RESULTS
  247 patients were identified; 177 (72%; 7.6 per 100,000/year) were community acquired, and 70 (28%; 3.0 per 100,000/year) were healthcare associated. The acquisition risk increased with advancing age. Females were at higher risk as compared to males [relative risk (RR) 4.3; 95% confidence interval (CI), 3.1-6.1] as were urban as compared to rural residents (RR 2.2; 95% CI, 1.4-3.6). A number of co-morbidities increased risk (RR; 95% CI) including requirement for hemodialysis (56.3; 15.1-147.4), urinary incontinence (21.7; 15.0-30.9), cancer (11.1; 7.0-17.0), heart disease (6.5; 4.3-9.7), and diabetes (4.4; 2.6-7.1). Overseas travel overall increased the risk (5.7; 4.1-7.8) and was highest in travelers to India (145.6; 77.7-252.1), the Middle East (18.1; 8.1-35.2), and Africa (7.7; 2.8-17.2).
  
  
  CONCLUSIONS
  Advancing age, female gender, co-morbid medical conditions, and foreign travel are important risk factors for developing community-onset ESBL-producing E. coli infections in our region. Emergence of anti-microbial-resistant pathogens is a global concern.
authors.affiliation: Department of Medicine, University of Calgary and Calgary Health Region, Calgary, Alberta, Canada. kevin.laupland@calgaryhealthregion.ca
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Laupland
authors.forename: Deirdre L
authors.initials: DL
authors.lastname: Church
authors.forename: Jeanne
authors.initials: J
authors.lastname: Vidakovich
authors.forename: Melissa
authors.initials: M
authors.lastname: Mucenski
authors.forename: Johann D D
authors.initials: JD
authors.lastname: Pitout
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014195:Travel; D014505:Urban Population; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases