title: Escherichia coli producing SHV-type extended-spectrum beta-lactamase is a significant cause of community-acquired infection.
abstract: OBJECTIVE
  Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasingly significant cause of community-acquired infection worldwide. The epidemiological features of CTX-M- and SHV-producing ESBLEC causing community-acquired infections are compared.
  
  
  METHODS
  A multicentre cohort study including all community-acquired infections caused by ESBLEC in four geographical areas of Spain was carried out. ESBL characterization was by isoelectric focusing, PCR and sequencing. Demographics, previous healthcare contact, co-morbidity, use of antimicrobials, invasive procedures and type of infection were collected for all patients. Patients with CTX-M- and SHV-producing isolates were compared using logistic regression.
  
  
  RESULTS
  One hundred and twenty-two cases (95% urinary tract infections) were included. ESBLs were characterized in 112 isolates; 77 isolates (69%) produced CTX-M, 36 (32%) produced SHV and 7 (6%) produced TEM enzymes (8 produced >1 ESBL). Patients with isolates producing CTX-M enzymes only (CTX-M group, n = 70) and SHV enzymes only (SHV group, n = 31) were compared. There were no differences in terms of underlying disease, previous healthcare contact, invasive procedures, antibiotic use or type of infection. Multivariate analysis including geographical area showed that a Charlson Index score of >2 (OR = 4.0; 95% CI = 1.2-12.6) was associated with SHV isolates, while age >60 (4.7; 1.7-12.5) was associated with CTX-M isolates.
  
  
  CONCLUSIONS
  SHV-producing ESBLEC is a significant cause of community-acquired infection in Spain; the clinical epidemiology of such isolates seems very similar to that of CTX-M-producing E. coli.
authors.affiliation: Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: Juan
authors.initials: J
authors.lastname: Alcalá
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Cisneros
authors.forename: Fabio
authors.initials: F
authors.lastname: Grill
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliver
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Horcajada
authors.forename: Teresa
authors.initials: T
authors.lastname: Tórtola
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mirelis
authors.forename: Gemma
authors.initials: G
authors.lastname: Navarro
authors.forename: María
authors.initials: M
authors.lastname: Cuenca
authors.forename: María
authors.initials: M
authors.lastname: Esteve
authors.forename: Carmen
authors.initials: C
authors.lastname: Peña
authors.forename: Ana C
authors.initials: AC
authors.lastname: Llanos
authors.forename: Rafael
authors.initials: R
authors.lastname: Cantón
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology*; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D029968:Escherichia coli Proteins / Q000096:biosynthesis / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007525:Isoelectric Focusing; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D013030:Spain / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics / Q000302:isolation & purification
chemical_list: D029968:Escherichia coli Proteins; D001618:beta-Lactamases