Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis.
BACKGROUND
There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality.


METHODS
Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study.


RESULTS
We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5-6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5-4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with beta-lactam/beta-lactam inhibitor combinations or carbapenems (8%-12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production.


CONCLUSIONS
ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.
Rodríguez-Baño
Jesús
J
Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Seville, Spain. jesusrodriguez@medynet.com
Picón
Encarnación
E
Gijón
Paloma
P
Hernández
José Ramón
JR
Ruíz
Maite
M
Peña
Carmen
C
Almela
Manuel
M
Almirante
Benito
B
Grill
Fabio
F
Colomina
Javier
J
Giménez
Monserrat
M
Oliver
Antonio
A
Horcajada
Juan Pablo
JP
Navarro
Gemma
G
Coloma
Ana
A
Pascual
Alvaro
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
D000900:Anti-Bacterial Agents; D001618:beta-Lactamases