title: Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis.
abstract: 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.
authors.affiliation: Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Seville, Spain. jesusrodriguez@medynet.com
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: Encarnación
authors.initials: E
authors.lastname: Picón
authors.forename: Paloma
authors.initials: P
authors.lastname: Gijón
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Hernández
authors.forename: Maite
authors.initials: M
authors.lastname: Ruíz
authors.forename: Carmen
authors.initials: C
authors.lastname: Peña
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.forename: Fabio
authors.initials: F
authors.lastname: Grill
authors.forename: Javier
authors.initials: J
authors.lastname: Colomina
authors.forename: Monserrat
authors.initials: M
authors.lastname: Giménez
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliver
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Horcajada
authors.forename: Gemma
authors.initials: G
authors.lastname: Navarro
authors.forename: Ana
authors.initials: A
authors.lastname: Coloma
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases