title: Risk factors and prognosis of nosocomial bloodstream infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli.
abstract: Extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR]=4.8; 95% confidence interval [CI]=1.4 to 15.7), the previous use of oxyimino-beta-lactams (OR=6.0; 95% CI=3.0 to 11.8), and unknown BSI source (protective; OR=0.4; 95% CI=0.2 to 0.9), and duration of hospital stay (OR=1.02; 95% CI=1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR=3.9; 95% CI=1.2 to 12.9), a high-risk source (OR=5.5; 95% CI=1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR=6.5; 95% CI=1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-beta-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality.
authors.affiliation: Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Seville, Avda. Dr. Fedriani, 3, Seville 41009, Spain. jesusrb@us.es
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: Jose M
authors.initials: JM
authors.lastname: Cisneros
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: Sonia
authors.initials: S
authors.lastname: Molinos
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliver
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-Mazarrasa
authors.forename: Gemma
authors.initials: G
authors.lastname: Navarro
authors.forename: Ana
authors.initials: A
authors.lastname: Coloma
authors.forename: Lorena
authors.initials: L
authors.lastname: López-Cerero
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004363:Drug Utilization; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases