title: Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli.
abstract: The purpose of this study was to identify risk factors for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli amongst community-onset bacteraemia and to evaluate treatment outcomes. From the database of a nationwide surveillance programme for bacteraemia, data from patients with community-onset E. coli bacteraemia were analysed. Patients with ESBL-producing E. coli bacteraemia were compared with those with non-ESBL-producing bacteraemia. The overall proportion of ESBL-producers was 9.5% (82/865) amongst community-onset E. coli bacteraemia cases. Healthcare-associated infection, underlying liver disease and primary bacteraemia were significant independent factors associated with ESBL-producing E. coli bacteraemia (P<0.05). There was a trend toward mortality being higher in the ESBL group compared with the non-ESBL group (15.0% vs. 7.6%; P=0.096). ESBL production was found to be an independent factor associated with mortality after adjusting for confounding variables (odds ratio=2.99, 95% confidence interval 1.01-8.84; P=0.048), along with severe sepsis, higher Pitt bacteraemia score, primary bacteraemia, pneumonia and underlying liver disease (P<0.05). ESBL-producing E. coli is a significant cause of bacteraemia, even in patients with community-onset infections, predicting higher mortality, particularly in patients with primary bacteraemia, underlying liver disease or healthcare-associated infection.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Joon-Sup
authors.initials: JS
authors.lastname: Yeom
authors.forename: Hyun Kyun
authors.initials: HK
authors.lastname: Ki
authors.forename: Jun Seong
authors.initials: JS
authors.lastname: Son
authors.forename: Seung Soon
authors.initials: SS
authors.lastname: Lee
authors.forename: Yeon-Sook
authors.initials: YS
authors.lastname: Kim
authors.forename: Sook-In
authors.initials: SI
authors.lastname: Jung
authors.forename: Shin-Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Hyun-Ha
authors.initials: HH
authors.lastname: Chang
authors.forename: Seong Yeol
authors.initials: SY
authors.lastname: Ryu
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kwon
authors.forename: Hyuck
authors.initials: H
authors.lastname: Lee
authors.forename: Chisook
authors.initials: C
authors.lastname: Moon
authors.forename: Sang Yop
authors.initials: SY
authors.lastname: Shin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D029968:Escherichia coli Proteins / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D029968:Escherichia coli Proteins; D001618:beta-Lactamases