title: Risk factors for and outcomes associated with clinical isolates of Escherichia coli and Klebsiella species resistant to extended-spectrum cephalosporins among patients admitted to Canadian hospitals.
abstract: BACKGROUND
  Clinical features associated with Gram-negative bacterial isolates with extended-spectrum beta-lactamase (ESBL)- and AmpC-mediated resistance identified in Canadian hospitals is largely unknown. The objective of the present study was to determine the demographics, risk factors and outcomes of patients with ESBL- or AmpC-mediated resistant organisms in Canadian hospitals.
  
  
  METHODS
  Patients with clinical cultures of Escherichia coli or Klebsiella species were matched with patients with a similar organism but susceptible to third-generation cephalosporins. Molecular identification of the AmpC or ESBL was determined using a combination of polymerase chain reaction and sequence analysis. Univariate and multivariate logistic regression analysis was performed to identify variables associated with becoming a case.
  
  
  RESULTS
  Eight Canadian hospitals identified 106 cases (ESBL/AmpC) and 106 controls. All risk factors identified in the univariate analysis as a predictor of being an ESBL/AmpC cases at the 0.20 P-value were included in the multivariate analysis. No significant differences in outcomes were observed (unfavourable responses 17% versus 15% and mortality rates 13% versus 7%, P not significant). Multivariate logistic regression found an association of becoming an ESBL/AmpC case with: previous admission to a nursing home (OR 8.28, P=0.01) or acute care facility (OR 1.96, P=0.03), length of stay before infection (OR 3.05, P=0.004), and previous use of first-generation cephalosporins (OR 2.38, P=0.02) or third-generation cephalosporins (OR 4.52, P=0.01). Appropriate antibiotics were more likely to be given to controls (27.0% versus 13.3%, P=0.05) and number of days to appropriate antibiotics was longer for cases (median 2.8 days versus 1.2 days, P=0.05).
  
  
  CONCLUSIONS
  The importance of patient medical history, present admission and antibiotic use should be considered for all E coli or Klebsiella species patients pending susceptibility testing results.
authors.affiliation: Pubic Health Agency of Canada, Ottawa, Ontario and Winnipeg, Manitoba;
authors.forename: Marianna
authors.initials: M
authors.lastname: Ofner-Agostini
authors.forename: Andrew
authors.initials: A
authors.lastname: Simor
authors.forename: Michael
authors.initials: M
authors.lastname: Mulvey
authors.forename: Alison
authors.initials: A
authors.lastname: McGeer
authors.forename: Zahir
authors.initials: Z
authors.lastname: Hirji
authors.forename: Melissa
authors.initials: M
authors.lastname: McCracken
authors.forename: Denise
authors.initials: D
authors.lastname: Gravel
authors.forename: David
authors.initials: D
authors.lastname: Boyd
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bryce
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