title: Cephalosporin and fluoroquinolone combinations are highly associated with CTX-M β-lactamase-producing Escherichia coli: a case-control study in a French teaching hospital.
abstract: The aim of this study was to investigate the risk factors associated with CTX-M-producing Escherichia coli strains isolated from infected or colonized patients. From 191 clinical samples, a case-control study was designed. From January 2005 to December 2007, 98 hospitalized patients infected or colonized with CTX-M-producing E. coli were included in the study. They were matched 1 : 1 with controls that had a non-CTX-M-producing E. coli infection on the basis of the site of sample, the unit of hospitalization and the time at risk. The rate of CTX-M-producing E. coli among those producing extended spectrum β-lactamases was always ≥90% from 2005 to 2008. All strains were susceptible to carbapenems. However, we observed a high rate of co-resistance to ciprofloxacin (61%), sulphonamides (86%) and gentamicin (34%). Significant risk factors identified by multivariate analysis were recurrent infections (OR = 2.93), presence of artificial nutrition (OR = 3.99), and recent exposure to quinolones (OR = 4.39), third- or fourth-generation cephalosporin (OR = 3.49) and the combination of both antibiotic classes (OR = 5.50). This report highlights the dramatic increase of CTX-M-producing E. coli and the need for changes in the use of antimicrobial drugs and in infection control measures to manage this major health concern.
authors.affiliation: Service d'Hygiène et d'Epidemiologie Hospitalière, University Hospital, Dijon, France.
authors.forename: P
authors.initials: P
authors.lastname: Cassier
authors.forename: S
authors.initials: S
authors.lastname: Lallechère
authors.forename: S
authors.initials: S
authors.lastname: Aho
authors.forename: K
authors.initials: K
authors.lastname: Astruc
authors.forename: C
authors.initials: C
authors.lastname: Neuwirth
authors.forename: L
authors.initials: L
authors.lastname: Piroth
authors.forename: P
authors.initials: P
authors.lastname: Chavanet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000382:microbiology; D016022:Case-Control Studies; D002511:Cephalosporins / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000379:methods; D004363:Drug Utilization / Q000706:statistics & numerical data; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D005602:France; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D001618:beta-Lactamases