title: Clinical characteristics of urosepsis caused by extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumonia and their emergence in the community.
abstract: BACKGROUND
  The purpose of this study is to delineate clinical characteristics of urosepsis caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) in different clinical settings, with an emphasis on community-acquired infections.
  
  
  METHODS
  A retrospective study was conducted at two medical centers in Taiwan. From May 2002 to August 2007, clinical data of adults with urosepsis caused by ESBL-EK were collected. Patients were categorized into three groups according to the place of acquisition. Baseline characteristics, microbiological data and clinical outcomes were compared.
  
  
  RESULTS
  Ninety-three cases of ESBL-EK urosepsis were included. Their mean age was 69.4 years, and 48.4% were men. Eleven (11.8%), 41 (44.1%), and 41 (44.1%) patients were categorized as having community-acquired, healthcare-associated, and hospital-acquired infections, respectively. Cases of ESBL-EK urosepsis from different settings shared similar characteristics in terms of age, gender, comorbidity and resistance profiles of bacterial strains. Of the bacterial isolates, 75% and 38.7% were resistant to fluoroquinolones and aminoglycosides, respectively. Cases of community-acquired urosepsis had a lower disease severity than those acquired in healthcare facilities or hospitals. Of note, there was no case fatality in 11 cases of community-acquired urosepsis and, in contrast, a crude mortality rate of 41.5% was found among adults with hospital-acquired urosepsis (p < 0.001).
  
  
  CONCLUSIONS
  A limited number of adults with community-acquired urosepsis caused by ESBL-EK in the present study had a favorable outcome. Nonetheless, clinicians should be cautious of the emergence of urinary tract infections caused by ESBL-producers in the community setting.
authors: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Jen-Chieh
authors: JC
authors: Lee
authors: Nan-Yao
authors: NY
authors: Lee
authors: Hsin-Chun
authors: HC
authors: Lee
authors: Wei-Han
authors: WH
authors: Huang
authors: Ko-Chung
authors: KC
authors: Tsui
authors: Chia-Ming
authors: CM
authors: Chang
authors: Ching-Chi
authors: CC
authors: Lee
authors: Po-Lin
authors: PL
authors: Chen
authors: Chi-Jung
authors: CJ
authors: Wu
authors: Po-Ren
authors: PR
authors: Hsueh
authors: Wen-Chien
authors: WC
authors: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D013624:Taiwan / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases