title: Epidemiology and risk factors for isolation of Escherichia coli producing CTX-M-type extended-spectrum β-lactamase in a large U.S. Medical Center.
abstract: A case-case-control study was conducted to identify independent risk factors for recovery of Escherichia coli strains producing CTX-M-type extended-spectrum β-lactamases (CTX-M E. coli) within a large Southeastern Michigan medical center. Unique cases with isolation of ESBL-producing E. coli from February 2010 through July 2011 were analyzed by PCR for blaCTX-M, blaTEM, and blaSHV genes. Patients with CTX-M E. coli were compared to patients with E. coli strains not producing CTX-M-type ESBLs (non-CTX-M E. coli) and uninfected controls. Of 575 patients with ESBL-producing E. coli, 491 (85.4%) isolates contained a CTX-M ESBL gene. A total of 319 (84.6%) patients with CTX-M E. coli (282 [74.8%] CTX-M-15 type) were compared to 58 (15.4%) non-CTX-M E. coli patients and to uninfected controls. Independent risk factors for CTX-M E. coli isolation compared to non-CTX-M E. coli included male gender, impaired consciousness, H2 blocker use, immunosuppression, and exposure to penicillins and/or trimethoprim-sulfamethoxazole. Compared to uninfected controls, independent risk factors for isolation of CTX-M E. coli included presence of a urinary catheter, previous urinary tract infection, exposure to oxyimino-cephalosporins, dependent functional status, non-home residence, and multiple comorbid conditions. Within 48 h of admission, community-acquired CTX-M E. coli (n = 51 [16%]) and non-CTX-M E coli (n = 11 [19%]) strains were isolated from patients with no recent health care contacts. CTX-M E. coli strains were more resistant to multiple antibiotics than non-CTX-M E. coli strains. CTX-M-encoding genes, especially bla(CTX-M-15) type, represented the most common ESBL determinants from ESBL-producing E. coli, the majority of which were present upon admission. Septic patients with risk factors for isolation of CTX-M E. coli should be empirically treated with appropriate agents. Regional infection control efforts and judicious antibiotic use are needed to control the spread of these organisms.
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA. kayokohayakawa@gmail.com
authors.forename: Kayoko
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authors.lastname: Sundaragiri
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authors.lastname: Nanjireddy
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authors.lastname: Dasagi
authors.forename: Satya
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authors.lastname: Datla
authors.forename: Vamsi
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authors.lastname: Kuchipudi
authors.forename: Swetha
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authors.lastname: Reddy
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authors.lastname: Shahani
authors.forename: Vijaya
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authors.lastname: Upputuri
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authors.forename: Vedavyas
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authors.lastname: Gannamani
authors.forename: Nandhini
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authors.lastname: Madhanagopal
authors.forename: Srinadh
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authors.lastname: Annangi
authors.forename: Busani
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authors.lastname: Sudha
authors.forename: Kalyan Srinivas
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authors.lastname: Muppavarapu
authors.forename: Judy A
authors.initials: JA
authors.lastname: Moshos
authors.forename: Paul R
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authors.lastname: Lephart
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
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authors.lastname: Bush
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D016022:Case-Control Studies; D002939:Ciprofloxacin / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology*; D029968:Escherichia coli Proteins / Q000235:genetics / Q000378:metabolism*; D005260:Female; D005798:Genes, Bacterial; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology; D014481:United States / Q000453:epidemiology; D062885:Urinary Catheters / Q000382:microbiology; D014552:Urinary Tract Infections / Q000382:microbiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D029968:Escherichia coli Proteins; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D001618:beta-Lactamases