title: Clinical and molecular epidemiology of community-onset bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli over a 6-year period.
abstract: Although extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) has emerged as a significant community-acquired pathogen, there is little epidemiological information regarding community-onset bacteremia due to ESBL-EC. A retrospective observational study from 2006 through 2011 was performed to evaluate the epidemiology of community-onset bacteremia caused by ESBL-EC. In a six-year period, the proportion of ESBL-EC responsible for causing community-onset bacteremia had increased significantly, from 3.6% in 2006 to 14.3%, in 2011. Of the 97 clinically evaluable cases with ESBL-EC bacteremia, 32 (33.0%) were further classified as healthcare-associated infections. The most common site of infection was urinary tract infection (n=35, 36.1%), followed by biliary tract infections (n=29, 29.9%). Of the 103 ESBL-EC isolates, 43 (41.7%) produced CTX-M-14 and 36 (35.0%) produced CTX-M-15. In the multilocus sequence typing (MLST) analysis of 76 isolates with CTX-M-14 or -15 type ESBLs, the most prevalent sequence type (ST) was ST131 (n=15, 19.7%), followed by ST405 (n=12, 15.8%) and ST648 (n=8, 10.5%). No significant differences in clinical features were found in the ST131 group versus the other group. These findings suggest that epidemic ESBL-EC clones such as CTX-M-14 or -15 type ESBLs and ST131 have disseminated in community-onset infections, even in bloodstream infections, which are the most serious type of infection.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. collacin@hotmail.com
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Min Kyeong
authors.initials: MK
authors.lastname: Cha
authors.forename: So Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Wi
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
mesh_terms: D000375:Aging; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology*; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000382:microbiology; D018550:Cephalosporin Resistance / Q000235:genetics; D002511:Cephalosporins / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004926:Escherichia coli / Q000302:isolation & purification / Q000378:metabolism; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D015995:Prevalence; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D002511:Cephalosporins; C456080:beta-lactamase CTX-M-14; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases
keywords: Bacteremia; Cephalosporin Resistance; Community-Acquired Infections; Epidemiology; Escherichia coli