title: Predictors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli infection in a Midwestern community.
abstract: OBJECTIVE
  To identify predictors of community-onset extended-spectrum β-lactamase (ESBL)-producing Escherichia coli infection.
  
  
  METHODS
  Prospective case-control study.
  
  
  METHODS
  Acute care hospitals and ambulatory clinics in the Chicago, Illinois, region.
  
  
  METHODS
  Adults with E. coli clinical isolates cultured in ambulatory settings or within 48 hours of hospital admission.
  
  
  METHODS
  Cases were patients with ESBL-producing E. coli clinical isolates cultured in ambulatory settings or within 48 hours of admission, and controls were patients with non-ESBL-producing E. coli isolates, matched to cases by specimen, location, and date. Clinical variables were ascertained through interviews and medical record review. Molecular methods were used to identify ESBL types, sequence type ST131, and aac(6')-Ib-cr.
  
  
  RESULTS
  We enrolled 94 cases and 158 controls. Multivariate risk factors for ESBL-producing E. coli infection included travel to India in the past year (odds ratio [OR], 14.40 [95% confidence interval (CI), 2.92-70.95]), ciprofloxacin use (OR, 3.92 [95% CI, 1.90-8.1]), and age (OR, 1.04 [95% CI, 1.02-1.06]). Case isolates exhibited high prevalence of CTX-M-15 (78%), ST131 (50%), and aac(6')-Ib-cr (66% of isolates with CTX-M-15).
  
  
  CONCLUSIONS
  Providers should be aware of the increased risk of ESBL-producing E. coli infection among returned travelers, especially those from India.
authors.affiliation: Mayo Clinic, Rochester, Minnesota 55905, USA. banerjee.ritu@mayo.edu
authors.forename: Ritu
authors.initials: R
authors.lastname: Banerjee
authors.forename: Jacob
authors.initials: J
authors.lastname: Strahilevitz
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
authors.forename: Payal P
authors.initials: PP
authors.lastname: Nagwekar
authors.forename: Donna M
authors.initials: DM
authors.lastname: Schora
authors.forename: Ilene
authors.initials: I
authors.lastname: Shevrin
authors.forename: Hongyan
authors.initials: H
authors.lastname: Du
authors.forename: Lance R
authors.initials: LR
authors.lastname: Peterson
authors.forename: Ari
authors.initials: A
authors.lastname: Robicsek
mesh_terms: D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D002641:Chicago / Q000453:epidemiology; D002939:Ciprofloxacin / Q000009:adverse effects / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects / Q000235:genetics; D004926:Escherichia coli / Q000187:drug effects / Q000235:genetics; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D014195:Travel; D018440:beta-Lactam Resistance / Q000235:genetics*
chemical_list: D002939:Ciprofloxacin
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