title: Risk factors associated with the community-acquired colonization of extended-spectrum beta-lactamase (ESBL) positive Escherichia Coli. an exploratory case-control study.
abstract: BACKGROUND
  The number of extended-spectrum beta-lactamase (ESBL) positive (+) Escherichia coli is increasing worldwide. In contrast with many other multidrug-resistant bacteria, it is suspected that they predominantly spread within the community. The objective of this study was to assess factors associated with community-acquired colonization of ESBL (+) E. coli.
  
  
  METHODS
  We performed a matched case-control study at the Charité University Hospital Berlin between May 2011 and January 2012. Cases were defined as patients colonized with community-acquired ESBL (+) E. coli identified <72 h after hospital admission. Controls were patients that carried no ESBL-positive bacteria but an ESBL-negative E.coli identified <72 h after hospital admission. Two controls per case were chosen from potential controls according to admission date. Case and control patients completed a questionnaire assessing nutritional habits, travel habits, household situation and language most commonly spoken at home (mother tongue). An additional rectal swab was obtained together with the questionnaire to verify colonization status. Genotypes of ESBL (+) E. coli strains were determined by PCR and sequencing. Risk factors associated with ESBL (+) E. coli colonization were analyzed by a multivariable conditional logistic regression analysis.
  
  
  RESULTS
  We analyzed 85 cases and 170 controls, respectively. In the multivariable analysis, speaking an Asian language most commonly at home (OR = 13.4, CI 95% 3.3-53.8; p<0.001) and frequently eating pork (≥ 3 meals per week) showed to be independently associated with ESBL colonization (OR = 3.5, CI 95% 1.8-6.6; p<0.001). The most common ESBL genotypes were CTX-M-1 with 44% (n = 37), CTX-M-15 with 28% (n = 24) and CTX-M-14 with 13% (n = 11).
  
  
  CONCLUSIONS
  An Asian mother tongue and frequently consuming certain types of meat like pork can be independently associated with the colonization of ESBL-positive bacteria. We found neither frequent consumption of poultry nor previous use of antibiotics to be associated with ESBL colonization.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany ; German National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Leistner
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Meyer
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Pfeifer
authors.forename: Christoph
authors.initials: C
authors.lastname: Eller
authors.forename: Petra
authors.initials: P
authors.lastname: Dem
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
mesh_terms: D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D044466:Asian People; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000208:ethnology* / Q000382:microbiology; D004926:Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000208:ethnology* / Q000382:microbiology; D005260:Female; D015870:Gene Expression; D005858:Germany; D006801:Humans; D008297:Male; D008460:Meat; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013552:Swine; D044465:White People; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000145:classification / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
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