title: Enterobacteriaceae bacteremia: risk factors for ESBLPE.
abstract: OBJECTIVE
  The increasing prevalence of extended spectrum beta-lactamase producing enterobacteriaceae (ESBLPE) requires defining the use of carbapenems in first intention. We analyzed the associations between enterobacteriaceae bacteremia (EbBact) and ESBLPE carriage during 10 years in a 950-bed teaching hospital.
  
  
  METHODS
  We analyzed a 10-year (July 2001 to June 2011) prospective collection of bacteremia cases including 2 databases: (1) EbBact and (2) a computerized database of patients carrying EBLSE. Only one episode of EbBact was analyzed per patient and hospital stay. Factors associated with ESBLPE bacteremia were assessed by univariate and multivariate logistic regression analysis.
  
  
  RESULTS
  Overall, 2355 cases of EbBact were identified, among which 135 (5.7%) were ESBLPE (2001-05: 1.4%, 2006-09: 7.6%, 2010-11: 14.2%). ESBLPE bacteremia was observed in 52 of the 88 (59%) patients carrying ESBLPE and in 83/2267 (3.7%) patients not known to be colonized with ESBLPE. Factors associated with ESBLPE bacteremia in patients not known to be colonized were: female gender (ORa=0.56, CI95% [0.34-0.91]), hospitalization in the ICU (ORa=2.51 [1.27-5.05]) or medical/surgical wards (ORa=1.83 [1.04-3.38]), the period (2006-09, ORa=4.08 [2.21-8.16]; 2010-11, ORa=8.17 [4.14-17.06] compared to 2001-05), and history of EbBact (ORa=2.29 [0.97-4.79]).
  
  
  CONCLUSIONS
  In case of EbBact, patients known to be colonized with ESBLPE present with ESBLPE bacteremia in more than half of the cases, requiring carbapenems as empirical antibiotic treatment. The global prevalence of ESBLPE among patients presenting with EbBact not known to be colonized with ESBLPE was 3.7%.
authors: Infection Control Unit, UHLIN, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
authors: C
authors: C
authors: Neulier
authors: Infection Control Unit, UHLIN, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; IAME, UMR 1137, université Paris-Diderot, Sorbonne Paris-Cité, 75018 Paris, France; IAME, UMR 1137, INSERM, 75018 Paris, France. Electronic address: gbirgand@gmail.com.
authors: G
authors: G
authors: Birgand
authors: Bacteriology laboratory, Bichat-Claude-Bernard Hospital, 75018 Paris, France.
authors: É
authors: É
authors: Ruppé
authors: Bacteriology laboratory, Bichat-Claude-Bernard Hospital, 75018 Paris, France.
authors: L
authors: L
authors: Armand-Lefèvre
authors: Infection Control Unit, UHLIN, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
authors: I
authors: I
authors: Lolom
authors: IAME, UMR 1137, université Paris-Diderot, Sorbonne Paris-Cité, 75018 Paris, France; IAME, UMR 1137, INSERM, 75018 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France.
authors: Y
authors: Y
authors: Yazdanpanah
authors: Infection Control Unit, UHLIN, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; IAME, UMR 1137, université Paris-Diderot, Sorbonne Paris-Cité, 75018 Paris, France; IAME, UMR 1137, INSERM, 75018 Paris, France.
authors: J-C
authors: JC
authors: Lucet
authors: Bacteriology laboratory, Bichat-Claude-Bernard Hospital, 75018 Paris, France.
authors: A
authors: A
authors: Andremont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001426:Bacterial Proteins / Q000032:analysis; D015780:Carbapenems / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006748:Hospital Departments; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013379:Substrate Specificity; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000032:analysis
chemical_list: D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases
keywords: Bacteremia; Bactériémies; Carbapenems; Carbapénèmes; Entérobactéries productrices de bêtalactamase à spectre étendu; Extended spectrum beta-lactamase producing enterobacteriaceae