title: Differences in risk-factor profiles between patients with ESBL-producing Escherichia coli and Klebsiella pneumoniae: a multicentre case-case comparison study.
abstract: BACKGROUND
  Generic epidemiological differences between extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), are poorly defined. Nonetheless, defining such differences and understanding their basis could have strategic implications for infection control policy and practice.
  
  
  METHODS
  Between 2009 and 2011 patients with bacteraemia due to ESBL-EC or ESBL-KP across all three acute hospitals in the city of Auckland, New Zealand, were eligible for inclusion. Recognised risk factors for ESBL bacteraemia were compared between species in a retrospective case-case study design using multivariate logistic regression. Representative isolates underwent ESBL gene characterisation and molecular typing.
  
  
  RESULTS
  170 patients and 176 isolates were included in the study (92 patients with ESBL-EC, 78 with ESBL-KP). 92.6% had CTX-Ms. 39% of EC were ST131 while 51% of KP belonged to 3 different STs (i.e. ST20, ST48 & ST1087). Specific sequence types were associated with specific hospitals for ESBL-KP but not ESBL-EC. Variables positively associated with ESBL-EC on multivariate analysis were: community acquired infection (odds ratio [OR] 7.9; 95% CI: 2.6-23.9); chronic pulmonary disease (OR 5.5; 95% CI: 1.5-20.1); and high prevalence country of origin (OR 4.3; 95% CI: 1.6-11.6). Variables negatively associated with ESBL-EC were previous transplant (OR 0.06; 95% CI: 0.007-0.6); Hospital 2 (OR 0.3; 95% CI: 0.1-0.7) and recent ICU admission (OR 0.3; 95% CI: 0.07-0.9).
  
  
  CONCLUSIONS
  Differences in risk profiles between patients with ESBL-EC and ESBL-KP suggest fundamental differences in transmission dynamics. Understanding the biological basis for these differences could have implications for infection control practice. Tailoring of infection control measures according to ESBL species may be indicated in some instances.
authors.affiliation: Department of Clinical Microbiology, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand ; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Freeman
authors.affiliation: Division of Microbiology, Calgary Laboratory Services, Departments of Pathology & Laboratory Medicine, Microbiology Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rubin
authors.affiliation: Department of Clinical Microbiology, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Gary N
authors.initials: GN
authors.lastname: McAuliffe
authors.affiliation: Division of Microbiology, Calgary Laboratory Services, Departments of Pathology & Laboratory Medicine, Microbiology Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Gisele
authors.initials: G
authors.lastname: Peirano
authors.affiliation: Department of Clinical Microbiology, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand ; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Roberts
authors.affiliation: Department of Clinical Microbiology, Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Dragana
authors.initials: D
authors.lastname: Drinković
authors.affiliation: Division of Microbiology, Calgary Laboratory Services, Departments of Pathology & Laboratory Medicine, Microbiology Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Johann Dd
authors.initials: JD
authors.lastname: Pitout
keywords: Bacteraemia; ESBL; Escherichia coli; Klebsiella pneumoniae; Risk factors