title: Prevalence, risk factors, and impact on clinical outcome of extended-spectrum beta-lactamase-producing Escherichia coli bacteraemia: a five-year study.
abstract: BACKGROUND
  The impact of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) bacteraemia on outcome remains controversial.
  
  
  METHODS
  A retrospective analysis of the prevalence, risk factors, clinical features, and outcomes of all ESBL-EC bacteraemia in one French hospital over a 5-year period was performed. A case-control study was undertaken: cases had at least one ESBL-EC bacteraemia and controls a positive non-ESBL-EC bacteraemia.
  
  
  RESULTS
  The prevalence of ESBL-EC bacteraemia increased from 5.2% of all positive E. coli blood cultures in 2005 to 13.5% in 2009 (p<0.003). CTX-M represented 70% of ESBL-EC bacteraemia strains, and strains were not clonally related. On adjusted analysis, the only significant risk factor for ESBL-EC bacteraemia was a previous ESBL-EC colonization (odds ratio 11.3, 95% confidence interval 1.2-107; p=0.003). Initial antimicrobial therapy was less frequently adequate in the ESBL-EC group (48% vs. 85%; p=0.003). The presence of ESBL-EC bacteraemia was not associated with a longer hospital stay (p=0.088). Day 30 mortality was high, but not significantly different in the two groups (30% vs. 27%; p=0. 82).
  
  
  CONCLUSIONS
  The prevalence of ESBL-EC bacteraemia has been increasing dramatically. Previous colonization with ESBL-EC was a strong risk factor for ESBL-EC bacteraemia. More inadequate initial antimicrobial therapy was noted in the ESBL-EC group, but mortality and length of hospital stay were not significantly different from those of patients with non-ESBL-EC bacteraemia.
authors.affiliation: Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France; Inserm UMRS 1136, UPMC Université Paris 06, Paris, France. Electronic address: blandine.denis@sls.aphp.fr.
authors.forename: B
authors.initials: B
authors.lastname: Denis
authors.affiliation: Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Lafaurie
authors.affiliation: Department of Microbiology, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Donay
authors.affiliation: Emergency Department, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Fontaine
authors.affiliation: Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Oksenhendler
authors.affiliation: Department of Haematology, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Raffoux
authors.affiliation: Department of Oncology, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Hennequin
authors.affiliation: Department of Gastroenterology, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Allez
authors.affiliation: Department of Haematology-Bone Marrow Transplantation, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Socie
authors.affiliation: Department of Intensive Care, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Maziers
authors.affiliation: Department of Biomedical Statistics and Methodology, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Porcher
authors.affiliation: Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Molina
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D001618:beta-Lactamases / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: Bacteraemia; ESBL Escherichia coli; Hospital stay; Mortality