title: Trends in Expanded-Spectrum Cephalosporin-Resistant Escherichia coli and Klebsiella pneumoniae among Dutch Clinical Isolates, from 2008 to 2012.
abstract: We investigated time trends in extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates from different patient settings in The Netherlands from 2008-2012. E. coli and K. pneumoniae isolates from blood and urine samples of patients > = 18 years were selected from the Dutch Infectious Disease Surveillance System-Antimicrobial Resistance (ISIS-AR) database. We used multivariable Poisson regression to study the rate per year of blood stream infections by susceptible and resistant isolates, and generalized estimating equation (GEE) log-binomial regression for trends in the proportion of extended-spectrum cephalosporin-resistant isolates. Susceptibility data of 197,513 E. coli and 38,244 K. pneumoniae isolates were included. The proportion of extended-spectrum cephalosporin-resistant E. coli and K. pneumoniae isolates from urine and blood samples increased in all patient settings, except for K. pneumoniae isolates from patients admitted to intensive care units. For K. pneumoniae, there was a different time trend between various patient groups (p<0.01), with a significantly higher increase in extended-spectrum cephalosporin-resistant isolates from patients attending a general practitioner than in isolates from hospitalized patients. For E. coli, the increasing time trends did not differ among different patient groups. This nationwide study shows a general increase in extended-spectrum cephalosporin-resistant E. coli and K. pneumoniae isolates. However, differences in trends between E. coli en K. pneumoniae underline the importance of E. coli as a community-pathogen and its subsequent influence on hospital resistance level, while for K. pneumoniae the level of resistance within the hospital seems less influenced by the resistance trends in the community.
authors.affiliation: Centre for Infectious disease control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: van der Steen
authors.affiliation: Centre for Infectious disease control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Tjalling
authors.initials: T
authors.lastname: Leenstra
authors.affiliation: Department of Medical Microbiology and Infection Control, VU Medical Center (VUmc), Amsterdam, the Netherlands; Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands.
authors.forename: Jan A J W
authors.initials: JA
authors.lastname: Kluytmans
authors.affiliation: Centre for Infectious disease control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Department of Medical Microbiology, Reinier de Graaf Groep, Delft, the Netherlands.
authors.forename: Akke K
authors.initials: AK
authors.lastname: van der Bij
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002511:Cephalosporins / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000652:urine; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000652:urine; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: D002511:Cephalosporins; D001618:beta-Lactamases