Risk factors and molecular epidemiology of community-onset, multidrug resistance extended-spectrum β-lactamase-producingEscherichia coliinfections.
OBJECTIVE
Although multidrug resistance (MDR) among extended-spectrum β-lactamase-producingEscherichia coli(ESBL-EC) poses significant therapeutic challenges, little is known regarding the risk factors and epidemiology of community-onset MDR-ESBL-EC infections. We performed this study to investigate risk factors and the molecular epidemiology of community-onset MDR-ESBL-EC infections.


METHODS
We conducted a case-control-control study of community-onset infections. MDR-ESBL-EC was defined as ESBL-EC that demonstratedin vitroresistance to trimethoprim-sulfamethoxazole, fluoroquinolones (FQs), and gentamicin. Patients with MDR-ESBL-EC infections were designated as case patients. A control group I (CG I) patient was defined as a person whose clinical sample yielded ESBL-EC that did not meet the criteria for MDR. A control group II (CG II) patient was defined as a patient with a non-ESBL-EC infection.


RESULTS
Of 108 patients with ESBL-EC infections, 30 cases (27.8%) were due to MDR-ESBL-EC. Compared with CG I, prior use of FQs (odds ratio [OR], 3.16; 95% confidence interval [CI], 1.11 to 8.98) and immunosuppressant use (OR, 10.47; 95% CI, 1.07 to 102.57) were significantly associated with MDR-ESBL-EC. Compared with CG II, prior use of FQs (OR, 15.53; 95% CI, 2.86 to 84.27) and healthcare-associated infection (OR, 5.98; 95% CI, 2.26 to 15.86) were significantly associated with MDR-ESBL-EC. CTX-M-15 was the most common in MDR-ESBL-EC infections (59.1% [13/22]), while CTX-M-14 was the most common in non-MDR-ESBL-EC infections (41.6% [32/77]). CTX-M-15 was significantly associated with MDR-ESBL-EC (59.1% vs. 32.5%,p= 0.028). Pulsed-field gel electrophoresis showed clonal diversity of MDR-ESBL-EC isolates.


CONCLUSIONS
The emergence of strains of MDR-ESBL-EC in the community poses an important new public health threat. More information on the emergence and transmission of these strains will be necessary in order to prevent their spread.
Division of Infectious Diseases, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.|Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
So Yeon
SY
Park
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cheol-In
CI
Kang
Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Yu Mi
YM
Wi
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Doo Ryeon
DR
Chung
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kyong Ran
KR
Peck
Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Nam-Yong
NY
Lee
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jae-Hoon
JH
Song
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D005260:Female; D005838:Genotype; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D066106:Seoul / Q000453:epidemiology; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D001618:beta-Lactamases
Community-onset infection; Drug resistance, multiple; Escherichia coli; Extended-spectrum β-lactamase