title: Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae.
abstract: Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.
authors.affiliation: Infection Control Unit, Avicenne University Hospital, APHP, Paris-Nord University (UFR SMBH), Bobigny, France; IAME U1137 Decision Science in Infectious Diseases, Inserm, Paris Diderot University, Paris, France.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: Antibiotic Team, Department of Biology, Hôpital Foch, Suresnes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lesprit
authors.affiliation: IAME U1137 Decision Science in Infectious Diseases, Inserm, Paris Diderot University, Paris, France; Department of Biostatistics, Outcomerea, Bobigny, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Ruckly
authors.affiliation: Infectious and Tropical Diseases Department, Perpignan General Hospital, Perpignan, France.
authors.forename: Aurelia
authors.initials: A
authors.lastname: Eden
authors.affiliation: Infectious and Tropical Diseases Department, Le Mans General Hospital, Le Mans, France.
authors.forename: Hitoto
authors.initials: H
authors.lastname: Hikombo
authors.affiliation: Internal Medicine and Infectious Diseases, Bretonneau University Hospital, Tours, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.affiliation: Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.affiliation: IAME U1137 Decision Science in Infectious Diseases, Inserm, Paris Diderot University, Paris, France; Department of Biostatistics, Outcomerea, Bobigny, France; Medical and Infectious Diseases ICU, APHP, Bichat-Claude Bernard University Hospital, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: Medical Intensive Care Unit and Infection Control Unit, Henri Mondor University Hospital, APHP, Paris-Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France. Electronic address: christian.brun-buisson@aphp.fr.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: Antibiotic appropriateness; Bacteraemia; Extended-spectrum β-lactamase; Risk factors