Community-onset Escherichia coli infection resistant to expanded-spectrum cephalosporins in low-prevalence countries

Rogers, Benjamin A., Ingram, Paul R., Runnegar, Naomi, Pitman, Matthew C., Freeman, Joshua T., Athan, Eugene, Havers, Sally M., Sidjabat, Hanna E., Jones, Mark, Gunning, Earleen, De Almeida, Mary, Styles, Kaylene and Paterson, David L. (2014) Community-onset Escherichia coli infection resistant to expanded-spectrum cephalosporins in low-prevalence countries. Antimicrobial Agents and Chemotherapy, 58 4: 2126-2134. doi:10.1128/AAC.02052-13

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Author Rogers, Benjamin A.
Ingram, Paul R.
Runnegar, Naomi
Pitman, Matthew C.
Freeman, Joshua T.
Athan, Eugene
Havers, Sally M.
Sidjabat, Hanna E.
Jones, Mark
Gunning, Earleen
De Almeida, Mary
Styles, Kaylene
Paterson, David L.
Title Community-onset Escherichia coli infection resistant to expanded-spectrum cephalosporins in low-prevalence countries
Journal name Antimicrobial Agents and Chemotherapy   Check publisher's open access policy
ISSN 0066-4804
1098-6596
Publication date 2014
Year available 2014
Sub-type Article (original research)
DOI 10.1128/AAC.02052-13
Open Access Status File (Publisher version)
Volume 58
Issue 4
Start page 2126
End page 2134
Total pages 9
Place of publication Washington, DC, United States
Publisher American Society for Microbiology
Collection year 2015
Language eng
Subject 2736 Pharmacology (medical)
3004 Pharmacology
2725 Infectious Diseases
Abstract By global standards, the prevalence of community-onset expanded-spectrum- cephalosporin-resistant (ESC-R) Escherichia coli remains low in Australia and New Zealand. Of concern, our countries are in a unique position, with high extramural resistance pressure from close population and trade links to Asia-Pacific neighbors with high ESC-R E. coli rates. We aimed to characterize the risks and dynamics of community-onset ESC-R E. coli infection in our low-prevalence region. A case-control methodology was used. Patients with ESC-R E. coli or ESC-susceptible E. coli isolated from blood or urine were recruited at six geographically dispersed tertiary care hospitals in Australia and New Zealand. Epidemiological data were prospectively collected, and bacteria were retained for analysis. In total, 182 patients (91 cases and 91 controls) were recruited. Multivariate logistic regression identified risk factors for ESC-R among E. coli strains, including birth on the Indian subcontinent (odds ratio [OR] = 11.13, 95% confidence interval [95% CI] = 2.17 to 56.98, P = 0.003), urinary tract infection in the past year (per-infection OR = 1.430, 95% CI = 1.13 to 1.82, P = 0.003), travel to southeast Asia, China, the Indian subcontinent, Africa, and the Middle East (OR = 3.089, 95% CI = 1.29 to 7.38, P = 0.011), prior exposure to trimethoprim with or without sulfamethoxazole and with or without an expanded-spectrum cephalosporin (OR = 3.665, 95% CI = 1.30 to 10.35, P = 0.014), and health care exposure in the previous 6 months (OR = 3.16, 95% CI = 1.54 to 6.46, P = 0.02). Among our ESC-R E. coli strains, the blaCTX-M ESBLs were dominant (83% of ESC-R E. coli strains), and the worldwide pandemic ST-131 clone was frequent (45% of ESC-R E. coli strains). In our low-prevalence setting, ESC-R among community-onset E. coli strains may be associated with both "export" from health care facilities into the community and direct "import" into the community from high-prevalence regions. Copyright
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