Community-associated extended-spectrum β-lactamase–producing Escherichia coli infection in the United States

Doi, Yohei, Park, Yoon Soo, Rivera, Jesabel I., Adams-Haduch, Jennifer M., Hingwe, Ameet, Sordillo, Emilia M., Lewis 2nd, James S., Howard, Wanita J., Johnson, Laura E., Polsky, Bruce, Jorgensen, James H., Richter, Sandra S., Shutt, Kathleen A. and Paterson, David L. (2013) Community-associated extended-spectrum β-lactamase–producing Escherichia coli infection in the United States. Clinical Infectious Diseases, 56 5: 641-648. doi:10.1093/cid/cis942


Author Doi, Yohei
Park, Yoon Soo
Rivera, Jesabel I.
Adams-Haduch, Jennifer M.
Hingwe, Ameet
Sordillo, Emilia M.
Lewis 2nd, James S.
Howard, Wanita J.
Johnson, Laura E.
Polsky, Bruce
Jorgensen, James H.
Richter, Sandra S.
Shutt, Kathleen A.
Paterson, David L.
Title Community-associated extended-spectrum β-lactamase–producing Escherichia coli infection in the United States
Formatted title
Community-associated extended-spectrum β-lactamase–producing Escherichia coli infection in the United States
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
1537-6591
Publication date 2013-03-01
Year available 2012
Sub-type Article (original research)
DOI 10.1093/cid/cis942
Open Access Status DOI
Volume 56
Issue 5
Start page 641
End page 648
Total pages 8
Place of publication Cary, NC, United States
Publisher Oxford University Press
Language eng
Subject 2726 Microbiology (medical)
2725 Infectious Diseases
Abstract Background. The occurrence of community-associated infections due to extended-spectrum -lactamase (ESBL)-producing Escherichia coli has been recognized as a major clinical problem in Europe and other regions.Methods. We conducted a prospective observational study to examine the occurrence of community-associated infections due to ESBL-producing E. coli at centers in the United States. Five academic and community hospitals and their affiliated clinics participated in this study in 2009 and 2010. Sites of acquisition of the organisms (community-associated or healthcare-associated), risk factors, and clinical outcome were investigated. Screening for the global epidemic sequence type (ST) 131 and determination of the ESBL types was conducted by polymerase chain reaction and sequencing.Results. Of the 291 patients infected or colonized with ESBL-producing E. coli as outpatients or within 48 hours of hospitalization, 107 (36.8%) had community-associated infection (81.5% of which represented urinary tract infection), while the remainder had healthcare-associated infection. Independent risk factors for healthcare-associated infection over community-associated infection were the presence of cardiovascular disease, chronic renal failure, dementia, solid organ malignancy, and hospitalization within the previous 12 months. Of the community-associated infections, 54.2% were caused by the globally epidemic ST131 strain, and 91.3% of the isolates produced CTX-M-type ESBL.Conclusions. A substantial portion of community-onset, ESBL-producing E. coli infections now occur among patients without discernible healthcare-associated risk factors in the United States. This epidemiologic shift has implications for the empiric management of community-associated infection when involvement of E. coli is suspected.
Formatted abstract
Background. The occurrence of community-associated infections due to extended-spectrum β-lactamase (ESBL)–producing Escherichia coli has been recognized as a major clinical problem in Europe and other regions.
Methods. We conducted a prospective observational study to examine the occurrence of community-associated infections due to ESBL-producing E. coli at centers in the United States. Five academic and community hospitals and their affiliated clinics participated in this study in 2009 and 2010. Sites of acquisition of the organisms (community-associated or healthcare-associated), risk factors, and clinical outcome were investigated. Screening for the global epidemic sequence type (ST) 131 and determination of the ESBL types was conducted by polymerase chain reaction and sequencing.
Results. Of the 291 patients infected or colonized with ESBL-producing E. coli as outpatients or within 48 hours of hospitalization, 107 (36.8%) had community-associated infection (81.5% of which represented urinary tract infection), while the remainder had healthcare-associated infection. Independent risk factors for healthcare-associated infection over community-associated infection were the presence of cardiovascular disease, chronic renal failure, dementia, solid organ malignancy, and hospitalization within the previous 12 months. Of the community-associated infections, 54.2% were caused by the globally epidemic ST131 strain, and 91.3% of the isolates produced CTX-M–type ESBL.
Conclusions. A substantial portion of community-onset, ESBL-producing E. coli infections now occur among patients without discernible healthcare-associated risk factors in the United States. This epidemiologic shift has implications for the empiric management of community-associated infection when involvement of E. coli is suspected.
Keyword Extended-spectrum beta-lactamase (ESBL)
Escherichia coli
Community-associated infection
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published online: November 13, 2012

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2013 Collection
 
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Created: Tue, 12 Feb 2013, 20:23:15 EST by Mrs Maureen Pollard on behalf of Paediatrics & Child Health - RBWH