Risk factors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli Bacteremia

Yoon Soo Park, Il Kwon Bae, Juwon Kim, Seokhoon Jeong, Seung Sik Hwang, Yiel Hea Seo, Yong Kyun Cho, Kyungwon Lee, June Myung Kim

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: Inadequate empirical therapy for severe infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. Materials and Methods: A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. Results: Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95% CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95% CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95% CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum β-lactamase (ESBL) gene identified was blaCTX-M-15 (n=31) followed by blaCTX-M-14 (n=23). Conclusion: The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.

Original languageEnglish
Pages (from-to)467-475
Number of pages9
JournalYonsei Medical Journal
Volume55
Issue number2
DOIs
Publication statusPublished - 2014 Mar 1

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Molecular Epidemiology
Bacteremia
Odds Ratio
Confidence Intervals
Escherichia coli
Septic Shock
Cross Infection
Urinary Tract Infections
Sepsis
Infection
Decision Trees
Carbapenems
Decision Support Techniques
Tertiary Healthcare
Cephalosporins
Korea
Tertiary Care Centers
Causality
Case-Control Studies
Outpatients

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Park, Yoon Soo ; Bae, Il Kwon ; Kim, Juwon ; Jeong, Seokhoon ; Hwang, Seung Sik ; Seo, Yiel Hea ; Cho, Yong Kyun ; Lee, Kyungwon ; Kim, June Myung. / Risk factors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli Bacteremia. In: Yonsei Medical Journal. 2014 ; Vol. 55, No. 2. pp. 467-475.
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abstract = "Purpose: Inadequate empirical therapy for severe infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. Materials and Methods: A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. Results: Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7{\%} of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95{\%} confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95{\%} CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95{\%} CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95{\%} CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95{\%} CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95{\%} CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum β-lactamase (ESBL) gene identified was blaCTX-M-15 (n=31) followed by blaCTX-M-14 (n=23). Conclusion: The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.",
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Risk factors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli Bacteremia. / Park, Yoon Soo; Bae, Il Kwon; Kim, Juwon; Jeong, Seokhoon; Hwang, Seung Sik; Seo, Yiel Hea; Cho, Yong Kyun; Lee, Kyungwon; Kim, June Myung.

In: Yonsei Medical Journal, Vol. 55, No. 2, 01.03.2014, p. 467-475.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli Bacteremia

AU - Park, Yoon Soo

AU - Bae, Il Kwon

AU - Kim, Juwon

AU - Jeong, Seokhoon

AU - Hwang, Seung Sik

AU - Seo, Yiel Hea

AU - Cho, Yong Kyun

AU - Lee, Kyungwon

AU - Kim, June Myung

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Purpose: Inadequate empirical therapy for severe infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. Materials and Methods: A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. Results: Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95% CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95% CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95% CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum β-lactamase (ESBL) gene identified was blaCTX-M-15 (n=31) followed by blaCTX-M-14 (n=23). Conclusion: The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.

AB - Purpose: Inadequate empirical therapy for severe infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. Materials and Methods: A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. Results: Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95% CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95% CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95% CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum β-lactamase (ESBL) gene identified was blaCTX-M-15 (n=31) followed by blaCTX-M-14 (n=23). Conclusion: The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.

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