Risk Factors for Bloodstream Infections due to Extended-spectrum β-lactamase-producing Escherichia coli

被引:38
作者
Wu, Un-In
Yang, Ching-Shiang [2 ]
Chen, Wan-Chin
Chen, Yee-Chun
Chang, Shan-Chwen [1 ,2 ]
机构
[1] Natl Taiwan Univ Hosp, Div Infect Dis, Dept Internal Med, Taipei, Taiwan
[2] Natl Taiwan Univ, Coll Med, Grad Inst Clin Pharm, Taipei 10764, Taiwan
关键词
bacteremia; bloodstream infection; case-control study; Escherichia coli; extended-spectrum beta-lactamase; risk factor; GRAM-NEGATIVE BACILLI; INTENSIVE-CARE UNITS; KLEBSIELLA-PNEUMONIAE; COMMUNITY-ONSET; ANTIMICROBIAL RESISTANCE; MOLECULAR EPIDEMIOLOGY; ENTEROBACTERIACEAE; BACTEREMIA; ACQUISITION; MORTALITY;
D O I
10.1016/S1684-1182(10)60048-5
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
BACKGROUND/PURPOSE: The risk factors for production of extended-spectrum beta-lactamases (ESBLs) have rarely been studied for bloodstream infections of Escherichia coli alone. A case-control study was undertaken to identify the risk factors associated with bloodstream infections caused by ESBL-producing E. coli. METHODS: From January 1, 2005 to June 30, 2007, all patients with a confirmed diagnosis of bloodstream infection caused by ESBL-producing E. coli were reviewed. Each patient was matched with one control subject who experienced ESBL-negative E. coli bacteremia during the same study period. RESULTS: Of the 97 patients diagnosed with ESBL-producing E. coli bacteremia, six were excluded owing to incomplete follow-up and missing data. Comparisons were made between 91 patients and their controls. Multivariate analysis identified urinary catheterization [odds ratio (OR) = 6.21, 95% confidence interval (CI) = 1.91-20.25; p = 0.003], prior exposure to antibiotics (OR = 2.93, 95% CI = 1.18-7.30; p = 0.021) and previous treatment with oxyimino-cephalosporins (OR = 5.16, 95% CI = 1.03-25.79; p = 0.046) as independent predictors for bloodstream infection by ESBL-producing E. coli. Conversely, patients classified as having a community-acquired infection were less likely to acquire bacteremia caused by ESBL-producing E. coli than those caused by non-ESBL-producing E. coli (OR = 0.22, 95% CI = 0.09-0.57; p = 0.002). CONCLUSION: More judicious use of antimicrobial agents, especially oxyimino-cephalosporins, and avoidance of urinary catheterization may decrease the possibility of ESBL-producing E. coli bacteremia in hospitalized patients.
引用
收藏
页码:310 / 316
页数:7
相关论文
共 39 条
[1]   Clinical and Molecular Epidemiology of Healthcare-Associated Infections Due to Extended-Spectrum β-Lactamase (ESBL) Producing Strains of Escherichia coli and Klebsiella pneumoniae That Harbor Multiple ESBL Genes [J].
Apisarnthanarak, Anucha ;
Kiratisin, Pattarachai ;
Mundy, Linda M. .
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2008, 29 (11) :1026-1034
[2]   Clinical and molecular epidemiology of community-onset, extendedspectrum β-lactamase-producing Escherichia coli infections in Thailand:: A case-case-control study [J].
Apisarnthanarak, Anucha ;
Kiratisin, Patarachai ;
Saifon, Piyawan ;
Kitphati, Rungrueng ;
Dejsirilert, Surang ;
Mundy, Linda M. .
AMERICAN JOURNAL OF INFECTION CONTROL, 2007, 35 (09) :606-612
[3]   CEFTAZIDIME RESISTANCE AMONG SELECTED NOSOCOMIAL GRAM-NEGATIVE BACILLI IN THE UNITED-STATES [J].
BURWEN, DR ;
BANERJEE, SN ;
GAYNES, RP .
JOURNAL OF INFECTIOUS DISEASES, 1994, 170 (06) :1622-1625
[4]   Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum β-lactamases [J].
Calbo, E ;
Romaní, V ;
Xercavins, M ;
Gómez, L ;
Vidal, CG ;
Quintana, S ;
Vila, J ;
Garau, J .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2006, 57 (04) :780-783
[5]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[6]   Evaluation of risk factors for the acquisition of bloodstream infections with extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species in the intensive care unit;: antibiotic management and clinical outcome [J].
Cordery, R. J. ;
Roberts, C. H. ;
Cooper, S. J. ;
Bellinghan, G. ;
Shetty, N. .
JOURNAL OF HOSPITAL INFECTION, 2008, 68 (02) :108-115
[7]   Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection:: risk factors and clinical outcome [J].
Du, B ;
Long, Y ;
Liu, HZ ;
Chen, DC ;
Liu, DW ;
Xu, YC ;
Xie, XL .
INTENSIVE CARE MEDICINE, 2002, 28 (12) :1718-1723
[8]   Community-onset genitourinary tract infection due to CTX-M-15-producing Escherichia coli among travelers to the Indian subcontinent in New Zealand [J].
Freeman, Joshua T. ;
McBride, Stephen J. ;
Heffernan, Helen ;
Bathgate, Tracy ;
Pope, Chris ;
Ellis-Pegler, Roderick B. .
CLINICAL INFECTIOUS DISEASES, 2008, 47 (05) :689-692
[9]   CDC DEFINITIONS FOR NOSOCOMIAL INFECTIONS, 1988 [J].
GARNER, JS ;
JARVIS, WR ;
EMORI, TG ;
HORAN, TC ;
HUGHES, JM .
AMERICAN JOURNAL OF INFECTION CONTROL, 1988, 16 (03) :128-140
[10]   Community emergence of CTX-M type extended-spectrum β-lactamases among urinary Escherichia coli from women [J].
Ho, P. L. ;
Poon, Winnie W. N. ;
Loke, S. L. ;
Leung, Marianne S. T. ;
Chow, K. H. ;
Wong, River C. W. ;
Yip, K. S. ;
Lai, Eileen L. ;
Tsang, Kenneth W. T. .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2007, 60 (01) :140-144