A Multinational Survey of Risk Factors for Infection with Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Nonhospitalized Patients
Background. Infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are increasing in frequency and are associated with high mortality rates. Circulation of CTX-M-type ESBLs in the community is of particular concern, because it may confound standard infection-control measures. Methods. We analyzed the results of epidemiologic studies of infection caused by ESBL-producing Enterobacteriaceae in nonhospitalized patients from 6 centers in Europe, Asia, and North America. Risk factors for infection with an ESBL-producing organism were identified by univariate and multivariate analyses. Results. A total of 983 patient-specific isolates were reviewed (890 [90.5%] of which were Escherichia coli, 68 [6.9%] of which were Klebsiella species, and 25 [2.5%] of which were Proteus mirabilis); 339 [34.5%] of the isolates produced ESBLs. CTX-M types were the most frequent ESBLs (accounting for 65%). Rates of co-resistance to ciprofloxacin among ESBL-producing isolates were high (> 70%), but significant variation was seen among centers with respect to rates of resistance to gentamicin, amoxicillin-clavulanate, and trimethoprim-sulfamethoxazole. Similar risk factors for infection with an ESBL-producing organism were found in the different participating centers. Significant risk factors, identified by multivariate analysis, were recent antibiotic use, residence in a longterm care facility, recent hospitalization, age ≥65 years, and male sex (area under the receiver-operator characteristic [ROC] curve, 0.80). However, 34% of ESBL-producing isolates (115 of 336 isolates) were obtained from patients with no recent health care contact; the area under the ROC curve for the multivariate model for this group of patients was only 0.70, which indicated poorer predictive value. Conclusions. Community-acquired ESBL-producing Enterobacteriaceae are now prevalent worldwide, necessitating international collaboration. Novel approaches are required to adequately address issues such as empirical treatment for severe community-acquired infection and infection control..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2009 |
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| Erschienen: |
2009 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:49 |
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| Enthalten in: |
Clinical Infectious Diseases - 49(2009), 5, Seite 682-690 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ben-Ami, Ronen [VerfasserIn] |
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JST091916178 |
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| 520 | |a Background. Infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are increasing in frequency and are associated with high mortality rates. Circulation of CTX-M-type ESBLs in the community is of particular concern, because it may confound standard infection-control measures. Methods. We analyzed the results of epidemiologic studies of infection caused by ESBL-producing Enterobacteriaceae in nonhospitalized patients from 6 centers in Europe, Asia, and North America. Risk factors for infection with an ESBL-producing organism were identified by univariate and multivariate analyses. Results. A total of 983 patient-specific isolates were reviewed (890 [90.5%] of which were Escherichia coli, 68 [6.9%] of which were Klebsiella species, and 25 [2.5%] of which were Proteus mirabilis); 339 [34.5%] of the isolates produced ESBLs. CTX-M types were the most frequent ESBLs (accounting for 65%). Rates of co-resistance to ciprofloxacin among ESBL-producing isolates were high (> 70%), but significant variation was seen among centers with respect to rates of resistance to gentamicin, amoxicillin-clavulanate, and trimethoprim-sulfamethoxazole. Similar risk factors for infection with an ESBL-producing organism were found in the different participating centers. Significant risk factors, identified by multivariate analysis, were recent antibiotic use, residence in a longterm care facility, recent hospitalization, age ≥65 years, and male sex (area under the receiver-operator characteristic [ROC] curve, 0.80). However, 34% of ESBL-producing isolates (115 of 336 isolates) were obtained from patients with no recent health care contact; the area under the ROC curve for the multivariate model for this group of patients was only 0.70, which indicated poorer predictive value. Conclusions. Community-acquired ESBL-producing Enterobacteriaceae are now prevalent worldwide, necessitating international collaboration. Novel approaches are required to adequately address issues such as empirical treatment for severe community-acquired infection and infection control. | ||
| 540 | |a Copyright 2009 Infectious Diseases Society of America | ||
| 655 | 4 | |a research-article | |
| 700 | 1 | |a Rodríguez-Baño, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Arslan, Hande |e verfasserin |4 aut | |
| 700 | 1 | |a Pitout, Johann D. D. |e verfasserin |4 aut | |
| 700 | 1 | |a Quentin, Claudine |e verfasserin |4 aut | |
| 700 | 1 | |a Calbo, Esther S. |e verfasserin |4 aut | |
| 700 | 1 | |a Azap, Özlem K. |e verfasserin |4 aut | |
| 700 | 1 | |a Arpin, Corinne |e verfasserin |4 aut | |
| 700 | 1 | |a Pascual, Alvaro |e verfasserin |4 aut | |
| 700 | 1 | |a Livermore, David M. |e verfasserin |4 aut | |
| 700 | 1 | |a Garau, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Carmeli, Yehuda |e verfasserin |4 aut | |
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