Risk Factors and Molecular Epidemiology of Community-Onset Extended-Spectrum β-Lactamase-Producing Escherichia coli Bacteremia

摘要

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 CTX-M-15 (n=31) followed by bla _CTX-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.