A multinational survey of risk factors for infection with extended-spectrum β-lactamase-producing enterobacteriaceae in nonhospitalized patients

Ronen Ben-Ami, Jesús Rodríguez-Baño, Hande Arslan, Johann D.D. Pitout, Claudine Quentin, Esther S. Caibo, Özlem K. Azap, Corinne Arpin, Alvaro Pascual, David M. Livermore, Javier Garau, Yehuda Carmeli

Research output: Contribution to journalArticlepeer-review

Abstract

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. 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. 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. 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.

Original languageEnglish
Pages (from-to)682-690
Number of pages9
JournalClinical Infectious Diseases
Volume49
Issue number5
DOIs
StatePublished - 1 Sep 2009
Externally publishedYes

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