Risks Factors for Infections with Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care University Hospital in Switzerland

• Published in: Infection Vol. 38; no. 1; pp. 33 - 40
• Main Authors: Kuster, S. P, Hasse, B, Huebner, V, Bansal, V, Zbinden, R, Ruef, C, Ledergerber, B, Weber, R
• Format: Journal Article
• Language: English
• Published: Munich Munich : Urban & Vogel 01.02.2010; Urban & Vogel; Springer; Springer Nature B.V
• Subjects: Anti-Bacterial Agents - therapeutic use; beta-Lactam Resistance; beta-Lactamases - biosynthesis; Biological and medical sciences; Case-Control Studies; Clinical and Epidemiological Study; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; E coli; Escherichia coli; Escherichia coli - enzymology; Escherichia coli - isolation & purification; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Family Medicine; General Practice; Hospitals, University; Humans; Infectious Diseases; Internal Medicine; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella pneumoniae; Klebsiella pneumoniae - enzymology; Klebsiella pneumoniae - isolation & purification; Medical instruments; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk assessment; Risk Factors; Switzerland - epidemiology; Travel; Switzerland; Recurrent Urinary Tract Infection; Clin Microbiol Infect; Bloodstream Infection; Antimicrob Agent; Chronic Disease Score; Nosocomial infection; Data analysis; Teaching hospital; Urinary system disease; Escherichia coli; Catheter; Case control study; Artificial ventilation; Infection; Antibiotic; Risk factor; Bacteriosis; Bacteria; Hospital; Hygiene; Resuscitation; Enterobacteriaceae
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-009-9207-z

Background: There are considerable geographical differencesin the occurrence of extended-spectrum beta-lactamase(ESBL)-producing bacteria, both in the community and in thehospital setting. Our aim was to assess risk factors forbloodstream, urinary tract, and vascular catheter-associatedinfections with ESBL-producing Escherichia coli and Klebsiellapneumoniae at a tertiary care hospital in a low-prevalencecountry. Methods: We performed a case-control study comparing 58patients with infections due to ESBL-producing E. coli orK. pneumoniae vs 116 controls with infections due to non-ESBL producing organisms at the University Hospital Zurich,Switzerland, between 1 July 2005 and 30 June 2007. Results: Cases included 15 outpatients and 43 inpatients.Multivariable analyses found three risk factors for ESBL-producingisolates: begin of symptoms or recent antibioticpre-treatment in a foreign country (odds ratio [OR] 27.01,95% confidence interval [CI] 2.38-1,733.28], p = 0.042),antibiotic therapy within the year preceding the isolation ofthe ESBL-producing strain (OR 2.88, 95% CI 1.13-8.49,p = 0.025), and mechanical ventilation (OR 10.56, 95% CI1.06-579.10, p = 0.042). Conclusions: The major risk factors for infections due toESBL-producing bacteria were travel in high-prevalencecountries, prior antibiotic use, and mechanical ventilationduring a stay in the intensive care unit. Community-acquiredinfections were documented in 17% of the patients.An early identification of risk factors is crucial to providingthe patients an optimal empiric antibiotic therapy and tokeep the use of carbapenems to a minimum.