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

• Published in: Journal of microbiology, immunology and infection Vol. 43; no. 4; pp. 310 - 316
• Main Authors: Wu, Un-In, Yang, Ching-Shiang, Chen, Wan-Chin, Chen, Yee-Chun, Chang, Shan-Chwen
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.08.2010
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; bacteremia; Bacteremia - epidemiology; Bacteremia - microbiology; beta-Lactam Resistance; beta-Lactamases - biosynthesis; bloodstream infection; Case-Control Studies; case-control study; Catheterization - adverse effects; Drug Utilization - standards; Escherichia coli; Escherichia coli - enzymology; Escherichia coli - isolation & purification; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Escherichia coli Proteins - biosynthesis; extended-spectrum β-lactamase; Female; Humans; Infectious Disease; Male; Medical Education; Middle Aged; risk factor; Risk Factors; extended-spectrum β-lactamase; bloodstream infection; case-control study; risk factor; Escherichia coli; bacteremia
• ISSN: 1684-1182; 1995-9133; 1995-9133
• DOI: 10.1016/S1684-1182(10)60048-5

The risk factors for production of extended-spectrum β-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. 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. 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). 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.