Prevalence of and risk factor for community-onset third-generation cephalosporin-resistant Escherichia coli bacteremia at a medical center in Taiwan

• Published in: BMC infectious diseases Vol. 19; no. 1; p. 245
• Main Authors: Lin, Wu-Pu, Huang, Yu-Shan, Wang, Jann-Tay, Chen, Yee-Chun, Chang, Shan-Chwen
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.03.2019; BioMed Central; BMC
• Subjects: Analysis; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Appropriate empirical treatment; Bacteremia; Bacteria; Care and treatment; Cephalosporins; Community-onset infection; Confidence intervals; Drug resistance; E coli; Emergency medical care; Empirical analysis; Escherichia coli; Escherichia coli infections; Health care facilities; Health care industry; Health facilities; Health risks; Health services; Immunology; Impact resistance; Infection; Infections; Infectious diseases; Intravenous administration; Long term care; Long term health care; Medical centers; Microbial drug resistance; Mortality; Older people; Outpatient care facilities; Pathogenic microorganisms; Pathogens; Patients; Prevalence studies (Epidemiology); Prostheses and implants; Resistance factors; Risk analysis; Risk factors; Teachers; Teaching hospitals; Third-generation cephalosporin resistance; Taiwan; Appropriate empirical treatment; Community-onset infection; Third-generation cephalosporin resistance; Escherichia coli; Bacteremia
• DOI: 10.1186/s12879-019-3880-z
• ISSN: 1471-2334

Increased resistance to third-generation cephalosporin (3GC) is a serious concern for community-onset Escherichia coli infection because this resistance easily delays effective treatment. This study surveyed the current antimicrobial resistance pattern among E. coli isolates that cause community-onset bacteremia, with a special focus on the prevalence of and the risk factors for 3GC resistance, and determined factors for poor outcomes among patients with community-onset E. coli bacteremia. This retrospective study was conducted at a tertiary-care teaching hospital in Taiwan. All adult patients with community-onset E. coli bacteremia between January 1, 2015, and December 31, 2015 were enrolled and were divided into two groups depending on whether the E. coli isolate was susceptible to 3GCs. Risk factors for 3GC resistance, 14-day all-cause mortality, and length of hospital stay were analyzed. The overall rate of 3GC resistance among E. coli isolates causing community-onset bacteremia was 19.7%, whereas it was 9.6% if only isolates causing community-acquired bacteremia were considered. Independent risk factors for 3GC-resistant community-onset E. coli bacteremia were hospitalization within the past 1 year (odds ratio: 2.4, 95% confidence interval: 1.6-3.7, P < 0.001), exposure to antibiotics within the past 15 days (2.6, 1.4-4.9, P = 0.002), residence in nursing home or long-term care facility (3.6, 1.0-12.3, P = 0.044), presence of underlying genitourinary disease (1.9, 1.2-2.9, P = 0.005), and presence of indwelling implantable intravenous port (2.2, 1.1-4.1, P = 0.021). 3GC resistance was independently associated with increased length of hospital stays (P < 0.001). In this study, the prevalence of 3GC resistance was high among both patients with community-onset and those with community-acquired E. coli bacteremia. 3GC resistance is a strong independent risk factor for length of hospital stay. The effectiveness of empirical antibiotic treatment would partially explain the impact of 3GC resistance, but more evidence is needed. The choice of appropriate empirical antibiotics for community-onset E. coli bacteremia might impact outcomes in terms of the length of hospital stay and need to be individualized according to the patient-specific risk for acquiring drug-resistant pathogens.