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Jesús Rodríguez-Baño, MD, PhD; Alvaro Pascual, MD, PhD

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We appreciate the comments made by Reiter et al about our study of community infections caused by ESBL-producing E coli¹ and would like to respond to their concerns. Reiter et al are surprised that we included community-onset, health care–associated infections in our study because these infections have "features that resemble those of nosocomial infections." This statement, however, has been studied for bloodstream infections² and pneumonia³ but not for urinary tract or intra-abdominal infections, which accounted for more than 95% of our cases. It is clinically sound to include all community-onset infections caused by ESBL-producing E coli because it reflects the problems faced by physicians in primary care and emergency departments. Hospital admission during the previous year was not an independent risk factor in our study; since 22% of 122 cases and 13% of 244 controls had been hospitalized during the . . . [Full Text of this Article]

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