 |
|
Community Infections Caused by Extended-Spectrum β-Lactamase–Producing Escherichia coli
Jesús Rodríguez-Baño, MD, PhD;
Juan C. Alcalá, MD;
Jose M. Cisneros, MD, PhD;
Fabio Grill, MD;
Antonio Oliver, PhD;
Juan P. Horcajada, MD, PhD;
Teresa Tórtola, MD;
Beatriz Mirelis, MD, PhD;
Gemma Navarro, MD;
María Cuenca, MD;
María Esteve, MD;
Carmen Peña, MD;
Ana C. Llanos, MD;
Rafael Cantón, PhD;
Alvaro Pascual, MD, PhD
Arch Intern Med. 2008;168(17):1897-1902.
Background Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is an increasingly important group of community pathogens worldwide. These organisms are frequently resistant to many of the antimicrobial agents usually recommended for the treatment of infections caused by E coli, such as penicillins, cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Data concerning risk factors, clinical features, and therapeutic options for such infections are scarce.
Methods A case-control study was performed to investigate the risk factors for all types of community-acquired infections caused by ESBL-producing E coli in 11 Spanish hospitals from February 2002 to May 2003. Controls were randomly chosen from among outpatients with a clinical sample not yielding ESBL-producing E coli. The clinical features of these infections were investigated in the case patients. The efficacy of fosfomycin tromethamine and amoxicillin-clavulanate potassium was observationally studied in patients with cystitis.
Results A total of 122 cases were included. Risk factors selected by multivariate analysis included the following: age older than 60 years; female sex; diabetes mellitus; recurrent urinary tract infections (UTIs); previous invasive procedures of the urinary tract; follow-up in outpatient clinic; and previous receipt of aminopenicillins, cephalosporins, and fluoroquinolones. Urinary tract infections accounted for 93% of the cases; 6% of the patients were bacteremic and 10% needed hospitalization. The cure rate of patients with cystitis was 93% with fosfomycin therapy (all isolates were susceptible); among patients treated with amoxicillin-clavulanate, cure rates were 93% for those with susceptible isolates (minimum inhibitory concentration  8 µg/mL) and 56% for those with intermediate or resistant isolates (minimum inhibitory concentration  16 µg/mL) (P = .02).
Conclusions In predisposed patients, ESBL-producing E coli is a notable cause of community-acquired infection, and particularly UTI. Fosfomycin and amoxicillin-clavulanate appear to be effective for cystitis caused by susceptible isolates.
Author Affiliations: Sección de Enfermedades Infecciosas (Dr Rodríguez-Baño) and Servicio de Microbiología (Drs Alcalá and Pascual), Hospital Universitario Virgen Macarena, Seville, Spain; Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Seville (Drs Cisneros and Llanos); Servicios de Enfermedades Infecciosas (Dr Grill) and Microbiología (Dr Cantón), Hospital Universitario Ramón y Cajal, Madrid, Spain; Servicio de Microbiología, Hospital Son Dureta, Palma de Majorca, Spain (Dr Oliver); Servicio de Enfermedades Infecciosas, Hospital Clinic, Barcelona, Spain (Dr Horcajada); Servicio de Microbiología, Hospital Vall d’Hebrón, Barcelona (Dr Tórtola); Servicio de Microbiología, Hospital Santa Creu i San Pau, Barcelona (Dr Mirelis); Unidad de Epidemiología, Corporación Sanitaria Parc Taulí, Sabadell, Spain (Dr Navarro); Servicio de Microbiología, Hospital de la Ribera, Alcira (Valencia), Spain (Dr Cuenca); Unidad de Medicina Preventiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain (Dr Esteve); and Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Barcelona (Dr Peña). Dr Horcajada is now with the Sección de Enfermedades Infecciosas, Hospital del Mar, Barcelona.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
Risk Factors for Community-Acquired Infections Caused by Extended-Spectrum β-Lactamase–Producing Escherichia coli
Keli Cristine Reiter, Sandra C. Fuchs, Nêmora T. Barcellos, and Alexandre P. Zavascki
Arch Intern Med. 2009;169(8):811.
EXTRACT
| FULL TEXT
Risk Factors for Community-Acquired Infections Caused by Extended-Spectrum β-Lactamase–Producing Escherichia coli—Reply
Jesús Rodríguez-Baño and Alvaro Pascual
Arch Intern Med. 2009;169(8):811-812.
EXTRACT
| FULL TEXT
RELATED ARTICLE
In This Issue of Archives of Internal Medicine
Arch Intern Med. 2008;168(17):1842.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
CTX-M-15-producing urinary Escherichia coli O25b-ST131-phylogroup B2 has acquired resistance to fosfomycin
Oteo et al.
J Antimicrob Chemother 2009;64:712-717.
ABSTRACT
| FULL TEXT
Susceptibility of Urinary Tract Bacteria to Fosfomycin
Maraki et al.
Antimicrob. Agents Chemother. 2009;53:4508-4510.
ABSTRACT
| FULL TEXT
Risk Factors for Community-Acquired Infections Caused by Extended-Spectrum {beta}-Lactamase-Producing Escherichia coli
Reiter et al.
Arch Intern Med 2009;169:811-811.
FULL TEXT
Risk Factors for Community-Acquired Infections Caused by Extended-Spectrum {beta}-Lactamase-Producing Escherichia coli--Reply
Rodriguez-Bano and Pascual
Arch Intern Med 2009;169:811-812.
FULL TEXT
Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections: results of the French prospective, observational EBIIA study
Montravers et al.
J Antimicrob Chemother 2009;63:785-794.
ABSTRACT
| FULL TEXT
Escherichia coli producing SHV-type extended-spectrum {beta}-lactamase is a significant cause of community-acquired infection
Rodriguez-Bano et al.
J Antimicrob Chemother 2009;63:781-784.
ABSTRACT
| FULL TEXT
Oral and Parenteral Therapeutic Options for Outpatient Urinary Infections Caused by Enterobacteriaceae Producing CTX-M Extended-Spectrum {beta}-Lactamases
Prakash et al.
Antimicrob. Agents Chemother. 2009;53:1278-1280.
ABSTRACT
| FULL TEXT
Carbapenem-Resistant Enterobacteriaceae: A Potential Threat
Schwaber and Carmeli
JAMA 2008;300:2911-2913.
FULL TEXT
|
