Abstract:
BACKGROUND:Extended-spectrum beta-lactamase (ESBL)-producing organisms, first identified in Germany in 1983, are now widely recognized as clinically relevant causes of infections in community. METHODS:Our objective was to evaluate the clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase (CO-ESBL)-producing Escherichia coli infections. We used a case-case-control study undertaken in a 450-bed, tertiary care hospital. Patients included case group (CG) I, which had confirmed CO-ESBL-producing E coli infections (n=46). Case group (CG) II (n=46) included patients with CO-non-ESBL-producing E coli infections. Controls (n=138) were patients without infections. RESULTS:By multivariate analysis, diabetes (95% confidence interval [CI]: 1.9-13.2, P< .001), prior ESBL E coli colonization (<90 days) (95% CI: 1.2-67.8, P< .001), recent receipt of antibiotics (<90 days) (95% CI: 4.2-44.2, P= .004), and previous exposure to third-generation cephalosporins (95% CI: 2.2-16.4, P= .001) and fluoroquinolones (95% CI: 1.4-18.3; P= .003) were associated risks among CG I. Diabetes (95% CI: 1.6-15.4, P= .005), stroke (95% CI: 1.5-17.1, P= .001), and diarrhea (95% CI: 3.8-65.8, P= .001) were risks among CG II. Patients with CO-ESBL in CG I versus controls were more likely to die (30% vs 0%, respectively; P< .001), had prolonged hospital length of stay (8 vs 5 days, respectively; P< .001), and had higher hospitalization costs (median, US $528 vs $108, respectively; P< .001). The plasmid carrying the CTX-M-15 gene was identified in 13 of 25 (52%) available CO-ESBL-producing E coli isolates. CONCLUSION:CO-ESBL-producing E coli is an emerging multidrug-resistant microorganism in Thailand. Patients with prior ESBL colonization and recent antibiotic exposures, especially to third-generation cephalosporins and fluoroquinolones, were at risk for CO-ESBL-producing E coli infection.
journal_name
Am J Infect Controljournal_title
American journal of infection controlauthors
Apisarnthanarak A,Kiratisin P,Saifon P,Kitphati R,Dejsirilert S,Mundy LMdoi
10.1016/j.ajic.2007.05.008subject
Has Abstractpub_date
2007-11-01 00:00:00pages
606-12issue
9eissn
0196-6553issn
1527-3296pii
S0196-6553(07)00620-7journal_volume
35pub_type
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journal_title:American journal of infection control
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journal_title:American journal of infection control
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更新日期:2008-02-01 00:00:00
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journal_title:American journal of infection control
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更新日期:1983-10-01 00:00:00
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更新日期:1993-12-01 00:00:00
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更新日期:2017-08-01 00:00:00
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更新日期:2013-08-01 00:00:00
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更新日期:2007-09-01 00:00:00
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journal_title:American journal of infection control
pub_type: 杂志文章,评审
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