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Changing epidemiology of infections due to extended spectrum beta-lactamase producing bacteria.

Kassakian SZ, Mermel LA - Antimicrob Resist Infect Control (2014)

Bottom Line: Fifty-eight cases (18%) were community-acquired, 170 (53%) were healthcare-associated, and 93 (29%) were hospital-acquired.For ESBL-producing E. coli isolates, resistance to both ciprofloxacin and trimethoprim-sulfamethoxazole was 95% and 65%, respectively but 94% of isolates were susceptible to nitrofurantoin.Most isolates are resistant to oral antibiotics commonly used to treat urinary tract infections.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. lmermel@lifespan.org.

ABSTRACT

Background: Community-associated infections caused by extended-spectrum beta-lactamase (ESBL) producing bacteria are a growing concern.

Methods: Retrospective cohort study of clinical infections due to ESBL-producing bacteria requiring admission from 2006-2011 at a tertiary care academic medical center in Providence, RI.

Results: A total of 321 infections due to ESBL-producing bacteria occurred during the study period. Fifty-eight cases (18%) were community-acquired, 170 (53%) were healthcare-associated, and 93 (29%) were hospital-acquired. The incidence of ESBL infections per 10,000 discharges increased during the study period for both healthcare-associated infections, 1.9 per year (95% CI 1-2.8), and for community-acquired infections, 0.85 per year (95% CI 0.3-1.4) but the rate remained unchanged for hospital-acquired infections. For ESBL-producing E. coli isolates, resistance to both ciprofloxacin and trimethoprim-sulfamethoxazole was 95% and 65%, respectively but 94% of isolates were susceptible to nitrofurantoin.

Conclusions: Community-acquired and healthcare-associated infections due to ESBL-producing bacteria are increasing in our community, particularly urinary tract infections due to ESBL-producing E. coli. Most isolates are resistant to oral antibiotics commonly used to treat urinary tract infections. Thus, our findings have important implications for outpatient management of such infections.

No MeSH data available.


Related in: MedlinePlus

Origin of infection due to ESBL-producing bacteria. Incidence of infections due to ESBL-producing bacteria by classification of origin over the study period.
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Figure 1: Origin of infection due to ESBL-producing bacteria. Incidence of infections due to ESBL-producing bacteria by classification of origin over the study period.

Mentions: During the study period, there were 321 incident infections due to ESBL-producing bacteria. Twenty-six patients experienced more than one infection. One patient had two different ESBL-producing bacteria in the same clinical sample at one time. The number of infections due to these pathogens increased consistently from 23 infections in 2006 to 81 in 2011 (Figure 1). Overall, 58 cases (18%) were community-acquired, 170 (53%) healthcare–associated, and 93 (29%) hospital-acquired. The incidence of infection due to ESBL-producing bacteria per 10,000 discharges increased significantly during the study period for health-care associated infections, 1.9 per year (95% CI 1-2.8; p = .003) and for community-acquired infections, 0.85 per year (95% CI 0.3-1.4; p = .01). There was no significant change in the hospital-acquired infection group. When this analysis was repeated after removing 26 recurrent episodes of infections, none of the significant changes over time became non-significant (data not shown).


Changing epidemiology of infections due to extended spectrum beta-lactamase producing bacteria.

Kassakian SZ, Mermel LA - Antimicrob Resist Infect Control (2014)

Origin of infection due to ESBL-producing bacteria. Incidence of infections due to ESBL-producing bacteria by classification of origin over the study period.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230027&req=5

Figure 1: Origin of infection due to ESBL-producing bacteria. Incidence of infections due to ESBL-producing bacteria by classification of origin over the study period.
Mentions: During the study period, there were 321 incident infections due to ESBL-producing bacteria. Twenty-six patients experienced more than one infection. One patient had two different ESBL-producing bacteria in the same clinical sample at one time. The number of infections due to these pathogens increased consistently from 23 infections in 2006 to 81 in 2011 (Figure 1). Overall, 58 cases (18%) were community-acquired, 170 (53%) healthcare–associated, and 93 (29%) hospital-acquired. The incidence of infection due to ESBL-producing bacteria per 10,000 discharges increased significantly during the study period for health-care associated infections, 1.9 per year (95% CI 1-2.8; p = .003) and for community-acquired infections, 0.85 per year (95% CI 0.3-1.4; p = .01). There was no significant change in the hospital-acquired infection group. When this analysis was repeated after removing 26 recurrent episodes of infections, none of the significant changes over time became non-significant (data not shown).

Bottom Line: Fifty-eight cases (18%) were community-acquired, 170 (53%) were healthcare-associated, and 93 (29%) were hospital-acquired.For ESBL-producing E. coli isolates, resistance to both ciprofloxacin and trimethoprim-sulfamethoxazole was 95% and 65%, respectively but 94% of isolates were susceptible to nitrofurantoin.Most isolates are resistant to oral antibiotics commonly used to treat urinary tract infections.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. lmermel@lifespan.org.

ABSTRACT

Background: Community-associated infections caused by extended-spectrum beta-lactamase (ESBL) producing bacteria are a growing concern.

Methods: Retrospective cohort study of clinical infections due to ESBL-producing bacteria requiring admission from 2006-2011 at a tertiary care academic medical center in Providence, RI.

Results: A total of 321 infections due to ESBL-producing bacteria occurred during the study period. Fifty-eight cases (18%) were community-acquired, 170 (53%) were healthcare-associated, and 93 (29%) were hospital-acquired. The incidence of ESBL infections per 10,000 discharges increased during the study period for both healthcare-associated infections, 1.9 per year (95% CI 1-2.8), and for community-acquired infections, 0.85 per year (95% CI 0.3-1.4) but the rate remained unchanged for hospital-acquired infections. For ESBL-producing E. coli isolates, resistance to both ciprofloxacin and trimethoprim-sulfamethoxazole was 95% and 65%, respectively but 94% of isolates were susceptible to nitrofurantoin.

Conclusions: Community-acquired and healthcare-associated infections due to ESBL-producing bacteria are increasing in our community, particularly urinary tract infections due to ESBL-producing E. coli. Most isolates are resistant to oral antibiotics commonly used to treat urinary tract infections. Thus, our findings have important implications for outpatient management of such infections.

No MeSH data available.


Related in: MedlinePlus