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Risk Factors and Molecular Epidemiology of Community-Onset Extended-Spectrum β-Lactamase-Producing Escherichia coli Bacteremia

 Yoon Soo Park  ;  Il Kwon Bae  ;  Juwon Kim  ;  Seok Hoon Jeong  ;  Seung-sik Hwang  ;  Yiel-Hea Seo  ;  Yong Kyun Cho  ;  Kyungwon Lee  ;  June Myung Kim 
 YONSEI MEDICAL JOURNAL, Vol.55(2) : 467-475, 2014 
Journal Title
Issue Date
Age Factors ; Aged ; Bacteremia/epidemiology* ; Bacteremia/microbiology* ; Case-Control Studies ; Cephalosporins/therapeutic use ; Community-Acquired Infections/epidemiology ; Community-Acquired Infections/microbiology ; Decision Making, Computer-Assisted ; Escherichia coli/metabolism* ; Escherichia coli/pathogenicity ; Escherichia coli Infections/epidemiology* ; Escherichia coli Infections/microbiology* ; Humans ; Middle Aged ; Molecular Epidemiology ; Republic of Korea/epidemiology ; Risk Factors ; Tertiary Care Centers ; Urinary Tract Infections/epidemiology ; Urinary Tract Infections/microbiology ; beta-Lactamases/genetics ; beta-Lactamases/metabolism*
CTX-M ; Escherichia coli ; Risk factors ; beta-lactamase
PURPOSE: Inadequate empirical therapy for severe infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. MATERIALS AND METHODS: A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. RESULTS: Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95% CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95% CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95% CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum β-lactamase (ESBL) gene identified was blaCTX-M-15 (n=31) followed by blaCTX-M-14 (n=23). CONCLUSION: The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.
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1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ju Won(김주원)
Kim, June Myung(김준명)
Bae, Il Kwon(배일권)
Lee, Kyungwon(이경원) ORCID logo https://orcid.org/0000-0003-3788-2134
Jeong, Seok Hoon(정석훈) ORCID logo https://orcid.org/0000-0001-9290-897X
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