Clinical and microbiologic characteristics of cephalosporin-resistant escherichia coli at three centers in the United States

Yoon Soo Park, Jennifer M. Adams-Haduch, Kathleen A. Shutt, Daniel M. Yarabinec, Laura E. Johnson, Ameet Hingwe, James S. Lewis, James H. Jorgensen, Yohei Doi

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Abstract

We investigated the clinical and microbiologic features of 300 cases of cephalosporin-resistant Escherichia coli producing extended-spectrum β-lactamase (ESBL) or plasmid-mediated AmpC β-lactamase (pAmpC) at three medical centers in the United States. Solid-organ malignancy, connective tissue disease, and a recent history of surgery were more common among pAmpC-producing cases (n = 49), whereas urinary catheter at enrollment, diabetes, and hospitalization in the past year were more common among ESBL-producing cases (n = 233). The factors independently associated with clinical outcome were the following: the presence of cardiovascular disease (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.29 to 6.43), intra-abdominal infection (OR, 6.35; 95% CI, 1.51 to 26.7), other or multiples sources of infection (OR, 8.12; 95% CI, 2.3 to 28.6), age of 65 years or greater (OR, 0.43; 95% CI, 0.2 to 0.95), favorable baseline health status (OR, 0.39; 95% CI, 0.16 to 0.95), and appropriate empirical antimicrobial therapy given in the first 72 h (OR, 0.42; 95% CI, 0.20 to 0.88). β-Lactamase genes responsible for cephalosporin resistance were identified in 291 cases. CTX-M-type ESBLs accounted for 72.0%. Of those, 88.0% were CTX-M-15. The next most common type was CMY-type pAmpC (16.7%), followed by SHV- and TEM-type ESBLs (6.3 and 1.3%, respectively). Seven cases (2.3%) had KPC-type β-lactamase. Ertapenem, imipenem, meropenem, doripenem, piperacillin-tazobactam, amikacin, nitrofurantoin, and tigecycline were highly active, with greater than 90% of the isolates being susceptible. Cefepime was less active, with only 74.2% being susceptible due to the predominance of CTX-M-15. These findings have implications in the selection of appropriate empirical therapy when infection due to cephalosporin-resistant E. coli is suspected.

Original languageEnglish
Pages (from-to)1870-1876
Number of pages7
JournalAntimicrobial agents and chemotherapy
Volume56
Issue number4
DOIs
Publication statusPublished - 04-2012

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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    Park, Y. S., Adams-Haduch, J. M., Shutt, K. A., Yarabinec, D. M., Johnson, L. E., Hingwe, A., Lewis, J. S., Jorgensen, J. H., & Doi, Y. (2012). Clinical and microbiologic characteristics of cephalosporin-resistant escherichia coli at three centers in the United States. Antimicrobial agents and chemotherapy, 56(4), 1870-1876. https://doi.org/10.1128/AAC.05650-11