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 - 01-04-2012

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Cephalosporins
Odds Ratio
Confidence Intervals
Escherichia coli
Plasmids
meropenem
doripenem
Cephalosporin Resistance
Intraabdominal Infections
Nitrofurantoin
Urinary Catheters
Connective Tissue Diseases
Amikacin
Imipenem
Infection
Health Status
Hospitalization
Cardiovascular Diseases
Therapeutics
Genes

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Park, Yoon Soo ; Adams-Haduch, Jennifer M. ; Shutt, Kathleen A. ; Yarabinec, Daniel M. ; Johnson, Laura E. ; Hingwe, Ameet ; Lewis, James S. ; Jorgensen, James H. ; Doi, Yohei. / Clinical and microbiologic characteristics of cephalosporin-resistant escherichia coli at three centers in the United States. In: Antimicrobial agents and chemotherapy. 2012 ; Vol. 56, No. 4. pp. 1870-1876.
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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.",
author = "Park, {Yoon Soo} and Adams-Haduch, {Jennifer M.} and Shutt, {Kathleen A.} and Yarabinec, {Daniel M.} and Johnson, {Laura E.} and Ameet Hingwe and Lewis, {James S.} and Jorgensen, {James H.} and Yohei Doi",
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Park, YS, Adams-Haduch, JM, Shutt, KA, Yarabinec, DM, Johnson, LE, Hingwe, A, Lewis, JS, Jorgensen, JH & Doi, Y 2012, 'Clinical and microbiologic characteristics of cephalosporin-resistant escherichia coli at three centers in the United States', Antimicrobial agents and chemotherapy, vol. 56, no. 4, pp. 1870-1876. https://doi.org/10.1128/AAC.05650-11

Clinical and microbiologic characteristics of cephalosporin-resistant escherichia coli at three centers in the United States. / Park, Yoon Soo; Adams-Haduch, Jennifer M.; Shutt, Kathleen A.; Yarabinec, Daniel M.; Johnson, Laura E.; Hingwe, Ameet; Lewis, James S.; Jorgensen, James H.; Doi, Yohei.

In: Antimicrobial agents and chemotherapy, Vol. 56, No. 4, 01.04.2012, p. 1870-1876.

Research output: Contribution to journalArticle

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T1 - Clinical and microbiologic characteristics of cephalosporin-resistant escherichia coli at three centers in the United States

AU - Park, Yoon Soo

AU - Adams-Haduch, Jennifer M.

AU - Shutt, Kathleen A.

AU - Yarabinec, Daniel M.

AU - Johnson, Laura E.

AU - Hingwe, Ameet

AU - Lewis, James S.

AU - Jorgensen, James H.

AU - Doi, Yohei

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N2 - 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.

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