Community-associated extended-spectrum -lactamase-producing Escherichia coli infection in the United States

Yohei Doi, Yoon Soo Park, Jesabel I. Rivera, Jennifer M. Adams-Haduch, Ameet Hingwe, Emilia M. Sordillo, James S. Lewis, Wanita J. Howard, Laura E. Johnson, Bruce Polsky, James H. Jorgensen, Sandra S. Richter, Kathleen A. Shutt, David L. Paterson

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Abstract

Background. The occurrence of community-associated infections due to extended-spectrum -lactamase (ESBL)-producing Escherichia coli has been recognized as a major clinical problem in Europe and other regions.Methods. We conducted a prospective observational study to examine the occurrence of community-associated infections due to ESBL-producing E. coli at centers in the United States. Five academic and community hospitals and their affiliated clinics participated in this study in 2009 and 2010. Sites of acquisition of the organisms (community-associated or healthcare-associated), risk factors, and clinical outcome were investigated. Screening for the global epidemic sequence type (ST) 131 and determination of the ESBL types was conducted by polymerase chain reaction and sequencing.Results. Of the 291 patients infected or colonized with ESBL-producing E. coli as outpatients or within 48 hours of hospitalization, 107 (36.8%) had community-associated infection (81.5% of which represented urinary tract infection), while the remainder had healthcare-associated infection. Independent risk factors for healthcare-associated infection over community-associated infection were the presence of cardiovascular disease, chronic renal failure, dementia, solid organ malignancy, and hospitalization within the previous 12 months. Of the community-associated infections, 54.2% were caused by the globally epidemic ST131 strain, and 91.3% of the isolates produced CTX-M-type ESBL.Conclusions. A substantial portion of community-onset, ESBL-producing E. coli infections now occur among patients without discernible healthcare-associated risk factors in the United States. This epidemiologic shift has implications for the empiric management of community-associated infection when involvement of E. coli is suspected.

Original languageEnglish
Pages (from-to)641-648
Number of pages8
JournalClinical Infectious Diseases
Volume56
Issue number5
DOIs
Publication statusPublished - 18-02-2013

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Escherichia coli Infections
Infection
Escherichia coli
Cross Infection
Hospitalization
Delivery of Health Care
Community Hospital
Urinary Tract Infections
Chronic Kidney Failure
Observational Studies
Sequence Analysis
Dementia
Outpatients
Cardiovascular Diseases
Prospective Studies
Polymerase Chain Reaction

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Doi, Y., Park, Y. S., Rivera, J. I., Adams-Haduch, J. M., Hingwe, A., Sordillo, E. M., ... Paterson, D. L. (2013). Community-associated extended-spectrum -lactamase-producing Escherichia coli infection in the United States. Clinical Infectious Diseases, 56(5), 641-648. https://doi.org/10.1093/cid/cis942
Doi, Yohei ; Park, Yoon Soo ; Rivera, Jesabel I. ; Adams-Haduch, Jennifer M. ; Hingwe, Ameet ; Sordillo, Emilia M. ; Lewis, James S. ; Howard, Wanita J. ; Johnson, Laura E. ; Polsky, Bruce ; Jorgensen, James H. ; Richter, Sandra S. ; Shutt, Kathleen A. ; Paterson, David L. / Community-associated extended-spectrum -lactamase-producing Escherichia coli infection in the United States. In: Clinical Infectious Diseases. 2013 ; Vol. 56, No. 5. pp. 641-648.
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title = "Community-associated extended-spectrum -lactamase-producing Escherichia coli infection in the United States",
abstract = "Background. The occurrence of community-associated infections due to extended-spectrum -lactamase (ESBL)-producing Escherichia coli has been recognized as a major clinical problem in Europe and other regions.Methods. We conducted a prospective observational study to examine the occurrence of community-associated infections due to ESBL-producing E. coli at centers in the United States. Five academic and community hospitals and their affiliated clinics participated in this study in 2009 and 2010. Sites of acquisition of the organisms (community-associated or healthcare-associated), risk factors, and clinical outcome were investigated. Screening for the global epidemic sequence type (ST) 131 and determination of the ESBL types was conducted by polymerase chain reaction and sequencing.Results. Of the 291 patients infected or colonized with ESBL-producing E. coli as outpatients or within 48 hours of hospitalization, 107 (36.8{\%}) had community-associated infection (81.5{\%} of which represented urinary tract infection), while the remainder had healthcare-associated infection. Independent risk factors for healthcare-associated infection over community-associated infection were the presence of cardiovascular disease, chronic renal failure, dementia, solid organ malignancy, and hospitalization within the previous 12 months. Of the community-associated infections, 54.2{\%} were caused by the globally epidemic ST131 strain, and 91.3{\%} of the isolates produced CTX-M-type ESBL.Conclusions. A substantial portion of community-onset, ESBL-producing E. coli infections now occur among patients without discernible healthcare-associated risk factors in the United States. This epidemiologic shift has implications for the empiric management of community-associated infection when involvement of E. coli is suspected.",
author = "Yohei Doi and Park, {Yoon Soo} and Rivera, {Jesabel I.} and Adams-Haduch, {Jennifer M.} and Ameet Hingwe and Sordillo, {Emilia M.} and Lewis, {James S.} and Howard, {Wanita J.} and Johnson, {Laura E.} and Bruce Polsky and Jorgensen, {James H.} and Richter, {Sandra S.} and Shutt, {Kathleen A.} and Paterson, {David L.}",
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Doi, Y, Park, YS, Rivera, JI, Adams-Haduch, JM, Hingwe, A, Sordillo, EM, Lewis, JS, Howard, WJ, Johnson, LE, Polsky, B, Jorgensen, JH, Richter, SS, Shutt, KA & Paterson, DL 2013, 'Community-associated extended-spectrum -lactamase-producing Escherichia coli infection in the United States', Clinical Infectious Diseases, vol. 56, no. 5, pp. 641-648. https://doi.org/10.1093/cid/cis942

Community-associated extended-spectrum -lactamase-producing Escherichia coli infection in the United States. / Doi, Yohei; Park, Yoon Soo; Rivera, Jesabel I.; Adams-Haduch, Jennifer M.; Hingwe, Ameet; Sordillo, Emilia M.; Lewis, James S.; Howard, Wanita J.; Johnson, Laura E.; Polsky, Bruce; Jorgensen, James H.; Richter, Sandra S.; Shutt, Kathleen A.; Paterson, David L.

In: Clinical Infectious Diseases, Vol. 56, No. 5, 18.02.2013, p. 641-648.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Community-associated extended-spectrum -lactamase-producing Escherichia coli infection in the United States

AU - Doi, Yohei

AU - Park, Yoon Soo

AU - Rivera, Jesabel I.

AU - Adams-Haduch, Jennifer M.

AU - Hingwe, Ameet

AU - Sordillo, Emilia M.

AU - Lewis, James S.

AU - Howard, Wanita J.

AU - Johnson, Laura E.

AU - Polsky, Bruce

AU - Jorgensen, James H.

AU - Richter, Sandra S.

AU - Shutt, Kathleen A.

AU - Paterson, David L.

PY - 2013/2/18

Y1 - 2013/2/18

N2 - Background. The occurrence of community-associated infections due to extended-spectrum -lactamase (ESBL)-producing Escherichia coli has been recognized as a major clinical problem in Europe and other regions.Methods. We conducted a prospective observational study to examine the occurrence of community-associated infections due to ESBL-producing E. coli at centers in the United States. Five academic and community hospitals and their affiliated clinics participated in this study in 2009 and 2010. Sites of acquisition of the organisms (community-associated or healthcare-associated), risk factors, and clinical outcome were investigated. Screening for the global epidemic sequence type (ST) 131 and determination of the ESBL types was conducted by polymerase chain reaction and sequencing.Results. Of the 291 patients infected or colonized with ESBL-producing E. coli as outpatients or within 48 hours of hospitalization, 107 (36.8%) had community-associated infection (81.5% of which represented urinary tract infection), while the remainder had healthcare-associated infection. Independent risk factors for healthcare-associated infection over community-associated infection were the presence of cardiovascular disease, chronic renal failure, dementia, solid organ malignancy, and hospitalization within the previous 12 months. Of the community-associated infections, 54.2% were caused by the globally epidemic ST131 strain, and 91.3% of the isolates produced CTX-M-type ESBL.Conclusions. A substantial portion of community-onset, ESBL-producing E. coli infections now occur among patients without discernible healthcare-associated risk factors in the United States. This epidemiologic shift has implications for the empiric management of community-associated infection when involvement of E. coli is suspected.

AB - Background. The occurrence of community-associated infections due to extended-spectrum -lactamase (ESBL)-producing Escherichia coli has been recognized as a major clinical problem in Europe and other regions.Methods. We conducted a prospective observational study to examine the occurrence of community-associated infections due to ESBL-producing E. coli at centers in the United States. Five academic and community hospitals and their affiliated clinics participated in this study in 2009 and 2010. Sites of acquisition of the organisms (community-associated or healthcare-associated), risk factors, and clinical outcome were investigated. Screening for the global epidemic sequence type (ST) 131 and determination of the ESBL types was conducted by polymerase chain reaction and sequencing.Results. Of the 291 patients infected or colonized with ESBL-producing E. coli as outpatients or within 48 hours of hospitalization, 107 (36.8%) had community-associated infection (81.5% of which represented urinary tract infection), while the remainder had healthcare-associated infection. Independent risk factors for healthcare-associated infection over community-associated infection were the presence of cardiovascular disease, chronic renal failure, dementia, solid organ malignancy, and hospitalization within the previous 12 months. Of the community-associated infections, 54.2% were caused by the globally epidemic ST131 strain, and 91.3% of the isolates produced CTX-M-type ESBL.Conclusions. A substantial portion of community-onset, ESBL-producing E. coli infections now occur among patients without discernible healthcare-associated risk factors in the United States. This epidemiologic shift has implications for the empiric management of community-associated infection when involvement of E. coli is suspected.

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