TY - JOUR
T1 - Influx of extended-spectrum β-lactamase-producing enterobacteriaceae into the hospital
AU - Ben-Ami, R.
AU - Schwaber, M. J.
AU - Navon-Venezia, S.
AU - Schwartz, D.
AU - Giladi, M.
AU - Chmelnitsky, I.
AU - Leavitt, A.
AU - Carmeli, Y.
N1 - Funding Information:
Potential conflicts of interest. R.B.-A. received a travel grant from Merck. Y.C. received grants, honoraria, travel support, consulting fees, and other forms of financial support from Bayer, Bristol-Myers Squibb, Merck, Neopharm, Pfizer Pharmaceuticals, Teva, Vicuron Pharmaceuticals, and XTL Pharmaceuticals. M.G. received lecture fees from Merck; travel grants from Merck, Pfizer Pharmaceuticals, and Teva; and advisory board fees from Pfizer Pharmaceuticals. All other authors: no conflicts.
PY - 2006/4/1
Y1 - 2006/4/1
N2 - Background. The prevalence of infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is increasing worldwide. The influx of these bacteria into hospitals has major implications for infection-control and empirical treatment strategies. Methods. Isolates from 2 patient cohorts-patients with gram-negative bacteremia within 2 days after admission and patients screened for fecal colonization at admission-were assessed for ESBL production. ESBL phenotype was confirmed according to Clinical and Laboratory Standards Institute guidelines. Predictors of ESBL phenotype were examined by univariate and multivariate analyses. Results. Of 80 Enterobacteriaceae isolates from blood samples obtained at admission to the hospital, 13.7% produced ESBL. Thirty-eight patients with ESBL-positive isolates and 72 with ESBL-negative isolates were included in a case-control study. Predictors of ESBL production were male sex and nursing home residence (area under receiver operator characteristic curve, 0.7). Of 241 persons screened at admission, 26 (10.8%) had fecal carriage of ESBL-producing Enterobacteriaceae. Predictors of fecal carriage were poor functional status, antibiotic use, chronic renal insufficiency, liver disease, and use of histamine2 blockers (area under receiver operator characteristic curve, 0.8). Four (15.4%) of the 26 individuals with fecal carriage had subsequent bacteremia with ceftazidime-resistant Enterobacteriaceae, compared with 1 (0.5%) noncarrier (odds ratio, 38.9; P < .00). Of 80 ESBL-producing Enterobacteriaceae isolates obtained at admission, 65 were health care associated, and 15 were community acquired. The 15 community-acquired ESBL-producing Enterobacteriaceae belonged to diverse clones. The most prevalent ESBL gene among these isolates was CTX-M-2 (found in 53.3% of the isolates). Conclusions. We report high rates of bacteremia and colonization with ESBL-producing Enterobacteriaceae at admission to our institution, which may undermine infection-control measures and complicate the selection of empirical treatment.
AB - Background. The prevalence of infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is increasing worldwide. The influx of these bacteria into hospitals has major implications for infection-control and empirical treatment strategies. Methods. Isolates from 2 patient cohorts-patients with gram-negative bacteremia within 2 days after admission and patients screened for fecal colonization at admission-were assessed for ESBL production. ESBL phenotype was confirmed according to Clinical and Laboratory Standards Institute guidelines. Predictors of ESBL phenotype were examined by univariate and multivariate analyses. Results. Of 80 Enterobacteriaceae isolates from blood samples obtained at admission to the hospital, 13.7% produced ESBL. Thirty-eight patients with ESBL-positive isolates and 72 with ESBL-negative isolates were included in a case-control study. Predictors of ESBL production were male sex and nursing home residence (area under receiver operator characteristic curve, 0.7). Of 241 persons screened at admission, 26 (10.8%) had fecal carriage of ESBL-producing Enterobacteriaceae. Predictors of fecal carriage were poor functional status, antibiotic use, chronic renal insufficiency, liver disease, and use of histamine2 blockers (area under receiver operator characteristic curve, 0.8). Four (15.4%) of the 26 individuals with fecal carriage had subsequent bacteremia with ceftazidime-resistant Enterobacteriaceae, compared with 1 (0.5%) noncarrier (odds ratio, 38.9; P < .00). Of 80 ESBL-producing Enterobacteriaceae isolates obtained at admission, 65 were health care associated, and 15 were community acquired. The 15 community-acquired ESBL-producing Enterobacteriaceae belonged to diverse clones. The most prevalent ESBL gene among these isolates was CTX-M-2 (found in 53.3% of the isolates). Conclusions. We report high rates of bacteremia and colonization with ESBL-producing Enterobacteriaceae at admission to our institution, which may undermine infection-control measures and complicate the selection of empirical treatment.
UR - http://www.scopus.com/inward/record.url?scp=33645086351&partnerID=8YFLogxK
U2 - 10.1086/500936
DO - 10.1086/500936
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C2 - 16511754
AN - SCOPUS:33645086351
SN - 1058-4838
VL - 42
SP - 925
EP - 934
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -