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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A multinational survey of risk factors for infection with extended-spectrum β-lactamase-producing enterobacteriaceae in nonhospitalized patients
Clinical Infectious Diseases, Volume 49, No. 5, Year 2009
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Description
Infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are increasing in frequency and are associated with high mortality rates. Circulation of CTX-M-type ESBLs in the community is of particular concern, because it may confound standard infection-control measures. We analyzed the results of epidemiologic studies of infection caused by ESBL-producing Enterobacteriaceae in nonhospitalized patients from 6 centers in Europe, Asia, and North America. Risk factors for infection with an ESBL-producing organism were identified by univariate and multivariate analyses. A total of 983 patient-specific isolates were reviewed (890 [90.5%] of which were Escherichia coli, 68 [6.9%] of which were Klebsiella species, and 25 [2.5%] of which were Proteus mirabilis); 339 [34.5%] of the isolates produced ESBLs. CTX-M types were the most frequent ESBLs (accounting for 65%). Rates of co-resistance to ciprofloxacin among ESBL-producing isolates were high (>70%), but significant variation was seen among centers with respect to rates of resistance to gentamicin, amoxicillin-clavulanate, and trimethoprim-sulfamethoxazole. Similar risk factors for infection with an ESBL-producing organism were found in the different participating centers. Significant risk factors, identified by multivariate analysis, were recent antibiotic use, residence in a longterm care facility, recent hospitalization, age ≥65 years, and male sex (area under the receiver-operator characteristic [ROC] curve, 0.80). However, 34% of ESBL-producing isolates (115 of 336 isolates) were obtained from patients with no recent health care contact; the area under the ROC curve for the multivariate model for this group of patients was only 0.70, which indicated poorer predictive value. Community-acquired ESBL-producing Enterobacteriaceae are now prevalent worldwide, necessitating international collaboration. Novel approaches are required to adequately address issues such as empirical treatment for severe community-acquired infection and infection control. © 2009 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Ben-Ami, Ronen
Israel, Tel Aviv-yafo
Tel Aviv Sourasky Medical Center
Rodríguez-Baño, Jesús
Spain, Sevilla
Hospital Universitario Virgen Macarena
Arslan, Hande
Turkey, Ankara
Başkent Üniversitesi
Pitout, Johann D.D.
Canada, Calgary
Calgary Laboratory Services
Quentin, Claudine F.
France, Bordeaux
Laboratoire de Microbiologie Fondamentale et Pathogénicité
Azap, Özlem Kurt
Turkey, Ankara
Başkent Üniversitesi
Arpin, Corinne
France, Bordeaux
Laboratoire de Microbiologie Fondamentale et Pathogénicité
Pascual, Álvaro
Spain, Sevilla
Hospital Universitario Virgen Macarena
Livermore, David M.
United Kingdom, London
Public Health England
Garau, Javier A.
Spain, Barcelona
Hospital Universitari de Bellvitge
Carmeli, Yehuda S.
Israel, Tel Aviv-yafo
Tel Aviv Sourasky Medical Center
Statistics
Citations: 405
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1086/604713
ISSN:
10584838
Research Areas
Health System And Policy
Study Design
Cross Sectional Study
Study Approach
Quantitative
Participants Gender
Male