J Korean Med Sci.  2013 Jul;28(7):998-1004. 10.3346/jkms.2013.28.7.998.

Clinical and Molecular Epidemiology of Community-Onset Bacteremia Caused by Extended-Spectrum beta-Lactamase-Producing Escherichia coli over a 6-Year Period

Affiliations
  • 1Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. collacin@hotmail.com
  • 2Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea.
  • 3Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea.
  • 4Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 5Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Although extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) has emerged as a significant community-acquired pathogen, there is little epidemiological information regarding community-onset bacteremia due to ESBL-EC. A retrospective observational study from 2006 through 2011 was performed to evaluate the epidemiology of community-onset bacteremia caused by ESBL-EC. In a six-year period, the proportion of ESBL-EC responsible for causing community-onset bacteremia had increased significantly, from 3.6% in 2006 to 14.3%, in 2011. Of the 97 clinically evaluable cases with ESBL-EC bacteremia, 32 (33.0%) were further classified as healthcare-associated infections. The most common site of infection was urinary tract infection (n=35, 36.1%), followed by biliary tract infections (n=29, 29.9%). Of the 103 ESBL-EC isolates, 43 (41.7%) produced CTX-M-14 and 36 (35.0%) produced CTX-M-15. In the multilocus sequence typing (MLST) analysis of 76 isolates with CTX-M-14 or -15 type ESBLs, the most prevalent sequence type (ST) was ST131 (n=15, 19.7%), followed by ST405 (n=12, 15.8%) and ST648 (n=8, 10.5%). No significant differences in clinical features were found in the ST131 group versus the other group. These findings suggest that epidemic ESBL-EC clones such as CTX-M-14 or -15 type ESBLs and ST131 have disseminated in community-onset infections, even in bloodstream infections, which are the most serious type of infection.

Keyword

Escherichia coli; Community-Acquired Infections; Cephalosporin Resistance; Bacteremia; Epidemiology

MeSH Terms

Aging
Bacteremia/drug therapy/*epidemiology
Biliary Tract Diseases/epidemiology/microbiology
Cephalosporin Resistance/genetics
Cephalosporins/therapeutic use
Community-Acquired Infections/*epidemiology/microbiology
Escherichia coli/isolation & purification/metabolism
Escherichia coli Infections/drug therapy/*epidemiology
Female
Humans
Male
Microbial Sensitivity Tests
Molecular Epidemiology
Multilocus Sequence Typing
Prevalence
Retrospective Studies
Urinary Tract Infections/epidemiology/microbiology
beta-Lactamases/*metabolism
Cephalosporins
beta-Lactamases

Figure

  • Fig. 1 Annual incidence and proportion of ESBL-producing E. coli isolates causing community-onset bacteremia (Gray bar, number; black line, prevalence).

  • Fig. 2 Change in the ESBL prevalence (%) and the types of CTX-M genes during six years of E. coli-related community-onset bacteremia cases. *Others: CTX-M-3, CTX-M-24, CTX-M-27, and CTX-M-57.

  • Fig. 3 Antimicrobial resistance rates (%) of ESBL-producing E. coli isolates.


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