Korean J Intern Med.  2017 Jan;32(1):146-157. 10.3904/kjim.2015.113.

Risk factors and molecular epidemiology of community-onset, multidrug resistance extended-spectrum β-lactamase-producing Escherichia coli infections

• Park SY
• Kang CI
• Wi YM
• Chung DR
• Peck KR
• Lee NY
• Song JH

• KMID: 2365989
• DOI: http://doi.org/10.3904/kjim.2015.113

Abstract

BACKGROUND/AIMS
Although multidrug resistance (MDR) among extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) poses significant therapeutic challenges, little is known regarding the risk factors and epidemiology of community-onset MDR-ESBL-EC infections. We performed this study to investigate risk factors and the molecular epidemiology of community-onset MDR-ESBL-EC infections.
METHODS
We conducted a case-control-control study of community-onset infections. MDR-ESBL-EC was defined as ESBL-EC that demonstrated in vitro resistance to trimethoprim-sulfamethoxazole, fluoroquinolones (FQs), and gentamicin. Patients with MDR-ESBL-EC infections were designated as case patients. A control group I (CG I) patient was defined as a person whose clinical sample yielded ESBL-EC that did not meet the criteria for MDR. A control group II (CG II) patient was defined as a patient with a non-ESBL-EC infection.
RESULTS
Of 108 patients with ESBL-EC infections, 30 cases (27.8%) were due to MDR-ESBL-EC. Compared with CG I, prior use of FQs (odds ratio [OR], 3.16; 95% confidence interval [CI], 1.11 to 8.98) and immunosuppressant use (OR, 10.47; 95% CI, 1.07 to 102.57) were significantly associated with MDR-ESBL-EC. Compared with CG II, prior use of FQs (OR, 15.53; 95% CI, 2.86 to 84.27) and healthcare-associated infection (OR, 5.98; 95% CI, 2.26 to 15.86) were significantly associated with MDR-ESBL-EC. CTX-M-15 was the most common in MDR-ESBL-EC infections (59.1% [13/22]), while CTX-M-14 was the most common in non-MDR-ESBL-EC infections (41.6% [32/77]). CTX-M-15 was significantly associated with MDR-ESBL-EC (59.1% vs. 32.5%, p = 0.028). Pulsed-field gel electrophoresis showed clonal diversity of MDR-ESBL-EC isolates.
CONCLUSIONS
The emergence of strains of MDR-ESBL-EC in the community poses an important new public health threat. More information on the emergence and transmission of these strains will be necessary in order to prevent their spread.

Keyword

Drug resistance, multiple; Extended-spectrum β-lactamase; Escherichia coli; Community-onset infection

MeSH Terms

Drug Resistance, Multiple*
Electrophoresis, Gel, Pulsed-Field
Epidemiology
Escherichia coli Infections*
Escherichia coli*
Escherichia*
Fluoroquinolones
Gentamicins
Humans
In Vitro Techniques
Molecular Epidemiology*
Public Health
Risk Factors*
Trimethoprim, Sulfamethoxazole Drug Combination
Fluoroquinolones
Gentamicins
Trimethoprim, Sulfamethoxazole Drug Combination