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Title

Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae

Authors
Zahar, Jean-Ralph
Lesprit, Philippe
Ruckly, Stephane
Eden, Aurelia
Hikombo, Hitoto
Timsit, Jean-François
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Published in International Journal of Antimicrobial Agents. 2017, vol. 49, no. 1, p. 67-73
Abstract Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.
Keywords AgedAged, 80 and overBacteremia/epidemiology/microbiologyCommunity-Acquired Infections/epidemiology/microbiologyCross Infection/microbiologyEnterobacteriaceae/classification/enzymology/isolation & purificationEnterobacteriaceae Infections/epidemiology/microbiologyFemaleHumansMaleMiddle AgedPrevalenceProspective StudiesRisk FactorsSurvival AnalysisTreatment Outcomebeta-Lactamases/secretion
Identifiers
PMID: 27890442
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Research group Groupe Harbarth Stephan (Staphylocoques dorés résistants à la méthicilline) (866)
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ZAHAR, Jean-Ralph et al. Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae. In: International Journal of Antimicrobial Agents, 2017, vol. 49, n° 1, p. 67-73. https://archive-ouverte.unige.ch/unige:99528

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Deposited on : 2017-11-22

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