Scientific article
English

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

Published inInternational Journal of Antimicrobial Agents, vol. 49, no. 1, p. 67-73
Publication date2017
Abstract

Extended-spectrum ß-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
  • Aged
  • Aged, 80 and over
  • Bacteremia/epidemiology/microbiology
  • Community-Acquired Infections/epidemiology/microbiology
  • Cross Infection/microbiology
  • Enterobacteriaceae/classification/enzymology/isolation & purification
  • Enterobacteriaceae Infections/epidemiology/microbiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome
  • beta-Lactamases/secretion
Citation (ISO format)
ZAHAR, Jean-Ralph et al. Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum ß-lactamase-producing Enterobacteriaceae. In: International Journal of Antimicrobial Agents, 2017, vol. 49, n° 1, p. 67–73. doi: 10.1016/j.ijantimicag.2016.09.032
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Identifiers
Journal ISSN0924-8579
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Update08/10/2024 09:12:56
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