Bacteremia Due to Extended-Spectrum β-Lactamase–Producing Escherichia coli in the CTX-M Era: A New Clinical Challenge

Background. Extended-spectrum β-lactamase (ESBL)–producing Escherichia coli, particularly those producing CTX-M types of ESBL, are emerging pathogens. Bacteremia caused by these organisms represents a clinical challenge, because the organisms are frequently resistant to the antimicrobials recommende...

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Bibliographic Details
Published in:Clinical infectious diseases 2006-12, Vol.43 (11), p.1407-1414
Main Authors: Rodríguez-Baño, Jesús, Navarro, Maria D., Romero, Luisa, Muniain, Miguel A., Cueto, Marina de, Ríos, María J., Hernández, José R., Pascual, Alvaro
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Amoxicillin-Potassium Clavulanate Combination - therapeutic use
Anti-Bacterial Agents - pharmacology
Bacteremia - drug therapy
Bacteremia - epidemiology
Bacteremia - microbiology
beta-Lactamases - genetics
beta-Lactamases - metabolism
Cephalosporins - therapeutic use
Cohort Studies
Community-Acquired Infections - drug therapy
Community-Acquired Infections - microbiology
Cross Infection - drug therapy
Cross Infection - microbiology
Drug Resistance, Multiple, Bacterial
Escherichia coli
Escherichia coli - drug effects
Escherichia coli - enzymology
Escherichia coli - genetics
Escherichia coli Infections - drug therapy
Escherichia coli Infections - epidemiology
Escherichia coli Infections - microbiology
Female
Fluoroquinolones - therapeutic use
Humans
Male
Middle Aged
Penicillanic Acid - analogs & derivatives
Penicillanic Acid - therapeutic use
Piperacillin - therapeutic use
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Summary:Background. Extended-spectrum β-lactamase (ESBL)–producing Escherichia coli, particularly those producing CTX-M types of ESBL, are emerging pathogens. Bacteremia caused by these organisms represents a clinical challenge, because the organisms are frequently resistant to the antimicrobials recommended for treatment of patients with suspected E. coli sepsis. Methods. A cohort study was performed that included all episodes of bloodstream infection due to ESBL-producing E. coli during the period from January 2001 through March 2005. Data on predisposing factors, clinical presentation, and outcome were collected. ESBLs were characterized using isoelectric focusing, polymerase chain reaction, and sequencing. Results. Forty-three episodes (8.8% of cases of bacteremia due to E. coli) were included; 70% of the isolates produced a CTX-M type of ESBL. The most frequent origins of infection were the urinary (46%) and biliary tracts (21%). Acquisition was nosocomial in 21 cases (49%), health care associated in 14 cases (32%), and strictly community acquired in 8 cases (19%). Thirty-eight percent and 25% of patients had obstructive diseases of the urinary and biliary tracts, respectively, and 38% had recently received antimicrobials. Nine patients (21%) died. Compared with β-lactam/β-lactamase–inhibitor and carbapenem-based regimens, empirical therapy with cephalosporins or fluoroquinolones was associated with a higher mortality rate (9% vs. 35%; P = .05) and needed to be changed more frequently (24% vs. 78%; P = .001). Conclusions. ESBL-producing E. coli is a significant cause of bloodstream infection in hospitalized and nonhospitalized patients in the context of the emergence of CTX-M enzymes. Empirical treatment of sepsis potentially caused by E. coli may need to be reconsidered in areas where such ESBL-producing isolates are present.
ISSN:1058-4838
1537-6591
DOI:10.1086/508877