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Predictors and Molecular Epidemiology of Community-Onset Extended-Spectrum β-Lactamase–Producing Escherichia coli Infection in a Midwestern Community

Published online by Cambridge University Press:  02 January 2015

Ritu Banerjee ,
Jacob Strahilevitz ,
James R. Johnson ,
Payai P. Nagwekar ,
Donna M. Schora ,
Ilene Shevrin ,
Hongyan Du ,
Lance R. Peterson  and
Ari Robicsek
Ritu Banerjee*
Affiliation:
Mayo Clinic, Rochester, Minnesota
Jacob Strahilevitz
Affiliation:
Hadassah-Hebrew University, Jerusalem, Israel
James R. Johnson
Affiliation:
Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota
Payai P. Nagwekar
Affiliation:
NorthShore University HealthSystem, Evanston, Illinois
Donna M. Schora
Affiliation:
NorthShore University HealthSystem, Evanston, Illinois
Ilene Shevrin
Affiliation:
University of Maryland Medical Center, Baltimore, Maryland
Hongyan Du
Affiliation:
NorthShore University HealthSystem, Evanston, Illinois
Lance R. Peterson
Affiliation:
NorthShore University HealthSystem, Evanston, Illinois
Ari Robicsek
Affiliation:
NorthShore University HealthSystem, Evanston, Illinois
*
Mayo Clinic, Division of Pediatric Infectious Diseases, 200 First Street SW, Rochester, MN 55905 ([email protected])
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Abstract

Objective.

To identify predictors of community-onset extended-spectrum β-lactamase (ESBL)-producing Escherichia coli infection.

Design.

Prospective case-control study.

Setting.

Acute care hospitals and ambulatory clinics in the Chicago, Illinois, region.

Patients.

Adults with E. coli clinical isolates cultured in ambulatory settings or within 48 hours of hospital admission.

Methods.

Cases were patients with ESBL-producing E. coli clinical isolates cultured in ambulatory settings or within 48 hours of admission, and controls were patients with non-ESBL-producing E. coli isolates, matched to cases by specimen, location, and date. Clinical variables were ascertained through interviews and medical record review. Molecular methods were used to identify ESBL types, sequence type ST131, and aac(6′)-Ib-cr.

Results.

We enrolled 94 cases and 158 controls. Multivariate risk factors for ESBL-producing E. coli infection included travel to India in the past year (odds ratio [OR], 14.40 [95% confidence interval (CI), 2.92-70.95]), ciprofloxacin use (OR, 3.92 [95% CI, 1.90-8.1]), and age (OR, 1.04 [95% CI, 1.02-1.06]). Case isolates exhibited high prevalence of CTX-M-15 (78%), ST131 (50%), and aac(6′)-Ib-cr (66% of isolates with CTX-M-15).

Conclusions.

Providers should be aware of the increased risk of ESBL-producing E. coli infection among returned travelers, especially those from India.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 9 , September 2013 , pp. 947 - 953
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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