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Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella Species: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence

Published online by Cambridge University Press:  02 January 2015

Gregory Bisson ,
Neil O. Fishman ,
Jean Baldus Patel ,
Paul H. Edelstein  and
Ebbing Lautenbach
Gregory Bisson
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Jean Baldus Patel
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Paul H. Edelstein
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ebbing Lautenbach*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, the Center for Clinical Epidemiology and Biostatistics, and theUniversity of Pennsylvania Center for Education and Research on Therapeutics (CERTs), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021
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Abstract

Objective:

The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producing Escherichia coli and Klebsiella species (ESβL-EK) remain unclear, as do methods to control their further emergence.

Design:

Case–control study.

Setting:

Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.

Patients:

Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.

Results:

Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a single K. oxytoca clone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P = .51).

Conclusions:

ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 5 , May 2002 , pp. 254 - 260
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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