JAC Advance Access originally published online on February 17, 2009
Journal of Antimicrobial Chemotherapy 2009 63(4):781-784; doi:10.1093/jac/dkp028
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Original research |
Escherichia coli producing SHV-type extended-spectrum β-lactamase is a significant cause of community-acquired infection
1 Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain 2 Servicio de Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain 3 Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, Spain 4 Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain 5 Servicio de Microbiología, Hospital Son Dureta, Palma de Mallorca, Spain 6 Servicio de Enfermedades Infecciosas, Hospital Clinic, Barcelona, Spain 7 Servicio de Microbiología, Hospital Vall d'Hebron, Barcelona, Spain 8 Servicio de Microbiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain 9 Unidad de Epidemiología, Corporación Sanitaria Parc Taulí, Sabadell, Spain 10 Servicio de Microbiología, Hospital de la Ribera, Alcira (Valencia), Spain 11 Unidad de Medicina Preventiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain 12 Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Barcelona, Spain 13 Servicio de Microbiología, Hospital Ramón y Cajal, Madrid, Spain 14 Departamento de Microbiología, Facultad de Medicina, Sevilla, Spain
Received 15 December 2008; returned 1 January 2009; revised 19 January 2009; accepted 19 January 2009
* Corresponding author. Department of Microbiology, School of Medicine, Av/ Sanchez Pizjuan SN, Sevilla 41009, Spain. Tel: +34-954552863; Fax: +34-954377413; E-mail: apascual{at}us.es
Objectives: Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasingly significant cause of community-acquired infection worldwide. The epidemiological features of CTX-M- and SHV-producing ESBLEC causing community-acquired infections are compared.
Methods: A multicentre cohort study including all community-acquired infections caused by ESBLEC in four geographical areas of Spain was carried out. ESBL characterization was by isoelectric focusing, PCR and sequencing. Demographics, previous healthcare contact, co-morbidity, use of antimicrobials, invasive procedures and type of infection were collected for all patients. Patients with CTX-M- and SHV-producing isolates were compared using logistic regression.
Results: One hundred and twenty-two cases (95% urinary tract infections) were included. ESBLs were characterized in 112 isolates; 77 isolates (69%) produced CTX-M, 36 (32%) produced SHV and 7 (6%) produced TEM enzymes (8 produced >1 ESBL). Patients with isolates producing CTX-M enzymes only (CTX-M group, n = 70) and SHV enzymes only (SHV group, n = 31) were compared. There were no differences in terms of underlying disease, previous healthcare contact, invasive procedures, antibiotic use or type of infection. Multivariate analysis including geographical area showed that a Charlson Index score of >2 (OR = 4.0; 95% CI = 1.2–12.6) was associated with SHV isolates, while age >60 (4.7; 1.7–12.5) was associated with CTX-M isolates.
Conclusions: SHV-producing ESBLEC is a significant cause of community-acquired infection in Spain; the clinical epidemiology of such isolates seems very similar to that of CTX-M-producing E. coli.
Keywords: ESBLs , CTX-M , resistance