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JAC Advance Access published online on February 21, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl035
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received October 7, 2005
Revised January 13, 2006
Accepted January 25, 2006

Brief report

Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum {beta}-lactamases

Esther Calbo 1 *, Verónica Romaní 1, Mariona Xercavins 2, Lucía Gómez 1, Carolina Garcia Vidal 1, Salvador Quintana 3, Jordi Vila 4, and Javier Garau 1

1 Department of Internal Medicine, Infectious Diseases Unit, Hospital Mútua de Terrassa, Barcelona, Spain
2 Service of Microbiology, Hospital Mútua de Terrassa, Barcelona, Spain
3 Intensive Care Unit, Hospital Mútua de Terrassa, Barcelona, Spain
4 Department of Microbiology, Hospital Clínic, University of Barcelona, Spain

* To whom correspondence should be addressed.
Esther Calbo, E-mail: esthercalbo{at}hotmail.com


  Abstract

Objectives: Extended-spectrum {beta}-lactamase (ESBL)-producing Escherichia coli have been increasingly recognized in the community. The aim of this study was to determine the prevalence, types of ESBLs and risk factors for community-onset ESBL-producing E. coli in urinary tract infections (UTIs).

Methods: Adults with community-onset UTIs due to ESBL-producing E. coli (cases) and non-ESBL-producing E. coli (controls) were identified through records of the clinical microbiology laboratory of the hospital. Two different periods were studied: from January 2000 to January 2001 and from October to December 2003. Controls were matched in a 3:1 ratio to case patients according to age, sex, date of isolation and residence in a long-term care facility. Potential risk factors were recorded. Isoelectric focusing as well as PCR and DNA sequencing were used to characterize the blaTEM, blaSHV and blaCTX-M genes. A possible clonal relationship among the strains was determined by repetitive extragenic palindromic sequence PCR.

Results: The prevalence of infection due to ESBL-producing E. coli increased from 0.47% in 2000 to 1.7% in 2003 (P < 0.001). Community-onset ESBL-producing E. coli infection shifted from 50% in the first period to 79.5% in 2003 (P < 0.001). Nineteen cases and 55 matched controls of community-onset ESBL-producing E. coli UTI were included. ESBL-producing E. coli strains were clonally unrelated. On univariate analysis, genitourinary pathology (P < 0.03), previous bacterial infection (P = 0.01), intravenous antibiotic treatment (P = 0.01), hospitalization in the previous 12 months (P = 0.04) and previous exposure to oral second-generation cephalosporins (P < 0.05) were associated with community-onset infection due to ESBL-producing E. coli. In our regression model, only previous exposure to second-generation cephalosporins was strongly associated with E. coli harbouring ESBLs (OR, 21.42; CI 95%, 5.38-85.22; P < 0.05). In the first period, only TEM- and SHV-derived ESBLs were identified. The enzymes were characterized as members of the TEM group (60%), SHV group (16%) and CTX-M group (24%).

Conclusions: We detected a marked increase in infections due to ESBL-producing E. coli, especially in the community, in the periods studied. Only previous exposure to the oxyimino cephalosporin cefuroxime, and not to ciprofloxacin, aminoglycosides or third-generation cephalosporins, was predictive of an ESBL-producing E. coli community-onset infection in our area. The emergence of the CTX-M type of {beta}-lactamase in E. coli follows closely the spread of ESBLs in community isolates.

Keywords: ESBLs; UTIs; CTX-M {beta}-lactamases; cefuroxime; multiresistant E. coli.
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