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Title: Bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli in the CTX-M era: a new clinical challenge.
Authors: Rodríguez-Baño, Jesús
Navarro, María D.
Romero, Luisa
Muniain, Miguel A.
de Cueto, Marina
Ríos, María J.
Hernández, José R.
Pascual, Alvaro
metadata.dc.contributor.authoraffiliation: [Rodríguez-Baño,J; Navarro,MD; Muniain,MA, Ríos, MJ] Sección de Enfermedades Infecciosas Hospital Universitario Virgen Macarena. [Romero,L; de Cueto,M; Hernández,JR; Pascual A] Servicio de Microbiología, Hospital Universitario Virgen Macarena. [Rodríguez-Baño,J; Muniain MA] Departamento de Medicina Universidad de Sevilla, Seville, Spain.[Pascual,A] Departamento de Microbiología, Universidad de Sevilla, Seville, Spain
Keywords: Bacteremia;beta -lactamase;Escherichia coli;Bacteriemia;beta -lactamasas;Escherichia coli
metadata.dc.subject.mesh: Medical Subject Headings::Named Groups::Persons::Age Groups::Adult
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged::Aged, 80 and over
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Clavulanic Acids::Clavulanic Acid::Amoxicillin-Potassium Clavulanate Combination
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Bacteremia
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation::Systemic Inflammatory Response Syndrome::Sepsis::Bacteremia
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Cephalosporins
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Infection::Community-Acquired Infections
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Infection::Cross Infection
Medical Subject Headings::Phenomena and Processes::Microbiological Phenomena::Drug Resistance, Microbial::Drug Resistance, Bacterial::Drug Resistance, Multiple, Bacterial
Medical Subject Headings::Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Facultatively Anaerobic Rods::Enterobacteriaceae::Escherichia::Escherichia coli
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections::Escherichia coli Infections
Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 2-Ring::Quinolines::Quinolones::Fluoroquinolones
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Penicillins::Penicillanic Acid
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Penicillins::Penicillin G::Ampicillin::Piperacillin
Medical Subject Headings::Chemicals and Drugs::Enzymes and Coenzymes::Enzymes::Hydrolases::Amidohydrolases::beta-Lactamases
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Cephalosporins
Issue Date: 1-Dec-2006
Publisher: University of Chicago Press
Citation: Rodríguez-Baño J, Navarro MD, Romero L, Muniain MA, de Cueto M, Ríos MJ, et al. Bacteremia due to extended-spectrum beta -lactamase-producing Escherichia coli in the CTX-M era: a new clinical challenge. Clin Infect Dis. 2006 Dec 1;43(11):1407-14
Abstract: Extended-spectrum beta-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 beta-lactam/beta-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.
Description: Major article
metadata.dc.identifier.doi: 10.1086/508877
ISSN: 1058-4838
Appears in Collections:01- Artículos - Hospital Virgen Macarena

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