Bacteremia Caused by Escherichia Coli Producing Extended-Spectrum Beta-Lactamase: A Case-Control Study of Risk Factors and Outcomes

Scand J Infect Dis. 2002;34(8):567-73. doi: 10.1080/00365540210147516.

Abstract

A case-control study was conducted in order to identify the risk factors associated with bloodstream infection caused by Escherichia coli producing extended-spectrum beta-lactamase (ESBL) and to determine the outcomes of infected patients. Risk factors associated with ESBL production, according to univariate analysis, included a history of recent hospitalization [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.1-8.9; p < 0.001], severe underlying diseases (OR 15, 95% CI 4.4-51.5; p < 0.001), prior exposure to urinary catheters (OR 8.3, 95% CI 3.2-21.7; p < 0.001) and nosocomial (OR 14.1, 95% CI 6.1-32.8; p < 0.001) or urinary (OR 3.6, 95% CI 1.7-7.4; p < 0.001) origin of the bacteria. Multivariate analysis revealed that severe underlying diseases (OR 31.2, 95% CI 6.7-144; p < 0.001) and nosocomial (OR 16.5, 95% CI 5.6-49; p < 0.001) and urinary origins (OR 7.8, 95% CI 2.6-23.8; p < 0.001) of the bacteria were independently associated with ESBL production in bacteremic E. coli. Crude mortality in case patients was more than twice as high as that in controls (p = 0.04). Production of ESBL increased the risk of inappropriate initial therapy (OR 95.6, 95% CI 27.4-334.2; p < 0.001). Treatment failed in 4/7 case patients treated with ceftazidime to which the isolate was susceptible in vitro. Our findings have implications for the choice of empirical therapy in nosocomial urinary tract infection.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Anti-Bacterial Agents*
  • Bacteremia / diagnosis
  • Bacteremia / drug therapy*
  • Bacteremia / epidemiology*
  • Case-Control Studies
  • China / epidemiology
  • Cohort Studies
  • Confidence Intervals
  • Drug Therapy, Combination / therapeutic use*
  • Escherichia coli / enzymology*
  • Escherichia coli / isolation & purification
  • Escherichia coli Infections / diagnosis
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / epidemiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Microbial Sensitivity Tests
  • Multivariate Analysis
  • Probability
  • Risk Factors
  • Sex Distribution
  • Survival Rate
  • Treatment Outcome
  • beta-Lactamases / metabolism

Substances

  • Anti-Bacterial Agents
  • beta-Lactamases