Increasing Extended-Spectrum β-Lactamase-Producing Escherichia coli in Community Hospitals Throughout the Southeastern United States
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Infections with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are increasing worldwide. Although the epidemiology of ESBL-producing Enterobacteriaceae has been well-documented in tertiary medical centers, little is known about ESBL infections in community hospitals in the United States. Methods. ESBL-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) infections were identified at 26 community hospitals from January 2009 to December 2014 using CDC definitions and standardized surveillance methods. Poisson regression was used to determine trends in the rates of ESBL-EC and ESBL-KP detection and to calculate relative rates and 95% confidence intervals (CI). Figure. Rate of ESBL-EC (A) and ESBL-KP (B) infections in 26 community hospitals throughout the southeastern United States by year. Results. The incidence of ESBL-EC infections increased from 5.28 to 10.5 patients per 100,000 patient-days during the study period (P = .006) (figure). There were significant demographic differences between ESBL-EC and ESBL-KP patients as ESBL-EC infections were more common in females (54% versus 44%, P < .001), Caucasians (50% versus 40%), Hispanics (4% versus <1%, P < .00001), and were more likely to be isolated from the urinary tract (61% versus 52%, P < .00001). ESBL-EC infections were more often community-acquired (23% versus 10%, P < .00001) and admitted from home (57% versus 48%, P = .003). ESBL-EC infections were less often isolated from patients on dialysis (5% versus 8%, P = .01) and in the ICU (14% versus 19%, P = .02). The number of community hospitals with ESBL-EC infections increased from 18 (69%) in 2009 to 21 (81%) in 2014. The median ESBL-EC isolation rates among individual hospitals that had at least one ESBL-EC patient increased from 11.1/100,000 patient-days (range 2.2–33.9) in 2009 to 22.1/100,000 patient-days (range 0.66 to 134) in 2014 (P = .05). The incidence of ESBL-KP infections remained constant over the study period (P = 0.14) (figure 1). Conclusion. The rate of infections caused by ESBL-EC increased in community hospitals throughout the southeastern United States. The rate of ESBL-KP remained unchanged. Many ESBL-EC infections were admitted from home. Clinicians in community hospitals must be aware of this change in epidemiology. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Molecular Medicine
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2290738420