Abstract
BackgroundGeneric epidemiological differences between extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), are poorly defined. Nonetheless, defining such differences and understanding their basis could have strategic implications for infection control policy and practice.MethodsBetween 2009 and 2011 patients with bacteraemia due to ESBL-EC or ESBL-KP across all three acute hospitals in the city of Auckland, New Zealand, were eligible for inclusion. Recognised risk factors for ESBL bacteraemia were compared between species in a retrospective case-case study design using multivariate logistic regression. Representative isolates underwent ESBL gene characterisation and molecular typing.Results170 patients and 176 isolates were included in the study (92 patients with ESBL-EC, 78 with ESBL-KP). 92.6% had CTX-Ms. 39% of EC were ST131 while 51% of KP belonged to 3 different STs (i.e. ST20, ST48 & ST1087). Specific sequence types were associated with specific hospitals for ESBL-KP but not ESBL-EC. Variables positively associated with ESBL-EC on multivariate analysis were: community acquired infection (odds ratio [OR] 7.9; 95% CI: 2.6-23.9); chronic pulmonary disease (OR 5.5; 95% CI: 1.5-20.1); and high prevalence country of origin (OR 4.3; 95% CI: 1.6-11.6). Variables negatively associated with ESBL-EC were previous transplant (OR 0.06; 95% CI: 0.007-0.6); Hospital 2 (OR 0.3; 95% CI: 0.1-0.7) and recent ICU admission (OR 0.3; 95% CI: 0.07-0.9).ConclusionsDifferences in risk profiles between patients with ESBL-EC and ESBL-KP suggest fundamental differences in transmission dynamics. Understanding the biological basis for these differences could have implications for infection control practice. Tailoring of infection control measures according to ESBL species may be indicated in some instances.
Highlights
Generic epidemiological differences between extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), are poorly defined
Across all 3 sites during the study period there were a total of 206 patients with bloodstream infections with ESBL-E. coli (ESBL-EC) and ESBL-K. pneumoniae (ESBL-KP) (89, 57, and 60 from hospitals 1, 2 and 3 respectively)
173 patients (84.0%) had isolates available and were included in the study (33 patients were excluded due to not having an isolate available). These 173 patients had a total of 176 isolates because two patients had simultaneous bacteraemia with ESBL-EC and ESBL-KP and one patient had successive bacteraemic episodes, firstly with ESBL-KP and ESBL-EC over a year later
Summary
Generic epidemiological differences between extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), are poorly defined. The global dissemination of extended-spectrum βlactamase producing Enterobacteriaceae (ESBL-E) poses a growing challenge to both public health and hospital infection control services [1].Whereas early reports of ESBL-E typically described hospital outbreaks of TEM and SHV producing Klebsiella pneumoniae, over the last between these species have been assumed in recent guidelines [11], few studies have sought to systematically characterize and quantify these differences. Defining such differences and better understanding their biological basis could have strategic implications for policy and practice; both for community public health and hospital infection control. In view of this background, we sought to systematically identify and quantify differences in the risk factor profiles between patients with ESBL-E. coli (ESBL-EC) and ESBL-K. pneumoniae (ESBL-KP) bacteraemia over a three year period
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