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Risk Factors for Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Community-Onset Bloodstream Infection: Impact on Long-Term Care Hospitals in Korea

Annals of Laboratory Medicine 2021년 41권 5호 p.455 ~ 462
Baek Yae-Jee, 김영아, 김도균, 신종희, 어영, 신경섭, 신정환, 정석훈, 이근우, 이은지, 김동숙, 박윤수,
소속 상세정보
 ( Baek Yae-Jee ) - Yonsei University College of Medicine Department of Internal Medicine
김영아 ( Kim Young-Ah ) - National Health Insurance Service Ilsan Hospital Department of Laboratory Medicine
김도균 ( Kim Do-Kyun ) - Yonsei University College of Medicine Department of Laboratory Medicine
신종희 ( Shin Jong-Hee ) - Chonnam National University Medical School Department of Laboratory Medicine
어영 ( Uh Young ) - Yonsei University Wonju College of Medicine Department of Laboratory Medicine
신경섭 ( Shin Kyeong-Seob ) - Chungbuk National University College of Medicine Department of Laboratory Medicine
신정환 ( Shin Jeong-Hwan ) - Inje University College of Medicine Department of Laboratory Medicine
정석훈 ( Jeong Seok-Hoon ) - Yonsei University College of Medicine Department of Laboratory Medicine
이근우 ( Lee Geun-Woo ) - Health Insurance Review and Assessment Service
이은지 ( Lee Eun-Ji ) - Health Insurance Review and Assessment Service
김동숙 ( Kim Dong-Sook ) - Health Insurance Review and Assessment Service
박윤수 ( Park Yoon-Soo ) - Yonsei University College of Medicine Department of Internal Medicine

Abstract


Background: The prevalence of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) in the community has increased worldwide due to multifactorial reasons. ESBL-EC bloodstream infection (BSI) complicates the decision for proper antimicrobial administration. In this multicenter study, we investigated the prevalence, risk factors, and molecular background of community-onset (CO) ESBL-EC BSI.

Methods: We included data for all episodes of ESBL-EC BSI of community origin from May 2016 to April 2017 obtained from the Korean national antimicrobial resistance surveillance system, which comprises six sentinel hospitals. Data, including previous history of admission and use of antimicrobials and medical devices before BSI, were collected, along with microbiological analysis results.

Results: Among 1,189 patients with CO BSI caused by E. coli, 316 (27%) were identified as ESBL producers. History of admission, especially to a long-term care hospital (LTCH), and previous use of β-lactams/β-lactamase inhibitors, carbapenem, lincosamide, aminoglycoside, and extended-spectrum cephalosporin were independent risk factors for CO ESBL-EC BSI; admission to an LTCH showed the highest odds ratio (3.8, 95% confidence interval 2.3-6.1). The most common genotype was CTX-M-15 (N=131, 41%), followed by CTX-M-14 (N=86, 27%). ST131 was the most common sequence type among ESBL-EC groups (57%).

Conclusions: In Korea, 27% of CO E. coli BSI were caused by ESBL producers. From perspectives of empirical treatment and infection control, history of admission to an LTCH and antimicrobial use should be noted.

키워드

Community-onset infection; Extended-spectrum β-lactamase-producing Escherichia coli; Bloodstream infection; Prevalence; Risk factors; Molecular background

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