The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Risk factors and molecular epidemiology of community-onset, multidrug resistance extended-spectrum β-lactamase-producing Escherichia coli infections

  • Park, So Yeon (Division of Infectious Diseases, Hallym University Kangdong Sacred Heart Hospital) ;
  • Kang, Cheol-In (Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Wi, Yu Mi (Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Chung, Doo Ryeon (Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Peck, Kyong Ran (Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Nam-Yong (Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Song, Jae-Hoon (Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2015.04.27
  • Accepted : 2016.01.22
  • Published : 2017.01.01
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Abstract

Background/Aims: Although multidrug resistance (MDR) among extended-spectrum ${\beta}$-lactamase-producing Escherichia coli (ESBL-EC) poses significant therapeutic challenges, little is known regarding the risk factors and epidemiology of community-onset MDR-ESBL-EC infections. We performed this study to investigate risk factors and the molecular epidemiology of community-onset MDR-ESBL-EC infections. Methods: We conducted a case-control-control study of community-onset infections. MDR-ESBL-EC was defined as ESBL-EC that demonstrated in vitro resistance to trimethoprim-sulfamethoxazole, fluoroquinolones (FQs), and gentamicin. Patients with MDR-ESBL-EC infections were designated as case patients. A control group I (CG I) patient was defined as a person whose clinical sample yielded ESBL-EC that did not meet the criteria for MDR. A control group II (CG II) patient was defined as a patient with a non-ESBL-EC infection. Results: Of 108 patients with ESBL-EC infections, 30 cases (27.8%) were due to MDR-ESBL-EC. Compared with CG I, prior use of FQs (odds ratio [OR], 3.16; 95% confidence interval [CI], 1.11 to 8.98) and immunosuppressant use (OR, 10.47; 95% CI, 1.07 to 102.57) were significantly associated with MDR-ESBL-EC. Compared with CG II, prior use of FQs (OR, 15.53; 95% CI, 2.86 to 84.27) and healthcare-associated infection (OR, 5.98; 95% CI, 2.26 to 15.86) were significantly associated with MDR-ESBL-EC. CTX-M-15 was the most common in MDR-ESBL-EC infections (59.1% [13/22]), while CTX-M-14 was the most common in non-MDR-ESBL-EC infections (41.6% [32/77]). CTX-M-15 was significantly associated with MDR-ESBL-EC (59.1% vs. 32.5%, p = 0.028). Pulsed-field gel electrophoresis showed clonal diversity of MDR-ESBL-EC isolates. Conclusions: The emergence of strains of MDR-ESBL-EC in the community poses an important new public health threat. More information on the emergence and transmission of these strains will be necessary in order to prevent their spread.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

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