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Predisposing factors for CTX-M or SHV extended-spectrum b-lactamase-producing Escherichia coli in community-acquired infections

Abstract number: O91

Rodríguez-Baño J., Alcalá J., Cisneros J., Grill F., Oliver A., Horcajada J., Tórtola T., Mirelis B., Navarro G., Cuenca M., Esteve M., Peña C., Llanos A., Cantón R., Pascual A.

Objectives: Extended-spectrum b-lactamase-producing Escherichia coli (ESBLEC) is an increasingly significant cause of community-acquired (CA) infections worldwide. While much attention has been paid to CTX-M-producing isolates, there is scarce data about the epidemiology of SHV in the community. We compared the epidemiological features of CTX-M and SHV-producing ESBLEC causing community-acquired infections.

Methods: A multicentre cohort study including all CA infections caused by ESBLEC from 4 geographical areas in Spain was performed (Feb-2002 to May-2003). ESBL production was inferred following CLSI recommendations. ESBL was characterised by IEF, PCR and sequencing. The following data were collected: demographics, previous healthcare relation, co-morbidities, use of antimicrobials, invasive procedures and type of infection. Patients with CTX-M and SHV-producing isolates were compared using logistic regression.

Results: 122 cases (95% urinary tract infections) were included. ESBL was characterised in 112 isolates; 77 isolates (69%) produced CTX-M enzymes (40 produced CTX-M-9, 25 CTX-M-14), 36 (32%) SHV (31 SHV-12), and 7 (6%) TEM (4 TEM-116); 8 isolates produced >1 ESBL. Also, TEM-1 was produced by 52 isolates. CTX-M were the most frequent ESBL in the 4 areas (range, 56%-82%). Patients with isolates producing only CTX-M enzymes (CTX-M group, n = 70) and only SHV enzymes (SHV group, N=31) were compared; 70% of patients in the CTX-M group and 42% in the SHV group were >60 years old (p = 0.08); Charlson index >2 was found in 14% of patients in the CTX-M group and in 32% in the SHV group (p = 0.03). No differences in underlying diseases, previous healthcare relation, invasive procedures, antibiotic use or type of infections were found. Multivariate analysis including the geographical area showed that Charlson index >2 (OR=4.0, IC 95%: 1.2–12.6) was associated with SHV isolates, while age >60 (4.7; 1.7–12.5) was associated with CTX-M isolates.

Conclusions: SHV-producing ESBLEC are also a significant cause of community-acquired infections in Spain; the clinical epidemiology of such isolates seems much similar to CTX-M-producing ESBLEC. These data suggest that SHV-producing E. coli are also spreading in the community.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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