Increasing Incidence of Extended-Spectrum β-Lactamase-Producing Escherichia coli in Community Hospitals throughout the Southeastern United States. (13th October 2015)

• Record Type: Journal Article
• Authors: Thaden, Joshua T.; Fowler, Vance G.; Sexton, Daniel J.; Anderson, Deverick J.
• Is Part Of: Infection control and hospital epidemiology. Volume 37:Number 1(2016)
• Page Start: 49
• Page End: 54
• Publication Date: 2015-10-13
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2015.239
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract : OBJECTIVE: To describe the epidemiology of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) infections DESIGN: Retrospective cohort SETTING: Inpatient care at community hospitals PATIENTS: All patients with ESBL-EC or ESBL-KP infections METHODS: ESBL-EC and ESBL-KP infections from 26 community hospitals were prospectively entered into a centralized database from January 2009 to December 2014. RESULTS: A total of 925 infections caused by ESBL-EC (10.5 infections per 100, 000 patient days) and 463 infections caused by ESBL-KP (5.3 infections per 100, 000 patient days) were identified during 8, 791, 243 patient days of surveillance. 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). The number of community hospitals with ESBL-EC infections increased from 17 (65%) in 2009 to 20 (77%) in 2014. The median ESBL-EC infection rates among individual hospitals with ≥1 ESBL-EC infection increased from 11.1 infections/100, 000 patient days (range, 2.2–33.9 days) in 2009 to 22.1 infections per 100, 000 patient days (range, 0.66–134 days) in 2014 ( P=. 05). The incidence of ESBL-KP infections remained constant over the study period ( P=. 14). Community-associated and healthcare-associated ESBL-EC infections trended upward ( P =.006 and P=. 02, respectively), while hospital-onset infections remained stable ( P=. 07). ESBL-EC infections were more common in females (54% vs 44%, P<. 001) and Caucasians (50% vs 40%, P<. 0001), and were more likely to be isolated from the urinary tract (61% vs 52%, P<. 0001) than ESBL-KP infections. CONCLUSIONS: The incidence of ESBL-EC infection has increased in community hospitals throughout the southeastern United States, while the incidence of ESBL-KP infection has remained stable. Community- and healthcare-associated ESBL-EC infections are driving the upward trend. Infect. Control Hosp. Epidemiol. 2015;37(1):49–54