Clinical and Microbiologic Characteristics of Cephalosporin-Resistant Escherichia coli at Three Centers in the United States
- Authors
- Park, Yoon Soo; Adams-Haduch, Jennifer M.; Shutt, Kathleen A.; Yarabinec, Daniel M., III; Johnson, Laura E.; Hingwe, Ameet; Lewis, James S., II; Jorgensen, James H.; Doi, Yohei
- Issue Date
- Apr-2012
- Publisher
- AMER SOC MICROBIOLOGY
- Citation
- ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, v.56, no.4, pp.1870 - 1876
- Journal Title
- ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
- Volume
- 56
- Number
- 4
- Start Page
- 1870
- End Page
- 1876
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/16476
- DOI
- 10.1128/AAC.05650-11
- ISSN
- 0066-4804
- Abstract
- We investigated the clinical and microbiologic features of 300 cases of cephalosporin-resistant Escherichia coli producing extended-spectrum P-lactamase (ESBL) or plasmid-mediated AmpC beta-lactamase (pAmpC) at three medical centers in the United States. Solid-organ malignancy, connective tissue disease, and a recent history of surgery were more common among pAmpC-producing cases (n = 49), whereas urinary catheter at enrollment, diabetes, and hospitalization in the past year were more common among ESBL-producing cases (n = 233). The factors independently associated with clinical outcome were the following: the presence of cardiovascular disease (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.29 to 6.43), intra-abdominal infection (OR, 6.35; 95% CI, 1.51 to 26.7), other or multiples sources of infection (OR, 8.12; 95% CI, 2.3 to 28.6), age of 65 years or greater (OR, 0.43; 95% CI, 0.2 to 0.95), favorable baseline health status (OR, 0.39; 95% CI, 0.16 to 0.95), and appropriate empirical antimicrobial therapy given in the first 72 h (OR, 0.42; 95% CI, 0.20 to 0.88). beta-Lactamase genes responsible for cephalosporin resistance were identified in 291 cases. CTX-M-type ESBLs accounted for 72.0%. Of those, 88.0% were CTX-M-15. The next most common type was CMY-type pAmpC (16.7%), followed by SHV- and TEM-type ESBLs (6.3 and 1.3%, respectively). Seven cases (2.3%) had KPC-type beta-lactamase. Ertapenem, imipenem, meropenem, doripenem, piperacillin-tazobactam, amikacin, nitrofurantoin, and tigecycline were highly active, with greater than 90% of the isolates being susceptible. Cefepime was less active, with only 74.2% being susceptible due to the predominance of CTX-M-15. These findings have implications in the selection of appropriate empirical therapy when infection due to cephalosporin-resistant E. coli is suspected.
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