Community-onset Bloodstream Infection Caused by Extended Spectrum Beta-Lactamase Producing Escherichia coli (E.coli) at Tertiary-care Hospital in Thailand: Risk Factors and Clinical Outcome

Abstract

Objective: To determine the local epidemiology, risk factors and outcome of community-onset bloodstream infection (COBSI) caused by extended spectrum beta-lactamase (ESBL) producing E.coli.

Material and methods: Retrospective study was conducted at Nakhonpathom Hospital during December 1, 2012 and June 30, 2013. Eligible patients were adults, aged ≥ 15 years, who had COBSI due to E.coli. Baseline characteristics, comorbid conditions, site and type of infection were collected. Risk factors for infection with ESBL-producing E.coli were identified. Predictive values for mortality were assessed.

Result: There were 102 and 71 (69.6%) patients were female. Thirty-two (31%) patients had ESBL and 70 (69%) had non-ESBL producing E.coli bacteremia. Sixty-nine (67.6%) and 33 (32.4%) patients were classified as having community associated and healthcare associated COBSI, respectively. Factors associated with ESBL-producing E.coli COBSI including prior antibiotics used within 3 months (OR 4.5, 95%CI 1.7-12.1, p = 0.002), previous cephalosporins exposure (OR 2.91, 95%CI 1.01-8.4, p = 0.04), previous fluoroquinolones exposure (OR 6.2, 95%CI 1.5-25.6, p = 0.01) and prior hospitalization within 3 months (OR 2.8, 95%CI 1.1-6.7, p = 0.02). The in-hospital mortality rate of ESBL and non-ESBL were 29% and 15.5%, respectively. Predictors associated with dead were severe sepsis (OR 23.3, 95% CI 6.7-81.9, p < 0.001) and inappropriate empirical antimicrobial therapy (OR 3.3, 95%CI 1.2-9.2, p = 0.02). ESBL-producer did not influence outcome.

Conclusions: Infection caused by ESBL-producing E.coli is an emerging problem in community setting. Third-generation cephalosporins have been generally prescribed for community acquired sepsis. However, the high prevalence of ESBL producer in this study raises the question regarding the efficacy of them as an empirical therapy.