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Bloodstream infections caused by Escherichia coli producing AmpC β-lactamases: epidemiology and clinical features

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Abstract

The aim of the study was to investigate the epidemiology and clinical features of bloodstream infections due to Escherichia coli producing AmpC β-lactamases (AmpC-Ec-BSI). In a multi-centre case–control study, all third-generation-cephalosporin-resistant Escherichia coli BSI (3GC-Ec-BSI) isolates were analysed. Acquired bla AmpC (bla ac-AmpC) detection was done by polymerase chain reaction (PCR) and sequencing. Chromosomal bla AmpC (bla c-AmpC) expression was quantified by real-time PCR. Cases were patients with AmpC-Ec-BSI. Controls were patients with cephalosporin-susceptible E. coli BSI, matched 1:1 by sex and age. Demographics, comorbidities, intrinsic and extrinsic risk factors for antimicrobial resistance, clinical presentation and outcomes were investigated. Among 841 E. coli BSI, 17 were caused by AmpC-Ec (2 %). Eleven isolates (58.8 %) had bla ac-AmpC and six were bla c-AmpC overproducers. The mean age of cases was 66.2 years and 71 % were men. Cases were more frequently healthcare-related (82 vs. 52 % controls, p < 0.05) and presented more intrinsic and extrinsic risk factors. At least one risk factor was present in 94.1 % of cases vs. 41.7 % of controls (p = 0.002). Severity and length of stay (LOS) were higher among cases (mean Pitt Score 2.6 vs. 0.38 in controls, p = 0.03; LOS 17.5 days vs. 6 in controls, p = 0.02). Inappropriate empirical therapy (IET) was administered to 70.6 % of cases and 23.5 % of controls (p < 0.003). No differences were found in terms of cure rate at the 14th day and mortality. Bloodstream infections due to AmpC-Ec (mostly plasmid-mediated) are infrequent in our area. AmpC-Ec-BSI affects mainly patients with intrinsic risk factors and those with previous antibiotic exposure. A high proportion received IET.

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Authors and Affiliations

  1. Infectious Disease Unit, Service of Internal Medicine, Hospital Universitari Mútua de Terrassa, Plaza Dr. Robert 5, 08021, Terrassa, Barcelona, Spain

    V. Pascual, M. Rodríguez-Carballeira, J. Garau & E. Calbo

  2. Hospital de la Santa Creu i Sant Pau and Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

    N. Alonso, G. Ortiz, A. Rivera, E. Miró, F. Navarro & M. Gurguí

  3. Universitat Autònoma de Barcelona, Barcelona, Spain

    N. Alonso, F. Navarro & M. Gurguí

  4. Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain

    N. Alonso, E. Miró, F. Navarro & M. Gurguí

  5. Catlab, Barcelona, Spain

    M. Simó, M. Xercavins, M. A. Morera & J. Pérez

  6. Consorci Sanitari de Terrassa, Barcelona, Spain

    M. C. Garcia & E. Espejo

  7. Universitat Internacional de Catalunya, Barcelona, Spain

    E. Calbo

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  1. V. Pascual
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  2. N. Alonso
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  3. M. Simó
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Corresponding author

Correspondence to V. Pascual.

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Conflict of interest

J. G. has accepted grants from Vifor Pharma, Bayer and Pfizer, and speaking engagements and conference invitations from Astellas, AstraZeneca, Novartis, Pfizer, GSK, Bayer, Vifor Pharma, Cubist, Durata and Theravance. E. C. has accepted grants, speaking engagements and conference invitations from Astellas, AstraZeneca, Novartis, Pfizer and MSD. All other authors: none to declare.

Informed consent and ethical approval

The study was approved by the Ethics Committee of the participating hospitals. Informed consent was not deemed necessary due to the retrospective observational design of the study.

Funding

This work was supported by the Fundació Mútua de Terrassa, Grant SQ1Number BFMT 2010/B and by REIPI, RD06 by Plan Nacional I+D+I 2008–2011 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD12/0015)—co-financed by European Development Regional Fund ‘A way to achieve Europe’ ERDF.

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Pascual, V., Alonso, N., Simó, M. et al. Bloodstream infections caused by Escherichia coli producing AmpC β-lactamases: epidemiology and clinical features. Eur J Clin Microbiol Infect Dis 35, 1997–2003 (2016). https://doi.org/10.1007/s10096-016-2752-3

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  • DOI: https://doi.org/10.1007/s10096-016-2752-3

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