Subsequent infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in patients with prior infection or fecal colonization

  • Anna LindblomEmail author
  • Nahid Karami
  • Tim Magnusson
  • Christina Åhrén
Original Article


In clinical practice, there is a growing need to assess the impact of prior colonization or infection with extended-spectrum β-lactamase-producing Enterobacteriaceae (EPE) on new EPE infections. We have investigated the frequency of, and duration to, a subsequent EPE infection in patients with prior fecal carriage or infection with EPE. Culture data for 3272 EPE-positive patients in Western Sweden during 2004–2014 were evaluated. The median follow-up time was 3.7 years. The first recorded EPE-positive fecal screen, or clinical (urine, blood) culture, and subsequent EPE-positive clinical samples were analyzed, focusing on the first and last recurrence of EPE infection. ESBL Escherichia coli dominated (95%). Almost all (94%) patients initially positive in fecal screen (n = 1436) and 72 and 71% of those initially positive in urine (n = 1717) and blood (n = 119) had no further EPE clinical isolates. Subsequent EPE bacteremia was only detected in 0.7, 1.6, and 4.2% of the respective patient group. Recurrent EPE-positive urine cultures occurred in 27% (460/1717), most (75%) within 6 months, and rarely (13%) after 1 year. Repeated EPE-positive clinical samples were significantly (p < 0.01) more common in patients > 65 years and in men with ESBL Klebsiella pneumoniae. In our low-endemic setting, subsequent EPE infections in previously colonized patients were rare. On the other hand, in patients previously EPE-positive in urine or blood, subsequent EPE urinary tract infections were common, especially within 6 months and in patients > 65 years old.


Extended-spectrum β-lactamases (ESBL) E. coli K. pneumoniae Fecal screening Urinary tract infection Bacteremia Recurrent infection 



We thank the personnel at the Clinical Microbiology Laboratory at Sahlgrenska University Hospital for performing the bacterial culturing.

Funding information

This work was supported by the Centre for Antibiotic Resistance Research (CARe), University of Gothenburg and by Region Västra Götaland, Sweden (VGFOUREG-660231).

Compliance with ethical standards

This study was conducted in accordance with the Declaration of Helsinki and national and institutional regulations.

Ethical approval

The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (recordal: 170-17).

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

No informed consent was required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Anna Lindblom
    • 1
    • 2
    Email author
  • Nahid Karami
    • 1
    • 2
  • Tim Magnusson
    • 2
  • Christina Åhrén
    • 1
    • 3
  1. 1.Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe)University of GothenburgGothenburgSweden
  2. 2.Department of Clinical MicrobiologySahlgrenska University HospitalGothenburgSweden
  3. 3.Swedish Strategic Program Against Antimicrobial Resistance (Strama), Region Västra GötalandGothenburgSweden

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