Risk Factors for the Development of Extended-Spectrum Beta-Lactamase-Producing Bacteria in Nonhospitalized Patients

  • R. Colodner
  • W. Rock
  • B. Chazan
  • N. Keller
  • N. Guy
  • W. Sakran
  • R. Raz
Article

Abstract

Although the risk factors for acquiring infection by extended-spectrum beta-lactamase (ESBL)-producing bacteria have been investigated in hospitalized patients, such risk factors have not been defined in the community setting. In this study, clinical data from a total of 311 nonhospitalized patients with community-acquired urinary tract infection (128 with ESBL-positive strains and 183 with ESBL-negative strains) were obtained. According to a multivariate analysis, the following were identified as independent risk factors: previous hospitalization in the past 3 months (OR=8.95, 95%CI, 3.77–21.25), antibiotic treatment in the past 3 months (OR=3.23, 95%CI, 1.76–5.91), age over 60 years (OR=2.65, 95%CI, 1.45–4.83), diabetes (OR=2.57, 95%CI, 1.20–5.51), male gender (OR=2.47, 95%CI, 1.22–5.01), Klebsiella pneumoniae infection (OR=2.31, 95%CI, 1.17–4.54), previous use of third-generation cephalosporins (P=0.014, OR=15.8, 95%CI, 1.7–143), previous use of second-generation cephalosporins (P<0.0001, OR=10.1, 95%CI, 4.2–24), previous use of quinolones (P=0.001, OR=4.1, 95%CI, 1.8–9.0), and previous use of penicillin (P=0.003, OR=4.0, 95%CI, 1.6–9.0).

Notes

Acknowledgements

The authors thank Idit Lavie for performing the statistical analysis. This work complies with the current laws of Israel regarding clinical trials.

References

  1. 1.
    Bush K (1996) Is it important to identify extended-spectrum beta-lactamase-producing isolates? Eur J Clin Microb Infect Dis 15:361–364Google Scholar
  2. 2.
    Shah PW, Stille W (1983) Escherichia coli and Klebsiella pneumoniae strains more susceptible to cefoxitin than to third-generation cephalosporins. J Antimicrob Chemother 11:597–598PubMedGoogle Scholar
  3. 3.
    Jarlier V, Nicolas MH, Fournier G, Philippon A (1988) Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility pattern. Rev Infect Dis 10:867–878PubMedGoogle Scholar
  4. 4.
    Jacoby GA, Medeiros AA, O’Brien TF, Pinto ME, Jiang H (1988) Broad-spectrum, transmissible beta-lactamases. N Engl J Med 319:723–724PubMedGoogle Scholar
  5. 5.
    Quinn JP, Miyashiro D, Sahm D, Flamm R, Bush K (1989) Novel plasmid-mediated beta-lactamase (TEM-10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae. Antimicrob Agents Chemoter 33:1451–1456Google Scholar
  6. 6.
    Paterson DL, Mulazimoglu L, Casellas JM, Ko WC, Goossens H, Von Gottberg A, Mohapatra S, Trenholme GM, Klugman KP, McCormack JG, Yu VL (2000) Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum beta-lactamase production in Klebsiella pneumoniae isolates causing bacteremia. Clin Infect Dis 30:473–478CrossRefPubMedGoogle Scholar
  7. 7.
    Rice LB (1999) Successful interventions for gram-negative resistance to extended-spectrum beta-lactam antibiotics. Pharmacotheropy 19 (8 Pt 2):120S–128SGoogle Scholar
  8. 8.
    Pena C, Pujol M, Ricart A, Ardanuy C, Ayats J, Linares J, Garrigosa F, Ariza J, Gudiol F (1997) Risk factors for faecal carriage of Klebsiella pneumoniae producing extended-spectrum beta-lactamase in the intensive care unit. J Hosp Infect 35:9–16PubMedGoogle Scholar
  9. 9.
    Ho PL, Chan WM, Tsang KW, Wong SS, Young K (2002) Extended-spectrum beta-lactamases: frequency, risk factors, and outcomes. Pharmacotherapy 22:14–20PubMedGoogle Scholar
  10. 10.
    Mangeney N, Niel P, Paul G, Faubert E, Hue S, Dupeyron C, Louarn F, Leluan G (2000) A 5-year epidemiological study of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates in a medium- and long-stay neurological unit. J Appl Microbiol 88:504–511CrossRefPubMedGoogle Scholar
  11. 11.
    Barrett SP, Savage MA, Rebec MP, Guyot A, Andrews N, Shrimpton SB (1999) Antibiotic sensitivity of bacteria associated with community-acquired urinary tract infection in Britain. J Antimicrob Chem 44:359–365CrossRefGoogle Scholar
  12. 12.
    Colodner R, Keness Y, Chazan B, Raz R (2001) Antimicrobial susceptibility of community-acquired uropathogens in northern Israel. Int J Antimicrob Agents 18:189–192Google Scholar
  13. 13.
    Clarridge JE, Johnson JR, Pezzlo, AM (1998) Laboratory diagnosis of urinary tract infections. Cumitech 2B. American Society for Microbiology Press, Washington DCGoogle Scholar
  14. 14.
    National Committee for Clinical Laboratory Standards (2002) Performance standards for antimicrobial susceptibility testing. Twelfth informational supplement. Document M100-S12. NCCLS, Wayne, PA, p 39Google Scholar
  15. 15.
    Borer A, Gilad J, Menashe G, Peled N, Riesenberg K, Schlaeffer F (2002) Extended-spectrum beta-lactamase-producing Enterobacteriaceae strains in community-acquired bacteremia in southern Israel. Med Sci Monit 8:44–47Google Scholar
  16. 16.
    Raz R, Okev N, Kennes Y, Gilboa A, Lavi I, Bisharat N (2000) Demographic characteristics of patients with community-acquired bacteriuria and susceptibility of urinary pathogens to antimicrobials in northern Israel. Isr Med Assoc J 2:426–429PubMedGoogle Scholar
  17. 17.
    Bisson G, Fishman NO, Patel JB, Edelstein PH, Lautenbach E (2002) Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species: risk factors for colonization and impact of antimicrobial formulary interventions on colonization prevalence. Infect Control Hosp Epidemiol 23:254–260PubMedGoogle Scholar
  18. 18.
    Wiener J, Quinn JP, Bradford PA, Goering RV, Nathan C, Bush K, Weinstein RA (1999) Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 281:517–523CrossRefPubMedGoogle Scholar
  19. 19.
    Meyer KS, Urban C, Eagan JA, Berger BJ, Rahal JJ (1993) Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 119:353–358PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • R. Colodner
    • 1
  • W. Rock
    • 6
  • B. Chazan
    • 2
    • 4
  • N. Keller
    • 3
  • N. Guy
    • 4
  • W. Sakran
    • 2
    • 5
    • 6
  • R. Raz
    • 2
    • 6
  1. 1.Clinical Microbiology LaboratoryHa’Emek Medical CenterAfulaIsrael
  2. 2.Infectious Diseases UnitHa’Emek Medical CenterAfulaIsrael
  3. 3.Sheba Medical CenterTel HashomerIsrael
  4. 4.Department of Family MedicineHa’Emek Medical CenterAfulaIsrael
  5. 5.Pediatric B WardHa’Emek Medical CenterAfulaIsrael
  6. 6.The Rappaport Faculty of MedicineThe TechnionHaifaIsrael

Personalised recommendations