Differences in risk-factor profiles between patients with ESBL-producing Escherichia coli and Klebsiella pneumoniae: a multicentre case-case comparison study

Antimicrobial Resistance and Infection Control

Joshua T Freeman³  Joseph Rubin⁴  Gary N McAuliffe¹  Gisele Peirano⁴  Sally A Roberts³  Dragana Drinković²  Johann DD Pitout⁴ 

[1] Department of Clinical Microbiology, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand

[2] Department of Clinical Microbiology, Waitemata District Health Board, Auckland, New Zealand

[3] Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

[4] Division of Microbiology, Calgary Laboratory Services, Departments of Pathology & Laboratory Medicine, Microbiology Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada

关键词: Risk factors;    Bacteraemia;    Escherichia coli;    Klebsiella pneumoniae;    ESBL;   

Others  :  1084081
DOI  :  10.1186/2047-2994-3-27

 received in 2014-01-23, accepted in 2014-08-08,  发布年份 2014

【 摘 要 】

Background

Generic epidemiological differences between extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), are poorly defined. Nonetheless, defining such differences and understanding their basis could have strategic implications for infection control policy and practice.

Methods

Between 2009 and 2011 patients with bacteraemia due to ESBL-EC or ESBL-KP across all three acute hospitals in the city of Auckland, New Zealand, were eligible for inclusion. Recognised risk factors for ESBL bacteraemia were compared between species in a retrospective case-case study design using multivariate logistic regression. Representative isolates underwent ESBL gene characterisation and molecular typing.

Results

170 patients and 176 isolates were included in the study (92 patients with ESBL-EC, 78 with ESBL-KP). 92.6% had CTX-Ms. 39% of EC were ST131 while 51% of KP belonged to 3 different STs (i.e. ST20, ST48 & ST1087). Specific sequence types were associated with specific hospitals for ESBL-KP but not ESBL-EC. Variables positively associated with ESBL-EC on multivariate analysis were: community acquired infection (odds ratio [OR] 7.9; 95% CI: 2.6-23.9); chronic pulmonary disease (OR 5.5; 95% CI: 1.5-20.1); and high prevalence country of origin (OR 4.3; 95% CI: 1.6-11.6). Variables negatively associated with ESBL-EC were previous transplant (OR 0.06; 95% CI: 0.007-0.6); Hospital 2 (OR 0.3; 95% CI: 0.1-0.7) and recent ICU admission (OR 0.3; 95% CI: 0.07-0.9).

Conclusions

Differences in risk profiles between patients with ESBL-EC and ESBL-KP suggest fundamental differences in transmission dynamics. Understanding the biological basis for these differences could have implications for infection control practice. Tailoring of infection control measures according to ESBL species may be indicated in some instances.

【 授权许可】

   
2014 Freeman et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Pitout JD, Laupland KB: Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public health concern. Lancet Infect Dis 2008, 8:159-166.
• [2]Cantón R, Coque TM: The CTX-M β-lactamase pandemic. Curr Opin Microbiol 2006, 9:466-475.
• [3]Damjanova I, Tóth A, Pászti J, Hajbel-Vékony G, Jakab M, Berta J, Milch H, Füzi M: Expansion and countrywide dissemination of ST11, ST15 and ST147 ciprofloxacin-resistant CTX-M-15-type beta-lactamase-producing Klebsiella pneumoniae epidemic clones in Hungary in 2005–the new ‘MRSAs’? J Antimicrob Chemother 2008, 62:978-985.
• [4]Coelho A, Mirelis B, Alonso-Tarres C, Nieves Larrosa M, Miró E, Clivillé Abad R, Bartolomé RM, Castañer M, Prats G, Johnson JR, Navarro F, González-López JJ: Detection of three stable genetic clones of CTX-M-15-producing Klebsiella pneumoniae in the Barcelona metropolitan area, Spain. J Antimicrob Chemother 2009, 64:862-864.
• [5]Pierano G, Hung King Sang J, Pitondo-silva A, Laupland KB, Pitout JD: Molecular epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae over a 10 year period in Calgary, Canada. J Antimicrob Chemother 2012, 67:1114-1120.
• [6]Park SY, Kang CI, Joo EJ, Ha YE, Wi YM, Chung DR, Peck KR, Lee NY, Song JH: Risk factors for multidrug resistance in nosocomial bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Microb Drug Resist 2012, 18:518-524.
• [7]Freeman JT, McBride SJ, Nisbet MS, Gamble GD, Williamson DA, Taylor SL, Holland DJ: Bloodstream infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary care hospital in New Zealand: risk factors and outcomes. Int J Infect Dis 2012, 16:371-374.
• [8]Ben Ami R, Schwaber MJ, Nanon-Venezia S, Schwartz D, Giladi M, Chmelnitsky I, Leavitt A, Carmeli Y: Influx of extended-spectrum β-lactamase-producing Enterobacteriaceae into the hospital. Clin Infect Dis 2006, 42:925-934.
• [9]Hayakawa K, Gattu S, Marchaim D, Bhargava A, Palla M, Alshabani K, Gudur UM, Pulluru H, Bathina P, Sundaragiri PR, Sarkar M, Kakarlapudi H, Ramasamy B, Nanjireddy P, Mohin S, Dasagi M, Datla S, Kuchipudi V, Reddy S, Shahani S, Upputuri V, Marrey S, Gannamani V, Madhanagopal N, Annangi S, Sudha B, Muppavarapu KS, Moshos JA, Lephart PR, Pogue JM, et al.: Epidemiology and risk factors for isolation of Escherichia coli producing CTX-M-type extended-spectrum β-lactamase in a large US medical center. Antimicrob Agents Chemother 2013, 57:4010-4018.
• [10]Kang CI, Wi YM, Lee MY, Ko KS, Chung DR, Peck KR, Lee NY, Song JH: Epidemiology and risk factors of community onset infections caused by extended-spectrum β-lactamase-producing Escherichia coli strains. J Clin Microbiol 2012, 50:312-317.
• [11]Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, Kahlmeter G, Pan A, Petrosillo N, Rodríguez-Baño J, Singh N, Venditti M, Yokoe DS, Cookson B, European Society of Clinical Microbiology: ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014, 20(Suppl 1):1-55.
• [12]Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ: Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002, 137:791-797.
• [13]Hsueh PR, Badal RE, Hawser SP, Hoban DJ, Bouchillon SK, Ni Y, Paterson DL, 2008 Asia–Pacific SMART Group: Epidemiology and antimicrobial susceptibility profiles of aerobic and facultative gram negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region: 2008 results from SMART (Study for Monitoring Antimicrobial Resistance Trends). Int J Antimicrob Agents 2010, 36:408-414.
• [14]Abdul Rahman EM, El-Sherif RH: High rates of intestinal colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae among healthy individuals. J Investig Med 2011, 59:1284-1286.
• [15]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chron Dis 1987, 40:373-383.
• [16]Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing: nineteenth and twenty first informational supplements. Wayne, PA: Clinical and Laboratory Standards Institute; 2009:M100-S19 and 2011:M100-S21.
• [17]Pitout JD, Gregson DB, Campbell L, Laupland KB: Molecular characteristics of extended-spectrum-beta-lactamase-producing Escherichia coli isolates causing bacteremia in the Calgary Health Region from 2000 to 2007: emergence of clone ST131 as a cause of community-acquired infections. Antimicrob Agents Chemother 2009, 53:2846-2851.
• [18]Hunter SB, Vauterin P, Lambert-Fair MA, Van Duyne MS, Kubota K, Graves L, Wrigley D, Barrett T, Ribot E: Establishment of a universal size standard strain for use with the PulseNet standardized pulsed-field gel electrophoresis protocols: converting the national databases to the new size standard. J Clin Microbiol 2005, 43:1045-1050.
• [19]Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, Swaminathan B: Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995, 33:2233-2239.
• [20]Heffernan HM, Woodhouse RE, Pope CE, Blackmore TK: Prevalence and types of extended-spectrum beta-lactamases among urinary Escherichia coli and Klebsiella spp. in New Zealand. Int J Antimicrob Agents 2009, 34:544-549.
• [21]Romero L, Lopez L, Rodreguez-bano J, Ramon Hernandez J, Martinez-Martinez L, Pascual A: Long term study of the frequency of Escherichia coli and Klebsiella pneumoniae isolates producing extended-spectrum beta-lactamases. Clin Microbiol Infect 2005, 11:625-631.
• [22]Marcade G, Brisse S, Bialek S, Marcon E, Leflon-Guibout V, Passet V, Moreau R, Nicolas-Chanoine MH: The emergence of multidrug-resistant Klebsiella pneumoniae of international clones ST13, ST16, ST35, ST48 and ST101 in a teaching hospital in the Paris region. Epidemiol Infect 2013, 141:1705-1712.
• [23]Ma L, Lu PL, Siu LK, Hsieh MH: Molecular typing and resistance mechanisms of imipenem-non-susceptible Klebsiella pneumoniae in Taiwan: results from the Taiwan surveillance of antibiotic resistance (TSAR) study, 2002–2009. J Med Microbiol 2013, 62:101-107.
• [24]Freeman JT, Williamson DA, Heffernan H, Smith M, Bower JE, Roberts SA: Comparative epidemiology of CTX-M-14 and CTX-M-15 producing Escherichia coli: Association with distinct demographic groups in the community in New Zealand. Eur J Clin Microbiol Infect Dis 2012, 31:2057-2060.
• [25]Nicolas Chanoine MH, Jarlier V, Robert J, Arlet G, Drieux L, Leflon-Guibout V, Laouénan C, Larroque B, Caro V, Mentré F, Group Coli β: Patient’s origin and lifestyle associated with CTX-M-producing Escherichia coli: A case–control-control study. PLoS One 2012, 7:e30498.
• [26]Harris AD, Kotetishvili M, Shurland S, Johnson JA, Morris JG, Nemoy LL, Johnson JK: How important is patient to patient transmission in extended-spectrum β-lactamase Escherichia coli acquisition. Am J Infect Control 2007, 35:97-101.
• [27]Harris AD, Perencevich EN, Johnson JK, Paterson DL, Morris JG, Strauss SM, Johnson JA: Patient to patient transmission is important in extended-spectrum β-lactamase producing Klebsiella pneumoniae acquisition. Clin Infect Dis 2007, 45:1347-1350.
• [28]Hilty M, Betsch BY, Bogli-Stuber K, Heiniger N, Stadler M, Küffer M, Kronenberg A, Rohrer C, Aebi S, Endimiani A, Droz S, Mühlemann K: Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting. Clin Infect Dis 2012, 55:967-975.
• [29]Cholley P, Thouverez M, Gbaugidi-Haore H, Sauget M, Slekovec C, Bertrand X, Talon D, Hocquet D: Hospital cross-transmission of extended-spectrum β-lactamase Escherichia coli and Klebsiella pneumoniae. Med Mal Infect 2013, 43:331-336.
• [30]Freeman JT, Nimmo J, Gregory E, Tiong A, De Almeida M, McAuliffe GN, Roberts SA: Predictors of hospital surface contamination with extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumonia: patient and organism factors. Antimicrob Resist Infect Control 2014, 4:3-5. doi:10.1186/2047-2994-3-5
• [31]Moor CT, Roberts SA, Simmons G, Briggs S, Morris AJ, Smith J, Heffernan H: Extended-spectrum beta-lactamase enterobacteria: factors associated with infection in the community setting, Auckland, New Zealand. J Hosp Infect 2008, 68:355-362.
• [32]Rodriguez-Bano J, Picon E, Gijon P, Hernández JR, Ruíz M, Peña C, Almela M, Almirante B, Grill F, Colomina J, Giménez M, Oliver A, Horcajada JP, Navarro G, Coloma A, Pascual A, Spanish Network for Research in Infectious Diseases (REIPI): Community-Onset bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli: Risk Factors and Prognosis. Clin Infect Dis 2010, 50:40-48.