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Increasing Incidence of Extended-Spectrum β-Lactamase-Producing Escherichia coli in Community Hospitals throughout the Southeastern United States
Filetype[PDF - 549.14 KB]


Details:
  • Pubmed ID:
    26458226
  • Pubmed Central ID:
    PMC4748740
  • Funding:
    K23 AI095357/AI/NIAID NIH HHS/United States
    K23 AI095357/AI/NIAID NIH HHS/United States
    K24 AI093969/AI/NIAID NIH HHS/United States
    R01AI068804/AI/NIAID NIH HHS/United States
    U54 CK000164/CK/NCEZID CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    OBJECTIVE

    To describe the epidemiology of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) infections

    DESIGN

    Retrospective cohort

    SETTING

    Inpatient care at community hospitals

    PATIENTS

    All patients with ESBL-EC or ESBL-KP infections

    METHODS

    ESBL-EC and ESBL-KP infections from 26 community hospitals were prospectively entered into a centralized database from January 2009 to December 2014.

    RESULTS

    A total of 925 infections caused by ESBL-EC (10.5 infections per 100,000 patient days) and 463 infections caused by ESBL-KP (5.3 infections per 100,000 patient days) were identified during 8,791,243 patient days of surveillance. The incidence of ESBL-EC infections increased from 5.28 to 10.5 patients per 100,000 patient days during the study period (P =.006). The number of community hospitals with ESBL-EC infections increased from 17 (65%) in 2009 to 20 (77%) in 2014. The median ESBL-EC infection rates among individual hospitals with ≥1 ESBL-EC infection increased from 11.1 infections/100,000 patient days (range, 2.2–33.9 days) in 2009 to 22.1 infections per 100,000 patient days (range, 0.66–134 days) in 2014 (P =.05). The incidence of ESBL-KP infections remained constant over the study period (P = .14). Community-associated and healthcare-associated ESBL-EC infections trended upward (P =.006 and P = .02, respectively), while hospital-onset infections remained stable (P = .07). ESBL-EC infections were more common in females (54% vs 44%, P < .001) and Caucasians (50% vs 40%, P < .0001), and were more likely to be isolated from the urinary tract (61% vs 52%, P < .0001) than ESBL-KP infections.

    CONCLUSIONS

    The incidence of ESBL-EC infection has increased in community hospitals throughout the southeastern United States, while the incidence of ESBL-KP infection has remained stable. Community- and healthcare-associated ESBL-EC infections are driving the upward trend.