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Incidence of Extended-Spectrum β-Lactamase (ESBL)-Producing Escherichia coli and Klebsiella Infections in the United States: A Systematic Literature Review

  • Jennifer McDanel (a1) (a2) (a3), Marin Schweizer (a1) (a2) (a3), Victoria Crabb (a2) (a3), Richard Nelson (a4) (a5), Matthew Samore (a4) (a5), Karim Khader (a4) (a5), Amy E. Blevins (a6), Daniel Diekema (a1), Hsiu-Yin Chiang (a1), Rajeshwari Nair (a1) (a2) and Eli Perencevich (a1) (a2) (a3)...



Despite a reported worldwide increase, the incidence of extended-spectrum β-lactamase (ESBL) Escherichia coli and Klebsiella infections in the United States is unknown. Understanding the incidence and trends of ESBL infections will aid in directing research and prevention efforts.


To perform a literature review to identify the incidence of ESBL-producing E. coli and Klebsiella infections in the United States.


Systematic literature review.


MEDLINE via Ovid, CINAHL, Cochrane library, NHS Economic Evaluation Database, Web of Science, and Scopus were searched for multicenter (≥2 sites), US studies published between 2000 and 2015 that evaluated the incidence of ESBL-E. coli or ESBL-Klebsiella infections. We excluded studies that examined resistance rates alone or did not have a denominator that included uninfected patients such as patient days, device days, number of admissions, or number of discharges. Additionally, articles that were not written in English, contained duplicated data, or pertained to ESBL organisms from food, animals, or the environment were excluded.


Among 51,419 studies examined, 9 were included for review. Incidence rates differed by patient population, time, and ESBL definition and ranged from 0 infections per 100,000 patient days to 16.64 infections per 10,000 discharges and incidence rates increased over time from 1997 to 2011. Rates were slightly higher for ESBL-Klebsiella infections than for ESBL-E. coli infections.


The incidence of ESBL-E. coli and ESBL-Klebsiella infections in the United States has increased, with slightly higher rates of ESBL-Klebsiella infections. Appropriate estimates of ESBL infections when coupled with other mechanisms of resistance will allow for the appropriate targeting of resources toward research, drug discovery, antimicrobial stewardship, and infection prevention.

Infect Control Hosp Epidemiol 2017;38:1209–1215


Corresponding author

Address correspondence to Jennifer McDanel, MS, PhD, 200 Hawkins Dr, C52-J GH, Iowa City, IA 52242 (


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(Present affiliation: Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana [A.E.B.].).

PREVIOUS PRESENTATION: These data were presented in part at the Society for Healthcare Epidemiology of America 2015 Spring Conference in Orlando, Florida, on May 15, 2015.



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