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Increasing Incidence of Extended-Spectrum β-Lactamase-Producing Escherichia coli in Community Hospitals throughout the Southeastern United States

  • Joshua T. Thaden (a1), Vance G. Fowler (a1), Daniel J. Sexton (a1) (a2) and Deverick J. Anderson (a1) (a2)
Abstract
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.

Infect. Control Hosp. Epidemiol. 2015;37(1):49–54

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Copyright
Corresponding author
Address correspondence to Joshua T. Thaden, MD, PhD, Division of Infectious Diseases, Hanes House, 315 Trent Drive, Durham, NC 27710 (Joshua.Thaden@duke.edu).
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