Incidence of community-onset extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae infections: an 11-year population-based study in Denmark

Abstract Objectives To assess the impact of ESBL production on mortality and length of hospital stay (LOS) of community-onset infections due to Escherichia coli or Klebsiella pneumoniae. Methods A population-based cohort study including all adult patients hospitalized with a first-time community-onset E. coli or K. pneumoniae bacteraemia or urinary tract infection in the North Denmark Region between 2007 and 2017. For each bacterial agent, we computed 1 year Kaplan–Meier survival curves and cumulative incidence functions of LOS, and by use of Cox proportional hazard regression we computed HRs as estimates of 30 day and 1 year mortality rate ratios (MRRs) and LOS among patients with and without ESBL-producing infections. Results We included 24 518 cases (among 22350 unique patients), of whom 1018 (4.2%) were infected by an ESBL-producing bacterium. The 30 day cumulative mortality and adjusted MRR (aMRR) in patients with and without ESBL-producing isolates was as follows: E. coli bacteraemia (n = 3831), 15.8% versus 14.0%, aMRR = 1.01 (95% CI = 0.70–1.45); E. coli urinary tract infection (n = 17151), 9.5% versus 8.7%, aMRR = 0.97 (95% CI = 0.75–1.26); K. pneumoniae bacteraemia (n = 734), 0% versus 17.2%, aMRR = not applicable; and K. pneumoniae urinary tract infection (n = 2802), 13.8% versus 10.7%, aMRR = 1.13 (95% CI = 0.73–1.75). The 1 year aMRR remained roughly unchanged. ESBL-producing E. coli bacteraemia was associated with an increased LOS compared with non-ESBL production. Conclusions ESBL production was not associated with an increased short- or long-term mortality in community-onset infections due to E. coli or K. pneumoniae, yet ESBL-producing E. coli bacteraemia was associated with an increased LOS.

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Impact of Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae on the Outcome of Community-onset Bacteremic Urinary Tract Infections

Journal of Microbiology Immunology and Infection ◽

10.1016/s1684-1182(10)60031-x ◽

2010 ◽

Vol 43 (3) ◽

pp. 194-199 ◽

Cited By ~ 45

Author(s):

Ya-Sung Yang ◽

Chih-Hung Ku ◽

Jung-Chung Lin ◽

Shih-Ta Shang ◽

Chun-Hsiang Chiu ◽

...

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Urinary Tract Infections ◽

Extended Spectrum ◽

Tract Infections ◽

Community Onset

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Predictors of Mortality From Community-Onset Bloodstream Infections Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae

Infection Control and Hospital Epidemiology ◽

10.1086/588082 ◽

2008 ◽

Vol 29 (7) ◽

pp. 671-674 ◽

Cited By ~ 34

Author(s):

Anucha Apisarnthanarak ◽

Pattarachai Kiratisin ◽

Linda M. Mundy

Keyword(s):

Escherichia Coli ◽

Cohort Study ◽

Klebsiella Pneumoniae ◽

Bloodstream Infections ◽

Predictors Of Mortality ◽

Extended Spectrum ◽

To Receive ◽

Community Onset

In a cohort study of 36 patients with community-onset extended-spectrum β-lactamase (ESBL)–producing Escherichia coli or Klebsiella pneumoniae bloodstream infections, we found that predictors of mortality were community-onset infection with ESBL-producing K. pneumoniae pathogens (P = .02) and failure to receive an initial empirical regimen that included either β-lactam and β-lactamase–inhibitors or a carbapenem (P = .04).

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In vitro activity of mecillinam alone and combined with different beta-lactams and/or beta-lactamase inhibitors against extended spectrum beta-lactamase- and AmpC-producing Escherichia coli and Klebsiella pneumoniae

10.26226/morressier.56d5ba32d462b80296c94d86 ◽

2016 ◽

Author(s):

Frank Hansen

Keyword(s):

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Vitro Activity ◽

Beta Lactamase ◽

In Vitro Activity ◽

Beta Lactams ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

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Prevalence and Characterization of Extended-Spectrum β-Lactamase-Producing Antibiotic-Resistant Escherichia coli and Klebsiella pneumoniae in Ready-to-Eat Street Foods

Antibiotics ◽

10.3390/antibiotics10070850 ◽

2021 ◽

Vol 10 (7) ◽

pp. 850

Author(s):

Shobha Giri ◽

Vaishnavi Kudva ◽

Kalidas Shetty ◽

Veena Shetty

Keyword(s):

Escherichia Coli ◽

Food Safety ◽

Klebsiella Pneumoniae ◽

Rural Areas ◽

Significant Risk ◽

Microbiological Quality ◽

Resistant Bacteria ◽

Antibiotic Resistant ◽

E Coli ◽

Extended Spectrum

As the global urban populations increase with rapid migration from rural areas, ready-to-eat (RTE) street foods are posing food safety challenges where street foods are prepared with less structured food safety guidelines in small and roadside outlets. The increased presence of extended-spectrum-β-lactamase (ESBL) producing bacteria in street foods is a significant risk for human health because of its epidemiological significance. Escherichia coli and Klebsiella pneumoniae have become important and dangerous foodborne pathogens globally for their relevance to antibiotic resistance. The present study was undertaken to evaluate the potential burden of antibiotic-resistant E. coli and K. pneumoniae contaminating RTE street foods and to assess the microbiological quality of foods in a typical emerging and growing urban suburb of India where RTE street foods are rapidly establishing with public health implications. A total of 100 RTE food samples were collected of which, 22.88% were E. coli and 27.12% K. pneumoniae. The prevalence of ESBL-producing E. coli and K. pneumoniae was 25.42%, isolated mostly from chutneys, salads, paani puri, and chicken. Antimicrobial resistance was observed towards cefepime (72.9%), imipenem (55.9%), cefotaxime (52.5%), and meropenem (16.9%) with 86.44% of the isolates with MAR index above 0.22. Among β-lactamase encoding genes, blaTEM (40.68%) was the most prevalent followed by blaCTX (32.20%) and blaSHV (10.17%). blaNDM gene was detected in 20.34% of the isolates. This study indicated that contaminated RTE street foods present health risks to consumers and there is a high potential of transferring multi-drug-resistant bacteria from foods to humans and from person to person as pathogens or as commensal residents of the human gut leading to challenges for subsequent therapeutic treatments.

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