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Community-onset Escherichia coli infection resistant to expanded- spectrum cephalosporins in low-prevalence countries

Rogers, Benjamin A, Ingram, Paul R, Runnegar, Naomi, Pitman, Matthew C, Freeman, Joshua T, Athan, Eugene, Havers, Sally M, Sidjabat, Hanna E, Jones, Mark, Gunning, Earleen, De Almeida, Mary, Styles, Kaylene and Paterson, David L 2014, Community-onset Escherichia coli infection resistant to expanded- spectrum cephalosporins in low-prevalence countries, Antimicrobial Agents and Chemotherapy, vol. 58, no. 4, pp. 2126-2134, doi: 10.1128/AAC.02052-13.

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Title Community-onset Escherichia coli infection resistant to expanded- spectrum cephalosporins in low-prevalence countries
Author(s) Rogers, Benjamin A
Ingram, Paul R
Runnegar, Naomi
Pitman, Matthew C
Freeman, Joshua T
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Havers, Sally M
Sidjabat, Hanna E
Jones, Mark
Gunning, Earleen
De Almeida, Mary
Styles, Kaylene
Paterson, David L
Journal name Antimicrobial Agents and Chemotherapy
Volume number 58
Issue number 4
Start page 2126
End page 2134
Total pages 9
Publisher American Society for Microbiology
Place of publication Washington, DC
Publication date 2014
ISSN 0066-4804
Keyword(s) Escherichia coli
Expanded-spectrum cephalosporins
Summary Background
By global standards the prevalence of community onset expanded-spectrum cephalosporin resistant Escherichia coli (ESC-R-EC) remains low in Australia and New Zealand. Of concern, our countries are in a unique position with high extramural resistance pressure from close population and trade links to Asia-Pacific neighbours with high ESC-R-EC rates. We aim to characterize the risks and dynamics of community onset ESC-R-EC in our low-prevalence region.

Methods
A case-control methodology was used. Patients with ESC-R-EC or susceptible E. coli isolated from blood or urine were recruited at six geographically dispersed tertiary hospitals in Australia and New Zealand. Epidemiological data was prospectively collected and bacteria were retained for analysis.

Results
In total, 182 patients (91 cases and 91 controls) were recruited. Multivariate logistic regression identified risk factors for ESC-R amongst E. coli including birth on the Indian subcontinent (OR=11.13, 2.17-56.98, p=0.003), urinary tract infection in the past year (per infection OR=1.430, 1.13-1.82, p=0.003), travel to South East Asia, China, Indian subcontinent, Africa and the Middle East (OR=3.089, 1.29-7.38, p=0.011), prior exposure to trimethoprim+/-sulfamethoxazole &/or an expanded-spectrum cephalosporin (OR=3.665, 1.30-10.35, p=0.014) and healthcare exposure in the previous six months (OR=3.16, 1.54-6.46, p=0.02).

Amongst our ESC-R-EC the blaCTX-M ESBLs was dominant (83% of ESC-R-EC), and the worldwide pandemic clone ST-131 was frequent (45% of ESC-R-EC).

Conclusion
In our low prevalence setting, ESC-R amongst community onset E. coli may be associated with both ‘export’ from healthcare facilities into the community and direct ‘import’ into the community from high-prevalence regions.
Language eng
DOI 10.1128/AAC.02052-13
Field of Research 060501 Bacteriology
Socio Economic Objective 920109 Infectious Diseases
HERDC Research category C1.1 Refereed article in a scholarly journal
Persistent URL http://hdl.handle.net/10536/DRO/DU:30062462

Document type: Journal Article
Collection: School of Medicine
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Citation counts: TR Web of Science Citation Count  Cited 9 times in TR Web of Science
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Created: Thu, 10 Apr 2014, 12:20:58 EST by Jane Moschetti

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