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Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae

2016; Elsevier BV; Volume: 49; Issue: 1 Linguagem: Inglês

10.1016/j.ijantimicag.2016.09.032

1872-7913

Jean‐Ralph Zahar, Philippe Lesprit, Stéphane Ruckly, A. Eden, Hikombo Hitoto, Louis Bernard, Stephan Harbarth, Jean-François Timsit, Christian Brun‐Buisson, Nejla Aissa, Alain Losniewski, Sandrine Hénard, Christian Rabaud, C. Janssen, Léonardo Pagani, Stéphane Bland, J. Gaillat, Jean Pierre Bru, Pierre Bonnin, Gaelle Clavère, Virginie Vitrat, Laurence Maulin, Luc Quarsaet, Helene Roger, Jean-Baptiste Euzen, E. Denès, Elodie Couve-Daecon, Catherine Lechiche, Jean‐Philippe Lavigne, V. Mondain, Celine Pulcini, Véronique Vernet Garnier, Dorothée Lambert, Maxime Hentzien, Yohan N’Guyen, Jean Paul Talarmin, Pascaline Rameau, Françoise Geffroy, Arnaud Salmon‐Rousseau, Vincent Cattoir, Antoine Froissart, Saïd Aberrane, Laurence Legout, F. Roblot, Guillaume Béraud, Patricia Pavèse, Olivier Belmonte, Nicolas Traversier, Laurent Bellec, Marie Lagrange-Xélot, Marie-Pierre Moiton, Barbara Kuli, P. Longuet, A. Scanvic, Léa Colombain, Milagros Ferreyra, Maxime Jean, A. Eden, E. Laurens, Matthieu Saada, Hugues Aumaître, Martine Malet, Frederique Roustant, Vincent LeMoing, Jean-Pierre Helene, Jonathan Theodore, Caroline Garandeau, J. Caillon, Benjamin Olivero, D. Boutoille, Didier Lepelletier, L. Grandière-Pérez, Aurélie Beaudron, Céline Ramanantsoa, C. Varache, N Varache, N. Crochette, Hikombo Hitoto, Sophie Blanchi, Pascale Penn, Bernard Louis, D. Vanjak, Marie‐Christine Escande, René-Gilles Patrigeon, Stéphanie Honoré, Audrey Barrelet, Marlène Amara, Jean-Marc Galempoix, J.C. Reveil, Patricia Bucchiotty, C. Couzigou, Alban Le Monnier, Emilie Boidin, Stephane Sire, Nelly Luizy, Caroline Bronstain, Stephan Harbarth, Carolina Fankhauser, Caroline Brossier, Elodie von Dach, Colette Sauve, Colette Sauve, Marie-Noelle Adam, Laurent Hocqueloux, Laurent Bret, M. André, Régine Barruet, Marion Challier, André Cabié, Benoît Rozé, Patrick Plesiat, Katy Jeanot, Isabelle Patry, Joséphine Moreau, Catherine Chirouze, Aaron Laurent, Marie-Nadège Bachelier, G. Kac, Nicolas Farthouat, Nicolas Feuillebois, Thomas Guimard, Sandra Bourdon, Sophie Nguyen, S. Alfandari, H. Bentayeb, Mari-Thérèse Albertini, B. Marchou, N. Gaudré, Damien Dubois, Christelle Guillet-Caruba, Florence Doucet Populaire, Nicolas Fortineau, Leila Escaut, Philippe Lesprit, Vincent Fihman, R. Gauzit, Josette Raymond, Solene Kerneis, Véronique Leflon‐Guibout, A. Lefort, Aurélien Dinh, Anne‐Laure Roux, Sophie Abgrall, Françoise Jauréguy, Jean‐Christophe Lucet, Aurélien Dinh, Nathalie Soismier, Amanda Lopes, Emmanuelle Cambau, V. Manceron, Guilène Barnaud,

Pneumonia and Respiratory Infections

Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.