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Risks Factors for Infections with Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care University Hospital in Switzerland

Kuster, S. ; Hasse, B. ; Huebner, V. ; Bansal, V. ; Zbinden, R. ; Ruef, C. ; Ledergerber, B. ; Weber, R.

In: Infection, 2010, vol. 38, no. 1, p. 33-40

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    Titre
    • Risks Factors for Infections with Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae at a Tertiary Care University Hospital in Switzerland
    Auteur
    • Kuster, S.. Division of Infectious Diseases and Hospital Epidemiology, UniversityHospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Hasse, B.. Division of Infectious Diseases and Hospital Epidemiology, UniversityHospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Huebner, V.. Division of Infectious Diseases and Hospital Epidemiology, UniversityHospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Bansal, V.. Division of Infectious Diseases and Hospital Epidemiology, UniversityHospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Zbinden, R.. Institute of Medical Microbiology, University of Zurich, Gloriastrasse30/32, 8006, Zurich, Switzerland
    • Ruef, C.. Division of Infectious Diseases and Hospital Epidemiology, UniversityHospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Ledergerber, B.. Division of Infectious Diseases and Hospital Epidemiology, UniversityHospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Weber, R.. Division of Infectious Diseases and Hospital Epidemiology, UniversityHospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    Type de document
    • Postprint
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:315218
    Summary
    Abstract : Background: : There are considerable geographical differencesin the occurrence of extended-spectrum beta-lactamase(ESBL)-producing bacteria, both in the community and in thehospital setting. Our aim was to assess risk factors forbloodstream, urinary tract, and vascular catheter-associatedinfections with ESBL-producing Escherichia coli and Klebsiellapneumoniae at a tertiary care hospital in a low-prevalencecountry. Methods: : We performed a case-control study comparing 58patients with infections due to ESBL-producing E. coli orK. pneumoniae vs 116 controls with infections due to non-ESBL producing organisms at the University Hospital Zurich,Switzerland, between 1 July 2005 and 30 June 2007. Results: : Cases included 15 outpatients and 43 inpatients.Multivariable analyses found three risk factors for ESBL-producingisolates: begin of symptoms or recent antibioticpre-treatment in a foreign country (odds ratio [OR] 27.01,95% confidence interval [CI] 2.38-1,733.28], p = 0.042),antibiotic therapy within the year preceding the isolation ofthe ESBL-producing strain (OR 2.88, 95% CI 1.13-8.49,p = 0.025), and mechanical ventilation (OR 10.56, 95% CI1.06-579.10, p = 0.042). Conclusions: : The major risk factors for infections due toESBL-producing bacteria were travel in high-prevalencecountries, prior antibiotic use, and mechanical ventilationduring a stay in the intensive care unit. Community-acquiredinfections were documented in 17% of the patients.An early identification of risk factors is crucial to providingthe patients an optimal empiric antibiotic therapy and tokeep the use of carbapenems to a minimum