Background: Infections with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are increasing worldwide. Although the epidemiology of ESBL-producing Enterobacteriaceae has been well-documented in tertiary medical centers, little is known about ESBL infections in community hospitals in the United States.
Methods: ESBL-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) infections were identified at 26 community hospitals from January 2009 – December 2014 using CDC definitions and standardized surveillance methods. Poisson regression was used to determine trends in the rates of ESBL-EC and ESBL-KP detection and to calculate relative rates and 95% confidence intervals (CI).
Results: The incidence of ESBL-EC infections increased from 5.28 to 10.5 patients per 100,000 patient-days during the study period (P = 0.006) (Figure 1). There were significant demographic differences between ESBL-EC and ESBL-KP patients as ESBL-EC infections were more common in females (54% vs 44%, P < 0.001), Caucasians (50% vs 40%), Hispanics (4% vs <1%, P < 0.00001), and were more likely to be isolated from the urinary tract (61% vs 52%, P < 0.00001). ESBL-EC infections were more often community-acquired (23% vs 10%, P < 0.00001) and admitted from home (57% vs 48%, P = 0.003). ESBL-EC infections were less often isolated from patients on dialysis (5% vs 8%, P = 0.01) and in the ICU (14% vs 19%, P = 0.02). The number of community hospitals with ESBL-EC infections increased from 18 (69%) in 2009 to 21 (81%) in 2014. The median ESBL-EC isolation rates among individual hospitals that had at least one ESBL-EC patient increased from 11.1/100,000 patient-days (range 2.2-33.9) in 2009 to 22.1/100,000 patient-days (range 0.66 to 134) in 2014 (P = 0.05). The incidence of ESBL-KP infections remained constant over the study period (P = 0.14) (Figure 1).
Conclusion: The rate of infections caused by ESBL-EC increased in community hospitals throughout the southeastern U.S. The rate of ESBL-KP remained unchanged. Many ESBL-EC infections were admitted from home. Clinicians in community hospitals must be aware of this change in epidemiology.
Figure 1. Rate of ESBL-EC (A) and ESBL-KP (B) infections in 26 community hospitals throughout the southeastern United States by year.
J. T. Thaden,
D. J. Sexton, None
D. Anderson, None
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