1383. Increasing Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Community Hospitals throughout the Southeastern United States
Session: Oral Abstract Session: Epidemiology of Resistant Gram Negative Infections
Saturday, October 10, 2015: 11:45 AM
Room: 5--AB

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.

Joshua T. Thaden, MD, PhD1, Vance G. Fowler Jr., MD2, Daniel J. Sexton, MD, FIDSA, FSHEA1 and Deverick Anderson, MD, MPH, FIDSA, FSHEA1, (1)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (2)Duke University Medical Center, Durham, NC


J. T. Thaden, None

V. G. Fowler Jr., None

D. J. Sexton, None

D. Anderson, None

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