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Journal of Clinical Microbiology, March 2004, p. 1089-1094, Vol. 42, No. 3
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.3.1089-1094.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Epidemiology and Clinical Features of Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Nonhospitalized Patients

Jesús Rodríguez-Baño,1* Maria Dolores Navarro,1 Luisa Romero,2 Luis Martínez-Martínez,2,{dagger} Miguel A. Muniain,1 Evelio J. Perea,2 Ramón Pérez-Cano,1 and Alvaro Pascual2

Sección de Enfermedades Infecciosas, Servicio de Medicina Interna,1 Departamento de Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain2

Received 13 July 2003/ Returned for modification 23 September 2003/ Accepted 10 December 2003

Infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) in nonhospitalized patients seem to be emerging in different countries. Their incidence, epidemiology, and clinical impact in the community have not been studied. We describe the epidemiology and clinical features of infections caused by ESBLEC in nonhospitalized patients in Spain and the results of a case-control study performed to investigate the risk factors associated with the acquisition of these organisms. The clonal relatedness of the organisms was assessed by repetitive extragenic palindromic sequence PCR. The ESBLs and the genes encoding the ESBLs were initially characterized by isoelectric focusing and PCR, respectively. Forty-nine patients (76% with urinary tract infections, 22% with asymptomatic bacteriuria, and 2% with acute cholangitis) were included. Six patients were bacteremic. Diabetes mellitus (odds ratio, 5.5; 95% confidence interval, 1.6 to 18.7), previous fluoroquinolone use (odds ratio, 7.6; 95% confidence interval, 1.9 to 30.1), recurrent urinary tract infections (odds ratio, 4.5; 95% confidence interval, 1.3 to 15.1), a previous hospital admission (odds ratio, 18.2; 95% confidence interval, 5.3 to 61.1), and older age in male patients (odds ratio per year, 1.03; 95% confidence interval, 1.03 to 1.05) were identified as risk factors by multivariate analysis. The ESBLEC isolates were not clonally related. The ESBLs were characterized as members of the CTX-M-9 group, the SHV group, and the TEM group in 64, 18, and 18% of the isolates, respectively. ESBLEC is an emergent cause of urinary tract infections in nonhospitalized patients. There was no evidence of horizontal transmission of ESBLEC strains. Avoidance of fluoroquinolone use in high-risk patients should be considered whenever possible in order to avoid the selection of these organisms.

* Corresponding author. Mailing address: Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani, 3, 41071 Seville, Spain. Phone: 34 955 008 035. Fax: 34 955 009 024. E-mail: jrb{at}nacom.es.

{dagger} Present address: Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.

Journal of Clinical Microbiology, March 2004, p. 1089-1094, Vol. 42, No. 3
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.3.1089-1094.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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