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Epidemiology and Surveillance

Community-Onset Escherichia coli Infection Resistant to Expanded-Spectrum Cephalosporins in Low-Prevalence Countries

Benjamin A. Rogers, Paul R. Ingram, Naomi Runnegar, Matthew C. Pitman, Joshua T. Freeman, Eugene Athan, Sally M. Havers, Hanna E. Sidjabat, Mark Jones, Earleen Gunning, Mary De Almeida, Kaylene Styles, David L. Paterson
Benjamin A. Rogers
aThe University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Queensland, Australia
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Paul R. Ingram
bDepartments of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
cSchool of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia
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Naomi Runnegar
dInfection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
eThe University of Queensland, School of Medicine, Brisbane, Australia
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Matthew C. Pitman
fMicrobiology Department, The Royal Darwin Hospital, Tiwi, Northern Territory, Australia
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Joshua T. Freeman
gDepartment of Clinical Microbiology, Auckland City Hospital, Auckland, New Zealand
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Eugene Athan
hInfectious Diseases, Barwon Health, Geelong, Victoria, Australia
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Sally M. Havers
aThe University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Queensland, Australia
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Hanna E. Sidjabat
aThe University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Queensland, Australia
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Mark Jones
iThe University of Queensland, School of Population Health, Herston, Brisbane, Queensland, Australia
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Earleen Gunning
eThe University of Queensland, School of Medicine, Brisbane, Australia
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Mary De Almeida
fMicrobiology Department, The Royal Darwin Hospital, Tiwi, Northern Territory, Australia
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Kaylene Styles
hInfectious Diseases, Barwon Health, Geelong, Victoria, Australia
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David L. Paterson
aThe University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Queensland, Australia
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DOI: 10.1128/AAC.02052-13
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ABSTRACT

By global standards, the prevalence of community-onset expanded-spectrum-cephalosporin-resistant (ESC-R) Escherichia coli remains low in Australia and New Zealand. Of concern, our countries are in a unique position, with high extramural resistance pressure from close population and trade links to Asia-Pacific neighbors with high ESC-R E. coli rates. We aimed to characterize the risks and dynamics of community-onset ESC-R E. coli infection in our low-prevalence region. A case-control methodology was used. Patients with ESC-R E. coli or ESC-susceptible E. coli isolated from blood or urine were recruited at six geographically dispersed tertiary care hospitals in Australia and New Zealand. Epidemiological data were prospectively collected, and bacteria were retained for analysis. In total, 182 patients (91 cases and 91 controls) were recruited. Multivariate logistic regression identified risk factors for ESC-R among E. coli strains, including birth on the Indian subcontinent (odds ratio [OR] = 11.13, 95% confidence interval [95% CI] = 2.17 to 56.98, P = 0.003), urinary tract infection in the past year (per-infection OR = 1.430, 95% CI = 1.13 to 1.82, P = 0.003), travel to southeast Asia, China, the Indian subcontinent, Africa, and the Middle East (OR = 3.089, 95% CI = 1.29 to 7.38, P = 0.011), prior exposure to trimethoprim with or without sulfamethoxazole and with or without an expanded-spectrum cephalosporin (OR = 3.665, 95% CI = 1.30 to 10.35, P = 0.014), and health care exposure in the previous 6 months (OR = 3.16, 95% CI = 1.54 to 6.46, P = 0.02). Among our ESC-R E. coli strains, the blaCTX-M ESBLs were dominant (83% of ESC-R E. coli strains), and the worldwide pandemic ST-131 clone was frequent (45% of ESC-R E. coli strains). In our low-prevalence setting, ESC-R among community-onset E. coli strains may be associated with both “export” from health care facilities into the community and direct “import” into the community from high-prevalence regions.

FOOTNOTES

    • Received 19 September 2013.
    • Returned for modification 14 November 2013.
    • Accepted 19 January 2014.
    • Accepted manuscript posted online 27 January 2014.
  • Supplemental material for this article may be found at http://dx.doi.org/10.1128/AAC.02052-13.

  • Copyright © 2014, American Society for Microbiology. All Rights Reserved.
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Community-Onset Escherichia coli Infection Resistant to Expanded-Spectrum Cephalosporins in Low-Prevalence Countries
Benjamin A. Rogers, Paul R. Ingram, Naomi Runnegar, Matthew C. Pitman, Joshua T. Freeman, Eugene Athan, Sally M. Havers, Hanna E. Sidjabat, Mark Jones, Earleen Gunning, Mary De Almeida, Kaylene Styles, David L. Paterson on behalf of the Australasian Society for Infectious Diseases Clinical Research Network
Antimicrobial Agents and Chemotherapy Mar 2014, 58 (4) 2126-2134; DOI: 10.1128/AAC.02052-13

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Community-Onset Escherichia coli Infection Resistant to Expanded-Spectrum Cephalosporins in Low-Prevalence Countries
Benjamin A. Rogers, Paul R. Ingram, Naomi Runnegar, Matthew C. Pitman, Joshua T. Freeman, Eugene Athan, Sally M. Havers, Hanna E. Sidjabat, Mark Jones, Earleen Gunning, Mary De Almeida, Kaylene Styles, David L. Paterson on behalf of the Australasian Society for Infectious Diseases Clinical Research Network
Antimicrobial Agents and Chemotherapy Mar 2014, 58 (4) 2126-2134; DOI: 10.1128/AAC.02052-13
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