Bloodstream infections caused by Escherichia coli producing AmpC β-lactamases: epidemiology and clinical features. Pascual, V., Alonso, N., Simó, M., Ortiz, G., Garcia, M. C., Xercavins, M., Rivera, A., Morera, M. A., Miró, E., Espejo, E., Navarro, F., Gurguí, M., Pérez, J., Rodríguez-Carballeira, M., Garau, J., & Calbo, E. European Journal of Clinical Microbiology & Infectious Diseases: Official Publication of the European Society of Clinical Microbiology, 35(12):1997–2003, 2016.
doi  abstract   bibtex   
The aim of the study was to investigate the epidemiology and clinical features of bloodstream infections due to Escherichia coli producing AmpC β-lactamases (AmpC-Ec-BSI). In a multi-centre case-control study, all third-generation-cephalosporin-resistant Escherichia coli BSI (3GC-Ec-BSI) isolates were analysed. Acquired bla AmpC (bla ac-AmpC) detection was done by polymerase chain reaction (PCR) and sequencing. Chromosomal bla AmpC (bla c-AmpC) expression was quantified by real-time PCR. Cases were patients with AmpC-Ec-BSI. Controls were patients with cephalosporin-susceptible E. coli BSI, matched 1:1 by sex and age. Demographics, comorbidities, intrinsic and extrinsic risk factors for antimicrobial resistance, clinical presentation and outcomes were investigated. Among 841 E. coli BSI, 17 were caused by AmpC-Ec (2 %). Eleven isolates (58.8 %) had bla ac-AmpC and six were bla c-AmpC overproducers. The mean age of cases was 66.2 years and 71 % were men. Cases were more frequently healthcare-related (82 vs. 52 % controls, p \textless 0.05) and presented more intrinsic and extrinsic risk factors. At least one risk factor was present in 94.1 % of cases vs. 41.7 % of controls (p = 0.002). Severity and length of stay (LOS) were higher among cases (mean Pitt Score 2.6 vs. 0.38 in controls, p = 0.03; LOS 17.5 days vs. 6 in controls, p = 0.02). Inappropriate empirical therapy (IET) was administered to 70.6 % of cases and 23.5 % of controls (p \textless 0.003). No differences were found in terms of cure rate at the 14th day and mortality. Bloodstream infections due to AmpC-Ec (mostly plasmid-mediated) are infrequent in our area. AmpC-Ec-BSI affects mainly patients with intrinsic risk factors and those with previous antibiotic exposure. A high proportion received IET.
@article{pascual_bloodstream_2016,
	title = {Bloodstream infections caused by {Escherichia} coli producing {AmpC} β-lactamases: epidemiology and clinical features},
	volume = {35},
	issn = {1435-4373},
	shorttitle = {Bloodstream infections caused by {Escherichia} coli producing {AmpC} β-lactamases},
	doi = {10.1007/s10096-016-2752-3},
	abstract = {The aim of the study was to investigate the epidemiology and clinical features of bloodstream infections due to Escherichia coli producing AmpC β-lactamases (AmpC-Ec-BSI). In a multi-centre case-control study, all third-generation-cephalosporin-resistant Escherichia coli BSI (3GC-Ec-BSI) isolates were analysed. Acquired bla AmpC (bla ac-AmpC) detection was done by polymerase chain reaction (PCR) and sequencing. Chromosomal bla AmpC (bla c-AmpC) expression was quantified by real-time PCR. Cases were patients with AmpC-Ec-BSI. Controls were patients with cephalosporin-susceptible E. coli BSI, matched 1:1 by sex and age. Demographics, comorbidities, intrinsic and extrinsic risk factors for antimicrobial resistance, clinical presentation and outcomes were investigated. Among 841 E. coli BSI, 17 were caused by AmpC-Ec (2 \%). Eleven isolates (58.8 \%) had bla ac-AmpC and six were bla c-AmpC overproducers. The mean age of cases was 66.2 years and 71 \% were men. Cases were more frequently healthcare-related (82 vs. 52 \% controls, p {\textless} 0.05) and presented more intrinsic and extrinsic risk factors. At least one risk factor was present in 94.1 \% of cases vs. 41.7 \% of controls (p = 0.002). Severity and length of stay (LOS) were higher among cases (mean Pitt Score 2.6 vs. 0.38 in controls, p = 0.03; LOS 17.5 days vs. 6 in controls, p = 0.02). Inappropriate empirical therapy (IET) was administered to 70.6 \% of cases and 23.5 \% of controls (p {\textless} 0.003). No differences were found in terms of cure rate at the 14th day and mortality. Bloodstream infections due to AmpC-Ec (mostly plasmid-mediated) are infrequent in our area. AmpC-Ec-BSI affects mainly patients with intrinsic risk factors and those with previous antibiotic exposure. A high proportion received IET.},
	language = {eng},
	number = {12},
	journal = {European Journal of Clinical Microbiology \& Infectious Diseases: Official Publication of the European Society of Clinical Microbiology},
	author = {Pascual, V. and Alonso, N. and Simó, M. and Ortiz, G. and Garcia, M. C. and Xercavins, M. and Rivera, A. and Morera, M. A. and Miró, E. and Espejo, E. and Navarro, F. and Gurguí, M. and Pérez, J. and Rodríguez-Carballeira, M. and Garau, J. and Calbo, E.},
	year = {2016},
	pmid = {27549108},
	keywords = {Adult, Age Distribution, Aged, Aged, 80 and over, Anti-Bacterial Agents, Bacteremia, Bacterial Proteins, Case-Control Studies, DNA, Bacterial, Escherichia coli, Escherichia coli Infections, Female, Humans, Length of Stay, Male, Middle Aged, Polymerase Chain Reaction, Risk Factors, Sequence Analysis, DNA, Severity of Illness Index, Treatment Outcome, beta-Lactamases},
	pages = {1997--2003},
}

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