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Journal ArticleDOI

A Multinational Survey of Risk Factors for Infection with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Nonhospitalized Patients

TL;DR: Community- Acquired ESBL-producing Enterobacteriaceae are now prevalent worldwide, necessitating international collaboration and novel approaches are required to adequately address issues such as empirical treatment for severe community-acquired infection and infection control.
Abstract: Infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are increasing in frequency and are associated with high mortality rates. Circulation of CTX-M-type ESBLs in the community is of particular concern, because it may confound standard infection-control measures.

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Citations
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Journal ArticleDOI
TL;DR: Multiresistant bacteria, especially ESBL‐producing Enterobacteriaceae, are frequently isolated in nosocomial and, to a lesser extent, HCA infections in cirrhosis, rendering third‐generation cephalosporins clinically ineffective.

511 citations


Additional excerpts

  • ...Overall infections (n/%) 0 (0) 8 (20) 29 (39) 37 (23) 0....

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  • ...UTI (n/%) 1 (5) 12 (35) 25 (57) 38 (39) <0....

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Journal ArticleDOI
TL;DR: Initial clinical data support the use of fosfomycin for the treatment of urinary tract infections caused by members of the family Enterobacteriaceae with advanced resistance to antimicrobial drugs, although further research is needed.
Abstract: Summary Rising rates of resistance to antimicrobial drugs among Enterobacteriaceae limit the choice of reliably active forms of these drugs. We evaluated the evidence on fosfomycin as a treatment option for infections caused by members of the family Enterobacteriaceae with advanced resistance to antimicrobial drugs, including producers of extended-spectrum β-lactamase (ESBL). We systematically reviewed studies evaluating the antimicrobial activity, or the clinical effectiveness of fosfomycin. 17 antimicrobial-susceptibility studies were found and included in our Review, accounting for 5057 clinical isolates of Enterobacteriaceae with advanced resistance to antimicrobial drugs (4448 were producers of ESBL); 11 of the 17 studies reported that at least 90% of the isolates were susceptible to fosfomycin. Using a provisional minimum inhibitory concentration susceptibility breakpoint of 64 mg/L or less, 1604 (96·8%) of 1657 Escherichia coli isolates producing ESBL were susceptible to fosfomycin. Similarly, 608 (81·3%) of 748 Klebsiella pneumoniae isolates producing ESBL were susceptible to fosfomycin. In two clinical studies, oral treatment with fosfomycin–trometamol was clinically effective against complicated or uncomplicated lower urinary tract infections caused by ESBL-producing E coli in, cumulatively, 75 (93·8%) of the 80 patients evaluated. Initial clinical data support the use of fosfomycin for the treatment of urinary tract infections caused by these pathogens, although further research is needed.

453 citations

Journal ArticleDOI
TL;DR: This guideline summarizes the current recommendations developed by the SIS task force on the treatment of patients who have IAI regarding risk assessment in individual patients; source control; the timing, selection, and duration of antimicrobial therapy; and suggested approaches to patients who fail initial therapy.
Abstract: Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the t...

351 citations

Journal ArticleDOI
TL;DR: A substantial portion of community-onset, ESBL-producing E. coli infections now occur among patients without discernible healthcare-associated risk factors in the United States, which has implications for the empiric management ofcommunity-associated infection when involvement of E. bacteria is suspected.
Abstract: (See the Editorial Commentary by Foxman on pages 649–51.) Escherichia coli that produces extended-spectrum β-lactamase (ESBL) has become widespread in hospitals around the world since the late 1980s [1]. ESBLs refer to a group of β-lactamases that have acquired the capacity to hydrolyze penicillins, cephalosporins, and aztreonam [1, 2]. Organisms that produce ESBLs are thus resistant to most broad-spectrum β-lactams with the exception of carbapenems. The genes for these ESBLs are frequently encoded on transferable plasmids that also encode resistance genes for other classes of antimicrobials [3]. Acquisition of such plasmids can thus promptly render an organism multidrug-resistant [4]. In fact, it is commonly observed that ESBL-producing organisms are resistant to multiple classes of antimicrobials including β-lactams, fluoroquinolones, aminoglycosides, and sulfonamides [1]. The global spread of community-associated methicillin-resistant Staphylococcus aureus infections has emerged as a major public concern in recent years [5]. On the other hand, infections due to resistant gram-negative organisms have largely been regarded as a healthcare-associated phenomenon. However, emergence of community-associated infections caused by ESBL-producing E. coli has been reported in multiple countries since the mid-2000s [6–8]. In each of these instances, the ESBLs associated with community-associated infection have largely been the CTX-M type, specifically CTX-M-15, distinct from the TEM and SHV types that were historically common [2]. In addition, the majority of CTX-M–producing E. coli belong to a specific clone that is defined by phylogenetic group B2, serotype O25:H4, and multilocus sequence typing (MLST) profile ST131, including in the United States [9, 10]. However, the extent and significance of community-associated infections caused by ESBL-producing E. coli in the United States have not been elucidated. The potential spread of ESBL-producing E. coli in the community poses a public health concern as well as a challenge to the management of community-associated infections, which are typically treated empirically with agents such as oral cephalosporins or fluoroquinolones without antimicrobial susceptibility testing. The main objective of this study was to describe the occurrence of ESBL-producing E. coli in the community, and to assess the clinical outcome of these patients at multiple hospitals and their affiliated clinics across the United States. We also sought to identify additional risk factors associated with healthcare-associated ESBL-producing E. coli cases in comparison with community-associated cases.

284 citations

Journal ArticleDOI
01 Mar 2011
TL;DR: The development of antimicrobial resistance among gram-negative pathogens has been progressive and relentless, and pathogens of particular concern include extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteria, and multidrug-resistant Pseudomonas aeruginosa.
Abstract: The development of antimicrobial resistance among gram-negative pathogens has been progressive and relentless Pathogens of particular concern include extended-spectrum β-lactamase–producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa Classic agents used to treat these pathogens have become outdated Of the few new drugs available, many have already become targets for bacterial mechanisms of resistance This review describes the current approach to infections due to these resistant organisms and elaborates on the available treatment options

283 citations

References
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Journal ArticleDOI
21 Sep 1963-JAMA
TL;DR: The Index of ADL as discussed by the authors was developed to study results of treatment and prognosis in the elderly and chronically ill. Grades of the Index summarize over-all performance in bathing, dressing, going to toilet, transferring, continence, and feeding.
Abstract: The Index of ADL was developed to study results of treatment and prognosis in the elderly and chronically ill. Grades of the Index summarize over-all performance in bathing, dressing, going to toilet, transferring, continence, and feeding. More than 2,000 evaluations of 1,001 individuals demonstrated use of the Index as a survey instrument, as an objective guide to the course of chronic illness, as a tool for studying the aging process, and as an aid in rehabilitation teaching. Of theoretical interest is the observation that the order of recovery of Index functions in disabled patients is remarkably similar to the order of development of primary functions in children. This parallelism, and similarity to the behavior of primitive peoples, suggests that the Index is based on primary biological and psychosocial function, reflecting the adequacy of organized neurological and locomotor response.

10,971 citations

Journal Article
01 Jan 1963-JAMA

2,337 citations

Journal ArticleDOI
TL;DR: More rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.
Abstract: The medical community relies on clinical expertise and published guidelines to assist physicians with choices in empirical therapy for system-based infectious syndromes, such as community-acquired pneumonia and urinary-tract infections (UTIs). From the late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. Recent reports have also described ESBL-producing E coli as a cause of bloodstream infections associated with these community-onset UTIs. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Thus, more rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.

1,811 citations

Journal ArticleDOI
TL;DR: This report reviews the experience with Gram-negative bacteremia during an 8-year period at the University of Illinois Research and Educational Hospitals and determines the etiology and some aspects of the ecology of these infections.
Abstract: The pattern of life-threatening bacterial infections has changed since the introduction of potent antimicrobial agents. Infections caused by pneumococci and β-hemolytic streptococci are less frequent causes of potentially fatal infections, and severe infections caused by staphylococci, other bacteria, and fungi are relatively more frequent. 1-3 The importance and increasing incidence of infections caused by Gram-negative bacilli have been pointed out by several investigators, 1,4-7 but infections caused by these microorganisms have received less attention than those due to staphylococci. This report reviews the experience with Gram-negative bacteremia during an 8-year period at the University of Illinois Research and Educational Hospitals. The etiology and some aspects of the ecology of these infections have been determined and are reported in this paper. Clinical manifestations, the effect of corticosteroid administration, and antibiotic prophylaxis and therapy of Gram-negative bacteremia are given in another report. Clinical Material All blood culture isolates of a species of

1,422 citations

Journal ArticleDOI
TL;DR: Age, underlying host disease, granulocytopenia, congestive heart failure, diabetes mellitus, renal insufficiency, nosocomial infections, and antecedent treatment with antibiotics, corticosteroids, and antimetabolites significantly increased fatality rates.

1,332 citations