Risk factors for community-onset bloodstream infection with extended-spectrum β-lactamase-producing Enterobacteriaceae: national population-based case–control study

• Published in: Clinical microbiology and infection Vol. 25; no. 11; pp. 1408 - 1414
• Main Authors: Isendahl, J., Giske, C.G., Tegmark Wisell, K., Ternhag, A., Nauclér, P.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2019
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotic consumption; Antibiotic resistance; beta-Lactamases - metabolism; Bloodstream infection; Case-Control Studies; Case–control study; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Drug Utilization - statistics & numerical data; Enterobacteriaceae - enzymology; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - epidemiology; Epidemiology; ESBL; Escherichia coli; Female; Fluoroquinolones; Hospitalization - statistics & numerical data; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Risk Factors; Sepsis - epidemiology; Sepsis - microbiology; Socioeconomic Factors; Sweden - epidemiology; Young Adult; Sweden; Fluoroquinolones; Bloodstream infection; Cephalosporins; Escherichia coli; Antibiotic resistance; ESBL; Antibiotic consumption; Case–control study; Epidemiology; Risk factors
• ISSN: 1198-743X; 1469-0691; 1469-0691
• DOI: 10.1016/j.cmi.2019.04.002

The aim was to investigate risk factors for community-onset bloodstream infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (EPE BSI). It is mandatory to report EPE BSI to a national register at the Public Health Agency of Sweden. Using this register, we performed a population-based case–control study from 2007 to 2012 of 945 cases and 9390 controls. Exposure data on comorbidity, hospitalization, in- and outpatient antibiotic consumption and socio-economic status were collected from hospital and health registers. The overall incidence of EPE BSI was 1.7 per 100 000 person-years. The 30-day mortality was 11.3%. Urological disorders inferred the highest EPE BSI risk, adjusted odds ratio (aOR) 4.32 (95% Confidence Interval (CI) 3.41–5.47), followed by immunological disorders, aOR 3.54 (CI 2.01–6.23), haematological malignancy, aOR 2.77 (CI 1.57–4.87), solid tumours, aOR 2.28 (1.76–2.94) and diabetes, aOR 2.03 (1.58–2.61). Consumption of fluoroquinolones or mostly non-EPE-active antibiotics with selective Gram-negative spectrum of activity within the previous 3 months was associated with EPE BSI, aORs 5.52 (CI 2.8–11.0) and 3.8, CI 1.9–7.7) respectively. There was a dose–response relationship in EPE BSI risk with increasing number of consecutive regimens. Antibiotic consumption >3 months before EPE BSI was not associated with increased risk. Higher age, malignancies and education ≤12 years (aORs >2) were associated with increased 30-day mortality. Targeted interventions should be directed towards improving care for patients with immunosuppression, urological disorders and subjects with lower socio-economic status. Antibiotic stewardship should focus on reduction of fluoroquinolones.