Epidemiology and risk factors for infections due to AmpC ?-lactamase-producing Escherichia Coli


Por: Pascual V., Ortiz G., Simó M., Alonso N., 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.

Publicada: 1 ene 2015
Resumen:
Objectives: To describe the prevalence and risk factors for infection due to AmpC ?-lactamase-producing Escherichia coli (AmpC-EC). Methods: For the prevalence study, all clinical isolates of E. coli with reduced susceptibility to third-generation cephalosporins were prospectively included from June 2010 to November 2011. For risk factor analysis, a case-control study was conducted. Cases were patients with an infection due to AmpC-EC. Controls were patients infected with cephalosporin-susceptible E. coli, matched 1:2. Detection of blaAmpC genes was done with a multiplex AmpC-PCR, and hyperproduction of E. coli chromosomal blaAmpC by quantitative RT-PCR. Alteration of the blaAmpC promoter was studied by PCR and sequencing. Results:We identified 243 (1.1%) AmpC-EC strains out of 21563 clinical isolates. Three cases with strains carrying ESBLs, 18 strains that were considered due to colonization and 8 cases lost to clinical follow-up were excluded. Finally, 214 cases were included in the analysis. Ninety-one cases (42.5%) and 269 (62.8%) controls were strictly community acquired (P,0.001). Thirty-five (16.3%) cases and 186 controls (43.5%) did not have any identifiable risk factor (P,0.001). Among cases, 158 (73.8%) were found to harbour an acquired AmpC (73.4% CMY-2). Previous use of fluoroquinolones [OR 2.6 (95% CI 1.12-3.36); P1/40.008] was independently associated with AmpC-EC in the multivariate analysis. Conclusions: Prevalence of AmpC in E. coli remains low in our area. Plasmid acquisition (CMY type) represents the main mechanism of AmpC production. A high proportion of community-acquired isolates and patients with no identifiable risk factors were found. Previous use of fluoroquinolones was identified as a risk factor. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Filiaciones:
Pascual V.:
 Hospital Universitari Mútua de Terrassa, Barcelona, Spain

Ortiz G.:
 Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

Simó M.:
 CatLab, Barcelona, Spain

Alonso N.:
 Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

 Universitat Autònoma de Barcelona, Barcelona, Spain

 Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain

Garcia M.C.:
 Consorci Sanitari de Terrassa, Barcelona, Spain

Xercavins M.:
 CatLab, Barcelona, Spain

Rivera A.:
 Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

Morera M.A.:
 CatLab, Barcelona, Spain

Miró E.:
 Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

 Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain

Espejo E.:
 Consorci Sanitari de Terrassa, Barcelona, Spain

Navarro F.:
 Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

 Universitat Autònoma de Barcelona, Barcelona, Spain

 Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain

Gurguí M.:
 Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

 Universitat Autònoma de Barcelona, Barcelona, Spain

 Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain

Pérez J.:
 CatLab, Barcelona, Spain

Rodríguez-Carballeira M.:
 Hospital Universitari Mútua de Terrassa, Barcelona, Spain

Garau J.:
 Hospital Universitari Mútua de Terrassa, Barcelona, Spain

Calbo E.:
 Hospital Universitari Mútua de Terrassa, Barcelona, Spain

 Universitat Internacional de Catalunya, Barcelona, Spain
ISSN: 03057453
Editorial
OXFORD UNIV PRESS, GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND, Reino Unido
Tipo de documento: Article
Volumen: 70 Número: 3
Páginas: 899-904
WOS Id: 000350214700036
ID de PubMed: 25468902
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