Changing epidemiology of infections due to extended spectrum beta-lactamase producing bacteria

Steven Z. Kassakian, Leonard A. Mermel

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Background: Community-associated infections caused by extended-spectrum beta-lactamase (ESBL) producing bacteria are a growing concern.Methods: Retrospective cohort study of clinical infections due to ESBL-producing bacteria requiring admission from 2006-2011 at a tertiary care academic medical center in Providence, RI.Results: A total of 321 infections due to ESBL-producing bacteria occurred during the study period. Fifty-eight cases (18%) were community-acquired, 170 (53%) were healthcare-associated, and 93 (29%) were hospital-acquired. The incidence of ESBL infections per 10,000 discharges increased during the study period for both healthcare-associated infections, 1.9 per year (95% CI 1-2.8), and for community-acquired infections, 0.85 per year (95% CI 0.3-1.4) but the rate remained unchanged for hospital-acquired infections. For ESBL-producing E. coli isolates, resistance to both ciprofloxacin and trimethoprim-sulfamethoxazole was 95% and 65%, respectively but 94% of isolates were susceptible to nitrofurantoin.Conclusions: Community-acquired and healthcare-associated infections due to ESBL-producing bacteria are increasing in our community, particularly urinary tract infections due to ESBL-producing E. coli. Most isolates are resistant to oral antibiotics commonly used to treat urinary tract infections. Thus, our findings have important implications for outpatient management of such infections.

Original languageEnglish (US)
Article number9
JournalAntimicrobial Resistance and Infection Control
Issue number1
StatePublished - Mar 25 2014
Externally publishedYes


  • Antimicrobial resistance
  • Ciprofloxacin
  • Community-acquired infections
  • Extended-spectrum beta-lactamase
  • Urinary tract infection

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)


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