• Joshua T Freeman, Stephen J McBride, Mitzi S Nisbet, Greg D Gamble, Deborah A Williamson, Susan L Taylor, and David J Holland.
• Department of Clinical Microbiology, LabPlus, PO Box 110031, Auckland City Hospital, Auckland 1148, New Zealand. JoshuaF@adhb.govt.nz
• Int. J. Infect. Dis. 2012 May 1; 16 (5): e371-4.

ObjectivesTo define local risk factors and outcomes for bacteremia with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) at a tertiary hospital in New Zealand.MethodsPatients with ESBL-E bacteremia were compared to matched control patients with non-ESBL-producing Enterobacteriaceae bacteremia. Patients were matched by onset of bacteremia (community vs. hospital), site of blood culture collection (peripheral vs. via central line), and infecting organism species.ResultsForty-four cases with matched controls were included. Eight- and 30-day mortality was higher in cases than controls (27% vs. 7%; p=0.011 and 34% vs. 11%, p=0.011). Twenty-one cases (48%) were community-onset. Community-onset cases were associated with urinary tract infection, whereas hospital-onset cases were associated with central line infection, intensive care admission, and Enterobacter cloacae. Independent risk factors for ESBL-E bacteremia were fluoroquinolone exposure (odds ratio (OR) 6.56, 95% confidence interval (CI) 1.79-24), first-generation cephalosporin exposure (OR 12.3, 95% CI 1.01-148), and previously-known colonization with ESBL-E (OR 46.2, 95% CI 3.45-619).ConclusionsThe association with fluoroquinolone exposure suggests that measures to reduce unnecessary use may be an effective preventative strategy. Known colonization with ESBL-E is a strong risk factor for ESBL-E bacteremia, and colonization status should be taken into consideration when choosing empirical therapy.Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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