Abstract

BACKGROUND: In recent years, extended-spectrum beta-lactamase (ESBL)-producingEnterobacteriaceae have emerged in many hospitals worldwide. The increasing dissemination and long-termcarriage of these organisms within the community carry tremendous implications on the empirical therapyof community-acquired infection. MATERIAL/METHODS: To evaluate the prevalence and clinical features ofcommunity-acquired bacteremia involving ESBL-producing Enterobacteriaceae in southern Israel (ESBL-P)we retrospectively studied all Enterobacteriaceae bacteremias during an 8-month period in the Negev regionusing medical and laboratory records. Antibiotic susceptibility was determined using the disk-diffusionmethod. ESBL production was determined using an E-test ESBL strip. Cases involving ESBL-P were comparedto those involving non-producing strains (ESBL-NP) using the chi-square test. RESULTS: In all, 187 Enterobacteriaceaebacteremias were detected, of which 119 were community-acquired (63.6%). ESBL-P were found in six cases(5%) which are described herein in greater detail. Patients with ESBL-P bacteremia were older, and weremore likely to stay in the intensive-care unit. Urinary catheterization and bed-ridden conditions weresignificant risk factors for ESBL-P. ESBL-P strains were significantly resistant to nearly all antibioticagents except for imipienem and piperacillin-tazobactam as opposing to ESBL-NP. Patients with ESBL-Pbacteremia were more likely to suffer from complications and had a higher mortality. CONCLUSIONS: Thispaper is the first to describe community-acquired Enterobacteriaceae bacteremia involving ESBL-P strainsin Israel. Although the exact prevalence of these organisms in Israel is currently unknown, our findingssuggest that ESBL-producers have already begun to disseminate in our community.

Keywords: Aged, 80 and over, Community-Acquired Infections, Enterobacteriaceae, Enterobacteriaceae Infections, Israel, beta-Lactamases