infection control & hospital epidemiology october 2017, vol. 38, no. 10 original article
Incidence of Extended-Spectrum β-Lactamase (ESBL)-Producing Escherichia coli and Klebsiella Infections in the United States: A Systematic Literature Review
Jennifer McDanel, MS PhD;1,2,3 Marin Schweizer, PhD;1,2,3 Victoria Crabb, BSN MS;2,3 Richard Nelson, PhD;4,5 Matthew Samore, MD;4,5 Karim Khader, PhD;4,5 Amy E. Blevins, MALS;6 Daniel Diekema, MD, MS;1 Hsiu-Yin Chiang, PhD;1 Rajeshwari Nair, MBBS, PhD;1,2 Eli Perencevich, MD, MS1,2,3
background. Despite a reported worldwide increase, the incidence of extended-spectrum β-lactamase (ESBL) Escherichia coli and Klebsiella infections in the United States is unknown. Understanding the incidence and trends of ESBL infections will aid in directing research and prevention efforts.
objective. To perform a literature review to identify the incidence of ESBL-producing E. coli and Klebsiella infections in the United States. design. Systematic literature review.
methods. MEDLINE via Ovid, CINAHL, Cochrane library,NHSEconomic Evaluation Database, Web of Science, and Scopus were searched for multicenter (≥2 sites), US studies published between 2000 and 2015 that evaluated the incidence of ESBL-E. coli or ESBL-Klebsiella infections. We excluded studies that examined resistance rates alone or did not have a denominator that included uninfected patients such as patient days, device days, number of admissions, or number of discharges. Additionally, articles that were not written in English, contained duplicated data, or pertained to ESBL organisms from food, animals, or the environment were excluded.
results. Among 51,419 studies examined, 9 were included for review. Incidence rates differed by patient population, time, and ESBL definition and ranged from 0 infections per 100,000 patient days to 16.64 infections per 10,000 discharges and incidence rates increased over time from 1997 to 2011. Rates were slightly higher for ESBL-Klebsiella infections than for ESBL-E. coli infections.
conclusion. The incidence of ESBL-E. coli and ESBL-Klebsiella infections in the United States has increased, with slightly higher rates of ESBL-Klebsiella infections. Appropriate estimates of ESBL infections when coupled with other mechanisms of resistance will allow for the appropriate targeting of resources toward research, drug discovery, antimicrobial stewardship, and infection prevention.
Infect Control Hosp Epidemiol 2017;38:1209–1215
Since the late 1980s, infections caused by extended-spectrum β-lactamase (ESBL)-producing organisms have been reported worldwide.1–8 Patients infected with ESBL-producing E. coli or Klebsiella can have poor outcomes due to delays in receiving appropriate antimicrobial therapy and limited treatment options. Strains harboring ESBLs are resistant to third- generation cephalosporins, extended-spectrum penicillins, and monobactams.9,10 Additionally, many ESBL-producing strains of E. coli and Klebsiella demonstrate coresistance to other antimicrobial agents such as fluoroquinolones, aminoglycosides, and tetracyclines.11
Trends among surveillance studies suggest an increase in
the proportion of ESBL-producing strains among isolates collected from E. coli or Klebsiella infections.12–15 However, the incidence of E. coli or Klebsiella infections caused by ESBL-producing strains in the United States is unclear. Knowledge of the incidence and trends of ESBL infections will aid in directing appropriate empiric therapy for patients suspected of having ESBL-E. coli or ESBL-Klebsiella infections and will promote prevention efforts in places with high incidence of these resistant organisms. We performed a systematic literature review to identify the incidence and
Affiliations: 1. Department of Internal Medicine, University of Iowa, Iowa City, Iowa; 2. Iowa City Veteran Affairs Medical Center, Iowa City, Iowa;
3. Department of Epidemiology, University of Iowa, Iowa City, Iowa; 4. Department of Clinical Epidemiology, University of Utah, Salt Lake City, Utah; 5. Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; 6. Hardin Library for the Health Sciences, University of Iowa, Iowa City, Iowa. (Present affiliation: Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana [A.E.B.].).
PREVIOUS PRESENTATION: These data were presented in part at the Society for Healthcare Epidemiology of America 2015 Spring Conference in Orlando, Florida, on May 15, 2015.
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3810-0011. DOI: 10.1017/ice.2017.156 Received March 13, 2017; accepted June 18, 2017; electronically published July 31, 2017
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