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A comparison of extended-spectrum beta-lactamase (ESBL)– producing Escherichia coli and Klebsiella pneumoniae bloodstream infections in Alberta using a provincial surveillance system
Kathryn R. Bush MSc1, Jennifer Ellison MSc1, Kaitlin Hearn BEH(AD)1 —
To the Editor The recent study by Scheuerman et al1 investigating
risk factors associated with extended-spectrumβ-lactamase (ESBL)– producing Escherichia coli and ESBL-producing Klebsiella pneumoniae bloodstream infections was of interest to our group and spurred further investigation into local infection prevention andcontrol
surveillancedata.Datawere collectedprospectively from acute care
facilitieswithinAlberta.Thedatawere retrospectivelyana- lyzed for factors comparable to Scheuerman et al1 including gender, age, case classification, time from admission to positive culture, and source of secondary infection. The data reflect all ESBL bloodstream infection cases in Alberta from April 2013 to March 2018, and our results are similar to the findings of Scheuerman et al.1 (Table 1) Of 593 ESBL isolates, 551 (93%) were E. coli. Of the cases that were extracted fromour database, a statistically significant higher propor- tion of ESBL-producing K. pneumoniae bloodstreaminfectionswere classified as hospital acquired or healthcare associated with a longer average time fromadmission to culture than bloodstreaminfections with ESBL-producing E. coli. Conversely, a statistically significant higher proportion of ESBL E. coli bloodstream infection cases were notedtobecommunity-acquired;only19%ofKlebsiellaisolateswere considered community-acquired. The results obtained within Alberta are similar to the findings of
Scheuerman et al.1 Going forward, future investigations may pro- vide additional clarity on the differences between ESBL-producing isolates based on further study of clinical and nonclinical param- eters, including the proportion of nonurine ESBL-producing E. coli isolates compared to ESBL-producing K. pneumoniae isolates, the appropriateness of initial antimicrobial therapy, and the travel his- tory of patients with ESBL infections.
Author ORCIDs. Kaitlin Hearn, 0000-0002-8201-7986
Author for correspondence: Kathryn Bush, Email:
kathryn.bush@ahs.ca Cite this article: Bush KR, et al. (2019). A comparison of extended-spectrum beta-
lactamase (ESBL)–producing Escherichia coli and Klebsiella pneumoniae bloodstream infections in Alberta using a provincial surveillance system. Infection Control & Hospital Epidemiology, 40: 388,
https://doi.org/10.1017/ice.2018.353
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. , Ted Pfister MSc1 and Geoffrey Taylor MD1,2 1Infection Prevention and Control, Alberta Health Services, Alberta and 2Department of Medicine, University of Alberta, Edmonton, Alberta
Table 1. ComparisonofESBL-ECandESBL-KPBSICaseCharacteristics,2013–2018 ESBL-EC
Covariate Male
Median age (IQR)
BSI Classification Hospital-acquired
Healthcare-associated Community-acquired
Epidemiological Parameter Urinary tract Other
Time from admission to culture, average d
(n = 551), No. (%)
309 (56) 72 (22)
149 (27) 197 (36) 203 (37)
312 (76) 99 (24)
ESBL-KP (n = 42), No. (%)
28 (67) 67 (12)
22 (52) 12 (29) 8 (19)
17 (61) 11 (39)
919
P Valuea NS
<.05
<.05 NS
<.05 NS <.05 Note. ESBL, extended-spectrum β-lactamase; EC, Escherichia coli; KP, Klebsiella pneumoniae;
BSI, bloodstream infection; NS, not significant (P>.05). aThe Mann-Whitney U test was used to calculate P values for continuous variables. A test of proportions or the χ2 test was used for categorical variables.
Acknowledgments. We acknowledge the infection control professionals and physicians of Alberta Health Services and Covenant Health for these surveillance data.
Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
Reference 1. Scheuerman O, Schechner V, Carmeli Y, et al. Comparison of predictors and mortality between bloodstream infections caused by ESBL producing Escherichia coli and ESBL-producing Klebsiella pneumoniae. Infect Control Hospital Epidemiol 2018;39:660–667.
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