Spatial clusters of extended-spectrum beta-lactamase-producing Escherichia coli causing community-onset bacteriuria due to repeat infections: cluster analysis from a large urban medical center, San Francisco, 2014-2020.
Spatial clusters of extended-spectrum beta-lactamase-producing Escherichia coli causing community-onset bacteriuria due to repeat infections: cluster analysis from a large urban medical center, San Francisco, 2014-2020.
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扩展谱β-内酰胺酶产生的大肠杆菌的空间簇导致由于重复感染而引起的社区发作的细菌：旧金山大型城市医学中心的聚类分析，2014- 2020年。
DOI：
10.1186/s13756-023-01320-1
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发表时间：
2023-10-20
影响因子：
5.5
通讯作者：
Chambers, Henry F.
中科院分区：
文献类型：
--
作者：
Raphael, Eva;Inamdar, Pushkar P.;Belmont, Cheyenne;Shariff-Marco, Salma;Huang, Alison J.;Chambers, Henry F.
由产超广谱 β-内酰胺酶 (ESBL) 的大肠杆菌 (ESBL-E. coli) 引起的尿路感染可能因共同源暴露而暴发。然而，目前尚不清楚它们是否如预期的那样在地理上聚集，成为疫情爆发的一部分。我们收集了 2014 年 1 月至 2020 年 3 月期间居住在旧金山的安全网公共医疗保健系统中患有培养记录的社区发病大肠杆菌菌尿的所有患者的电子健康记录数据（入院后 48 小时内诊断或在过去 90 天内在门诊临床环境中确诊）。我们评估了 (1) ESBL-E 空间簇的存在。大肠杆菌菌尿发作，以及 (2) 患有任何 ESBL-E 的个体。大肠杆菌菌尿发作，采用全局和局部 Moran's I。我们通过泊松回归评估了 ESBL 产生的菌尿复发率的差异。在 4,304 个独特的个体中，我们确定了 ESBL-E 的空间集群。与非 ESBL-E 相比，大肠杆菌菌尿发作次数 (n = 461)。大肠杆菌菌尿发作（n = 5477；Global Moran’s p < 0.001）。患有由 ESBL-E 引起的菌尿的个体的空间集群。未鉴定出大肠杆菌 (p = 0.43)。 ESBL-E 更容易出现菌尿复发。大肠杆菌（优势比 [OR] 2.78，95% 置信区间 [95% CI] 2.10, 3.66，p< 0.001），特别是在初始 ESBL-E 之后。大肠杆菌菌尿发作（OR 2.27，95% CI 1.82，2.83，p< 0.001）。我们发现了 ESBL-E 的空间簇。大肠杆菌菌尿发作。然而，这在一定程度上可以解释为个体内部的聚集多于个体之间的聚集，即具有 ESBL-E。大肠杆菌菌尿与 ESBL-E 复发相关。大肠杆菌。这些发现可能有助于更好地调整由 ESBL-E 引起的初次发作后复发性尿路感染患者的临床治疗。大肠杆菌。在线版本包含可在 10.1186/s13756-023-01320-1 获取的补充材料。 • 在一个大型公共医疗保健系统中，从2014 年到2020 年，我们发现所有产生超广谱β-内酰胺酶的大肠杆菌(ESBL-E. coli) 菌尿事件均呈空间集群，但不是在个体水平。 ESBL-E。大肠杆菌更有可能引起复发性菌尿。在线版本包含可在 10.1186/s13756-023-01320-1 获取的补充材料。
Urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) may occur as outbreaks due to common-source exposures. Yet, it is currently unknown if they cluster geographically as would be expected as part of an outbreak. We collected electronic health record data on all patients living in San Francisco with culture-documented community-onset E. coli bacteriuria in a safety-net public healthcare system from January 2014 to March 2020 (diagnosed < 48 h after hospital admission or in outpatient clinical settings without a hospitalization in the past 90 days). We assessed the presence of spatial clusters of (1) ESBL-E. coli bacteriuria episodes, and (2) individuals with any ESBL-E. coli bacteriuria episode, with Global and Local Moran’s I. We evaluated differences in prevalence of bacteriuria recurrence by ESBL-production by Poisson regression. Out of 4,304 unique individuals, we identified spatial clusters of ESBL-E. coli bacteriuria episodes (n = 461) compared to non-ESBL-E. coli bacteriuria episodes (n = 5477; Global Moran’s p < 0.001). Spatial clusters of individuals with any bacteriuria caused by ESBL-E. coli were not identified (p = 0.43). Bacteriuria recurrence was more likely to occur with ESBL-E. coli (odds ratio [OR] 2.78, 95% confidence interval [95% CI] 2.10, 3.66, p < 0.001), particularly after an initial ESBL-E. coli bacteriuria episode (OR 2.27, 95% CI 1.82, 2.83, p < 0.001). We found spatial clusters of ESBL-E. coli bacteriuria episodes. However, this was partly explained by clustering within individuals more than between individuals, as having an ESBL-E. coli bacteriuria was associated with recurrence with ESBL-E. coli. These findings may help better tailor clinical treatment of patients with recurrent urinary tract infections after an initial episode caused by ESBL-E. coli. The online version contains supplementary material available at 10.1186/s13756-023-01320-1. • In a large public healthcare system, from 2014 to 2020, we found spatial clusters of all extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E. coli) bacteriuria episodes, but not at the individual level. ESBL-E. coli was more likely to cause recurrent bacteriuria. The online version contains supplementary material available at 10.1186/s13756-023-01320-1.
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