Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2026
Clinical epidemiology and risk factors for community-onset isolation of extended-spectrum β-lactamase-producing Escherichia coli from clinical specimens in Japan.
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Hayakawa Kayoko, Tsuda Yusuke, Tsuzuki Shinya, Matsumura Yasufumi, Ohmagari Norio
Аннотация
BACKGROUND: Community-onset isolation of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBLEC) from clinical specimens is an increasing public health concern. We aimed to identify healthcare- and community-associated factors associated with community-onset ESBLEC isolation in Japanese adults.
METHODS: We conducted a case-control study at two tertiary care hospitals in Japan, combining chart review with a structured questionnaire. Adults with community-onset ESBLEC isolated in an outpatient setting or within 3 days after admission were enrolled as cases, and adults with community-onset third-generation cephalosporin-susceptible E. coli served as controls. Multivariable logistic regression was used to identify the independent factors associated with ESBLEC isolation.
RESULTS: In total, 124 patients, comprising 57 cases and 67 controls, were included. Chart-derived antibiotic exposure within one year (adjusted odds ratio [aOR], 2.68; 95% CI, 1.07-6.72) and self-reported history of antimicrobial-resistant organism detection within one year (aOR, 5.13; 95% CI, 1.24-21.25) were independently associated with ESBLEC isolation. An exploratory inverse association was observed for handwashing before toilet use (aOR, 0.24; 95% CI, 0.06-0.90), but this association was not statistically significant in the sensitivity analysis restricted to soap or alcohol use. Readmission within 30 days was more frequent among cases (5/41 [12.2%] vs. 0/48 [0.0%]); none of the five readmissions was attributed to ESBLEC-related infection.
CONCLUSIONS: Prior antibiotic exposure and a history of antimicrobial-resistant organism detection were the principal independent correlates of community-onset ESBLEC isolation. The inverse association with pre-toilet handwashing should be considered exploratory and hypothesis-generating and warrants confirmation in larger prospective studies.
METHODS: We conducted a case-control study at two tertiary care hospitals in Japan, combining chart review with a structured questionnaire. Adults with community-onset ESBLEC isolated in an outpatient setting or within 3 days after admission were enrolled as cases, and adults with community-onset third-generation cephalosporin-susceptible E. coli served as controls. Multivariable logistic regression was used to identify the independent factors associated with ESBLEC isolation.
RESULTS: In total, 124 patients, comprising 57 cases and 67 controls, were included. Chart-derived antibiotic exposure within one year (adjusted odds ratio [aOR], 2.68; 95% CI, 1.07-6.72) and self-reported history of antimicrobial-resistant organism detection within one year (aOR, 5.13; 95% CI, 1.24-21.25) were independently associated with ESBLEC isolation. An exploratory inverse association was observed for handwashing before toilet use (aOR, 0.24; 95% CI, 0.06-0.90), but this association was not statistically significant in the sensitivity analysis restricted to soap or alcohol use. Readmission within 30 days was more frequent among cases (5/41 [12.2%] vs. 0/48 [0.0%]); none of the five readmissions was attributed to ESBLEC-related infection.
CONCLUSIONS: Prior antibiotic exposure and a history of antimicrobial-resistant organism detection were the principal independent correlates of community-onset ESBLEC isolation. The inverse association with pre-toilet handwashing should be considered exploratory and hypothesis-generating and warrants confirmation in larger prospective studies.