Abstract
This review covers the recent findings on extended spectrum beta-lactamases (ESBL) pathogens, focusing on the epidemiology of infection due to this pathogen. Use of ESBL is growing rapidly and widely. CTX-M-15 producing ESBL Escherichia coli is the most commonly encountered in clinical practice. In general, ESBL infections are represented by urinary tract infections, but they can also cause fatal infections involving the vascular system and central nervous system. Because E. coli is a common colonizer of normal intestine, increasing prevalence of ESBL-producing pathogens is particularly troublesome. In a situation where ESBLs are disseminated in the community, the ideal control of this multidrug-resistant pathogen will be challenging. Precise data on the prevalence and risk factors of ESBL-producing microorganism are still undetermined. More epidemiological studies are needed for the question to be answered. In order to maximize efficiency of treatment, information on the trend of increasing numbers of ESBLs is also needed on persistence of ESBLs in carriers as well as better understanding of how antibiotic treatment and other risk factors affect their persistence and further dissemination. The global emergence of multidrug-resistant ESBL pathogen has recently led to critical treatment problems. Early detection, adequate antibiotic therapy, and effective prevention are necessary for achievement of a safe community.
REFERENCES
1.Paterson DL., Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev. 2005. 18:657–86.
2.Knothe H., Shah P., Krcmery V., Antal M., Mitsuhashi S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection. 1983. 11:315–7.
3.Pitout JD. Extraintestinal pathogenic Escherichia coli: an update on antimicrobial resistance, laboratory diagnosis and treatment. Expert Rev Anti Infect Ther. 2012. 10:1165–76.
4.Rawat D., Nair D. Extended-spectrum β-lactamases in Gram negative bacteria. J Glob Infect Dis. 2010. 2:263–74.
5.Kiratisin P., Henprasert A. Resistance phenotype-genotype correlation and molecular epidemiology of Citrobacter, Enterobacter, Proteus, Providencia, Salmonella and Serratia that carry extended-spectrum β-lactamases with or without plasmid-mediated AmpC β-lactamase genes in Thailand. Trans R Soc Trop Med Hyg. 2011. 105:46–51.
6.El-Khizzi NA., Bakheshwain SM. Prevalence of extended-spectrum beta-lactamases among Enterobacteriaceae isolated from blood culture in a tertiary care hospital. Saudi Med J. 2006. 27:37–40.
7.Babay HA. Detection of extended-spectrum b-lactamases in members of the family enterobacteriaceae at a teaching hospital, Riyadh, Kingdom of Saudi Arabia. Saudi Med J. 2002. 23:186–90.
8.Karim A., Poirel L., Nagarajan S., Nordmann P. Plasmid-mediated extended-spectrum beta-lactamase (CTX-M-3 like) from India and gene association with insertion sequence ISEcp1. FEMS Microbiol Lett. 2001. 201:237–41.
9.Coque TM., Novais A., Carattoli A., Poirel L., Pitout J., Peixe L, et al. Dissemination of clonally related Escherichia coli strains expressing extended-spectrum beta-lactamase CTX-M-15. Emerg Infect Dis. 2008. 14:195–200.
10.Nicolas-Chanoine MH., Blanco J., Leflon-Guibout V., Demarty R., Alonso MP., Caniça MM, et al. Intercontinental emergence of Escherichia coli clone O25: H4-ST131 producing CTX-M-15. J Antimicrob Chemother. 2008. 61:273–81.
11.Bush K., Jacoby GA., Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother. 1995. 39:1211–33.
12.Lee NY., Lee CC., Huang WH., Tsui KC., Hsueh PR., Ko WC. Carbapenem therapy for bacteremia due to extended-spectrum-β-lactamase-producing Escherichia coli or Klebsiella pneumoniae: implications of ertapenem susceptibility. Antimicrob Agents Chemother. 2012. 56:2888–93.
13.Rogers BA., Sidjabat HE., Paterson DL. Escherichia coli O25b-ST131: a pandemic, multiresistant, community-associated strain. J Antimicrob Chemother. 2011. 66:1–14.
14.Peirano G., van Greune CH., Pitout JD. Characteristics of infections caused by extended-spectrum β-lactamase-producing Escherichia coli from community hospitals in South Africa. Diagn Microbiol Infect Dis. 2011. 69:449–53.
15.Banerjee R., Johnston B., Lohse C., Porter SB., Clabots C., Johnson JR. Escherichia coli sequence type 131 is a dominant, antimicrobial-resistant clonal group associated with healthcare and elderly hosts. Infect Control Hosp Epidemiol. 2013. 34:361–9.
16.Nicolas-Chanoine MH., Bertrand X., Madec JY. Escherichia coli ST131, an intriguing clonal group. Clin Microbiol Rev. 2014. 27:543–74.
17.Johnson JR., Johnston B., Clabots C., Kuskowski MA., Castanheira M. Escherichia coli sequence type ST131 as the major cause of serious multidrug-resistant E. coli infections in the United States. Clin Infect Dis. 2010. 51:286–94.
18.Vigil KJ., Johnson JR., Johnston BD., Kontoyiannis DP., Mulanovich VE., Raad II, et al. Escherichia coli Pyomyositis: an emerging infectious disease among patients with hematologic malignancies. Clin Infect Dis. 2010. 50:374–80.
19.Clermont O., Dhanji H., Upton M., Gibreel T., Fox A., Boyd D, et al. Rapid detection of the O25b-ST131 clone of Escherichia coli encompassing the CTX-M-15-producing strains. J Antimicrob Chemother. 2009. 64:274–7.
20.Johnson JR., Menard M., Johnston B., Kuskowski MA., Nichol K., Zhanel GG. Epidemic clonal groups of Escherichia coli as a cause of antimicrobial-resistant urinary tract infections in Canada, 2002 to 2004. Antimicrob Agents Chemother. 2009. 53:2733–9.
21.Oteo J., Diestra K., Juan C., Bautista V., Novais A., Pérez-Vázquez M, et al. Spanish Network in Infectious Pathology Project (REIPI). Extended-spectrum beta-lactamase-producing Escherichia coli in Spain belong to a large variety of multilocus sequence typing types, including ST10 complex/A, ST23 complex/A and ST131/B2. Int J Antimicrob Agents. 2009. 34:173–6.
22.Moreno E., Andreu A., Pérez T., Sabaté M., Johnson JR., Prats G. Relationship between Escherichia coli strains causing urinary tract infection in women and the dominant faecal flora of the same hosts. Epidemiol Infect. 2006. 134:1015–23.
23.Banerjee R., Johnson JR. A new clone sweeps clean: the enigmatic emergence of Escherichia coli sequence type 131. Antimicrob Agents Chemother. 2014. 58:4997–5004.
24.Zhang H., Zhou Y., Guo S., Chang W. Multidrug resistance found in extended-spectrum beta-lactamase-producing Enterobacteriaceae from rural water reservoirs in Guantao, China. Front Microbiol. 2015. 6:267.
25.Del Rosario-Quintana C., Tosco-Núñez T., Lorenzo L., Martín-Sánchez AM., Molina-Cabrillana J. Prevalence and risk factors of multidrug resistant organism colonization among long-term care facilities in Gran Canaria (Spain). Rev Esp Geriatr Gerontol. 2015. 50:232–6.
26.Hawser SP., Bouchillon SK., Hoban DJ., Badal RE., Hsueh PR., Paterson DL. Emergence of high levels of extended-spectrum-beta-lactamase-producing gram-negative bacilli in the Asia-Pacific region: data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) program, 2007. Antimicrob Agents Chemother. 2009. 53:3280–4.
27.Ahoyo AT., Baba-Moussa L., Anago AE., Avogbe P., Missihoun TD., Loko F, et al. Incidence of infections dues to Escherichia coli strains producing extended spectrum betalactamase, in the Zou/Collines Hospital Centre (CHDZ/C) in Benin. Med Mal Infect. 2007. 37:746–52.
28.Bercion R., Mossoro-Kpinde D., Manirakiza A., Le Faou A. Increasing prevalence of antimicrobial resistance among Enterobacteriaceae uropathogens in Bangui, Central African Republic. J Infect Dev Ctries. 2009. 3:187–90.
29.Hawkey PM. Prevalence and clonality of extended-spectrum beta-lactamases in Asia. Clin Microbiol Infect. 2008. 14(Suppl 1):159–65.
30.Fam N., Leflon-Guibout V., Fouad S., Aboul-Fadl L., Marcon E., Desouky D, et al. CTX-M-15-producing Escherichia coli clinical isolates in Cairo (Egypt), including isolates of clonal complex ST10 and clones ST131, ST73, and ST405 in both community and hospital settings. Microb Drug Resist. 2011. 17:67–73.
31.Saied T., Elkholy A., Hafez SF., Basim H., Wasfy MO., El-Shoubary W, et al. Antimicrobial resistance in pathogens causing nosocomial bloodstream infections in university hospitals in Egypt. Am J Infect Control. 2011. 39:e61–5.
32.Varaiya AY., Dogra JD., Kulkarni MH., Bhalekar PN. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in diabetic foot infections. Indian J Pathol Microbiol. 2008. 51:370–2.
33.Kohli R., Omuse G., Revathi G. Antibacterial susceptibility patterns of blood stream isolates in patients investigated at the Aga Khan University Hospital, Nairobi. East Afr Med J. 2010. 87:74–80.
34.Barguigua A., El Otmani F., Talmi M., Reguig A., Jamali L., Zerouali K, et al. Prevalence and genotypic analysis of plasmid-mediated β-lactamases among urinary Klebsiella pneumoniae isolates in Moroccan community. J Antibiot (Tokyo). 2013. 66:11–6.
35.Barguigua A., El Otmani F., Talmi M., Bourjilat F., Haouzane F., Zerouali K, et al. Characterization of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates from the community in Morocco. J Med Microbiol. 2011. 60:1344–52.
36.Aibinu I., Odugbemi T., Koenig W., Ghebremedhin B. Sequence type ST131 and ST10 complex (ST617) predominant among CTX-M-15-producing Escherichia coli isolates from Nigeria. Clin Microbiol Infect. 2012. 18:E49–51.
37.Ogbolu DO., Daini OA., Ogunledun A., Alli AO., Webber MA. High levels of multidrug resistance in clinical isolates of Gram-negative pathogens from Nigeria. Int J Antimicrob Agents. 2011. 37:62–6.
38.Sire JM., Nabeth P., Perrier-Gros-Claude JD., Bahsoun I., Siby T., Macondo EA, et al. Antimicrobial resistance in outpatient Escherichia coli urinary isolates in Dakar, Senegal. J Infect Dev Ctries. 2007. 1:263–8.
39.Keddy KH., Sooka A., Crowther-Gibson P., Quan V., Meiring S., Cohen C, et al. Group for Enteric, Respiratory, and Meningeal Disease Surveillance in South Africa (GERMS-SA). Systemic shigellosis in South Africa. Clin Infect Dis. 2012. 54:1448–54.
40.Bamford C., Bonorchis K., Ryan A., Hoffmann R., Naicker P., Nana T, et al. Antimicrobial susceptibility patterns of Escherichia coli strains isolated from urine samples in South Africa from 2007-2011. South Afr J Epidemiol Infect. 2012. 27:46–52.
41.Brink AJ., Botha RF., Poswa X., Senekal M., Badal RE., Grolman DC, et al. Antimicrobial susceptibility of gram-negative pathogens isolated from patients with complicated intra-abdominal infections in South African hospitals (SMART Study 2004-2009): impact of the new carbapenem breakpoints. Surg Infect (Larchmt). 2012. 13:43–9.
42.Habte TM., Dube S., Ismail N., Hoosen AA. Hospital and community isolates of uropathogens at a tertiary hospital in South Africa. S Afr Med J. 2009. 99:584–7.
43.Brink A., Moolman J., da Silva MC., Botha M. National Antibiotic Surveillance Forum. Antimicrobial susceptibility profile of selected bacteraemic pathogens from private institutions in South Africa. S Afr Med J. 2007. 97:273–9.
44.Ko KS., Lee MY., Song JH., Lee H., Jung DS., Jung SI, et al. Prevalence and characterization of extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated in Korean hospitals. Diagn Microbiol Infect Dis. 2008. 61:453–9.
45.Chambers HF. Beta-lactam antibiotics and other inhibitors of cell wall synthesis. Katzung BG, Masters SB, Trevor AJ, editors. editors.Basic & clinical pharmacology. Boston, MA: McGraw-Hill;2005. p. 734–53.
46.Blomberg B., Jureen R., Manji KP., Tamim BS., Mwakagile DS., Urassa WK, et al. High rate of fatal cases of pediatric septicemia caused by gram-negative bacteria with extended-spectrum beta-lactamases in Dar es Salaam, Tanzania. J Clin Microbiol. 2005. 43:745–9.
47.Ben Haj Khalifa A., Khedher M. Epidemiological study of Klebsiella spp. uropathogenic strains producing extended-spectrum β-lactamase in a Tunisian university hospital, 2009. Pathol Biol (Paris). 2012. 60:e1–5.
48.Jones SL., Nguyen VK., Nguyen TM., Athan E. Prevalence of multiresistant Gram-negative organisms in a surgical hospital in Ho Chi Minh City, Vietnam. Trop Med Int Health. 2006. 11:1725–30.
49.Stobberingh EE., Arends J., Hoogkamp-Korstanje JA., Goessens WH., Visser MR., Buiting AG, et al. Occurrence of extended-spectrum betalactamases (ESBL) in Dutch hospitals. Infection. 1999. 27:348–54.
50.Branger C., Lesimple AL., Bruneau B., Berry P., Lambert-Zechovsky N. Long-term investigation of the clonal dissemination of Klebsiella pneumoniae isolates producing extended-spectrum beta-lactamases in a university hospital. J Med Microbiol. 1998. 47:201–9.
51.Brolund A., Edquist PJ., Mäkitalo B., Olsson-Liljequist B., Söderblom T., Wisell KT, et al. Epidemiology of extended-spectrum β-lactamase-producing Escherichia coli in Sweden 2007-2011. Clin Microbiol Infect. 2014. 20:O344–52.
52.Naseer U., Haldorsen B., Tofteland S., Hegstad K., Scheutz F., Simonsen GS, et al. Norwegian ESBL Study Group. Molecular characterization of CTX-M-15-producing clinical isolates of Escherichia coli reveals the spread of multidrug-resistant ST131 (O25: H4) and ST964 (O102: H6) strains in Norway. APMIS. 2009. 117:526–36.
53.Olesen B., Hansen DS., Nilsson F., Frimodt-Møller J., Leihof RF., Struve C, et al. Prevalence and characteristics of the epidemic multiresistant Escherichia coli ST131 clonal group among extended-spectrum beta-lactamase-producing E. coli isolates in Copenhagen, Denmark. J Clin Microbiol. 2013. 51:1779–85.
54.Forssten SD., Kolho E., Lauhio A., Lehtola L., Mero S., Oksaharju A, et al. Emergence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae during the years 2000 and 2004 in Helsinki, Finland. Clin Microbiol Infect. 2010. 16:1158–61.
55.Nyberg SD., Osterblad M., Hakanen AJ., Huovinen P., Jalava J., Resistance TF. Detection and molecular genetics of extended-spectrum beta-lactamases among cefuroxime-resistant Escherichia coli and Klebsiella spp. isolates from Finland, 2002-2004. Scand J Infect Dis. 2007. 39:417–24.
56.Baraniak A., Fiett J., Sulikowska A., Hryniewicz W., Gniadkowski M. Countrywide spread of CTX-M-3 extended-spectrum beta-lactamase-producing microorganisms of the family Enterobacteriaceae in Poland. Antimicrob Agents Chemother. 2002. 46:151–9.
57.Livermore DM., Canton R., Gniadkowski M., Nordmann P., Rossolini GM., Arlet G, et al. CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemother. 2007. 59:165–74.
58.Jacoby GA. Extended-spectrum beta-lactamases and other enzymes providing resistance to oxyimino-beta-lactams. Infect Dis Clin North Am. 1997. 11:875–87.
59.Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev. 2001. 14:933–51. table of contents.
60.Doi Y., Park YS., Rivera JI., Adams-Haduch JM., Hingwe A., Sordillo EM, et al. Community-associated extended-spectrum β-lactamase-producing Escherichia coli infection in the United States. Clin Infect Dis. 2013. 56:641–8.
61.Winokur PL., Canton R., Casellas JM., Legakis N. Variations in the prevalence of strains expressing an extended-spectrum beta-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific region. Clin Infect Dis. 2001. 32(Suppl 2):S94–103.
62.Cantón R., Coque TM. The CTX-M beta-lactamase pandemic. Curr Opin Microbiol. 2006. 9:466–75.
63.Naseer U., Sundsfjord A. The CTX-M conundrum: dissemination of plasmids and Escherichia coli clones. Microb Drug Resist. 2011. 17:83–97.
64.Jones RN. Summation: beta-lactam resistance surveillance in the Asia-Western Pacific region. Diagn Microbiol Infect Dis. 1999. 35:333–8.
65.Choi SH., Lee JE., Park SJ., Kim MN., Choo EJ., Kwak YG, et al. Prevalence, microbiology, and clinical characteristics of extended-spectrum beta-lactamase-producing Enterobacter spp., Serratia marcescens, Citrobacter freundii, and Morganella morganii in Korea. Eur J Clin Microbiol Infect Dis. 2007. 26:557–61.
66.Chong Y., Shimoda S., Yakushiji H., Ito Y., Miyamoto T., Kamimura T, et al. Community spread of extended-spectrum β-lactamase-producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis: a long-term study in Japan. J Med Microbiol. 2013. 62:1038–43.
67.Xia S., Fan X., Huang Z., Xia L., Xiao M., Chen R, et al. Dominance of CTX-M-type extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolated from patients with community-onset and hospital-onset infection in China. PLoS One. 2014. 9:e100707.
68.Muzaheed. Doi Y., Adams-Haduch JM., Endimiani A., Sidjabat HE., Gaddad SM, et al. High prevalence of CTX-M-15-producing Klebsiella pneumoniae among inpatients and outpatients with urinary tract infection in Southern India. J Antimicrob Chemother. 2008. 61:1393–4.
69.Ben Slama K., Jouini A., Ben Sallem R., Somalo S., Sáenz Y., Estepa V, et al. Prevalence of broad-spectrum cephalosporin-resistant Escherichia coli isolates in food samples in Tunisia, and characterization of integrons and antimicrobial resistance mechanisms implicated. Int J Food Microbiol. 2010. 137:281–6.
70.Machado E., Coque TM., Cantón R., Sousa JC., Peixe L. Antibiotic resistance integrons and extended-spectrum {beta}-lactamases among Enterobacteriaceae isolates recovered from chickens and swine in Portugal. J Antimicrob Chemother. 2008. 62:296–302.
71.Tian SF., Chen BY., Chu YZ., Wang S. Prevalence of rectal carriage of extended-spectrum beta-lactamase-producing Escherichia coli among elderly people in community settings in China. Can J Microbiol. 2008. 54:781–5.
72.Vinué L., Sáenz Y., Martínez S., Somalo S., Moreno MA., Torres C, et al. Prevalence and diversity of extended-spectrum beta-lactamases in faecal Escherichia coli isolates from healthy humans in Spain. Clin Microbiol Infect. 2009. 15:954–7.
73.Guimarães B., Barreto A., Radhouani H., Figueiredo N., Gaspar E., Rodrigues J, et al. Genetic detection of extended-spectrum beta-lactamase-containing Escherichia coli isolates and vancomycin-resistant enterococci in fecal samples of healthy children. Microb Drug Resist. 2009. 15:211–6.
74.Reinthaler FF., Feierl G., Galler H., Haas D., Leitner E., Mascher F, et al. ESBL-producing E. coli in Austrian sewage sludge. Water Res. 2010. 44:1981–5.
75.Costa D., Vinué L., Poeta P., Coelho AC., Matos M., Sáenz Y, et al. Prevalence of extended-spectrum beta-lactamase-producing Escherichia coli isolates in faecal samples of broilers. Vet Microbiol. 2009. 138:339–44.
76.Yuan L., Liu JH., Hu GZ., Pan YS., Liu ZM., Mo J, et al. Molecular characterization of extended-spectrum beta-lactamase-producing Escherichia coli isolates from chickens in Henan Province, China. J Med Microbiol. 2009. 58:1449–53.
77.Bonnedahl J., Drobni M., Gauthier-Clerc M., Hernandez J., Granholm S., Kayser Y, et al. Dissemination of Escherichia coli with CTX-M type ESBL between humans and yellow-legged gulls in the south of France. PLoS One. 2009. 4:e5958.
78.Poeta P., Radhouani H., Pinto L., Martinho A., Rego V., Rodrigues R, et al. Wild boars as reservoirs of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli of different phylogenetic groups. J Basic Microbiol. 2009. 49:584–8.
79.Literak I., Dolejska M., Radimersky T., Klimes J., Friedman M., Aarestrup FM, et al. Antimicrobial-resistant faecal Escherichia coli in wild mammals in central Europe: multiresistant Escherichia coli producing extended-spectrum beta-lactamases in wild boars. J Appl Microbiol. 2010. 108:1702–11.
80.Rooney PJ., O'Leary MC., Loughrey AC., McCalmont M., Smyth B., Donaghy P, et al. Nursing homes as a reservoir of extended-spectrum beta-lactamase (ESBL)-producing ciprofloxacin-resistant Escherichia coli. J Antimicrob Chemother. 2009. 64:635–41.
81.March A., Aschbacher R., Dhanji H., Livermore DM., Böttcher A., Sleghel F, et al. Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria. Clin Microbiol Infect. 2010. 16:934–44.
82.Sasaki T., Hirai I., Niki M., Nakamura T., Komalamisra C., Maipanich W, et al. High prevalence of CTX-M beta-lactamase-producing Enterobacteriaceae in stool specimens obtained from healthy individuals in Thailand. J Antimicrob Chemother. 2010. 65:666–8.
83.Rodríguez-Baño J., López-Cerero L., Navarro MD., Díaz de Alba P., Pascual A. Faecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli: prevalence, risk factors and molecular epidemiology. J Antimicrob Chemother. 2008. 62:1142–9.
84.Gudiol C., Calatayud L., Garcia-Vidal C., Lora-Tamayo J., Cisnal M., Duarte R, et al. Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome. J Antimicrob Chemother. 2010. 65:333–41.
85.Nicoletti J., Kuster SP., Sulser T., Zbinden R., Ruef C., Ledergerber B, et al. Risk factors for urinary tract infections due to ciprofloxacin-resistant Escherichia coli in a tertiary care urology department in Switzerland. Swiss Med Wkly. 2010. 140:w13059.
86.Rodríguez-Baño J., Picón E., Gijón P., Hernández JR., Ruíz M., Peña C, et al. Spanish Network for Research in Infectious Diseases (REIPI). Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis. Clin Infect Dis. 2010. 50:40–8.
87.Ben-Ami R., Rodríguez-Baño J., Arslan H., Pitout JD., Quentin C., Calbo ES, et al. A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing enterobacteriaceae in nonhospitalized patients. Clin Infect Dis. 2009. 49:682–90.
88.Azap OK., Arslan H., Serefhanoğlu K., Colakoğlu S., Erdoğan H., Timurkaynak F, et al. Risk factors for extended-spectrum beta-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections. Clin Microbiol Infect. 2010. 16:147–51.
89.Laupland KB., Church DL., Vidakovich J., Mucenski M., Pitout JD. Community-onset extended-spectrum beta-lactamase (ESBL) producing Escherichia coli: importance of international travel. J Infect. 2008. 57:441–8.
90.Freeman JT., McBride SJ., Heffernan H., Bathgate T., Pope C., Ellis-Pegler RB. Community-onset genitourinary tract infection due to CTX-M-15-Producing Escherichia coli among travelers to the Indian subcontinent in New Zealand. Clin Infect Dis. 2008. 47:689–92.