Background: Global dissemination of Escherichia coli producing CTX-M extended-spectrum b-lactamases (ESBL) is a public\r\nhealth concern. The aim of the study was to determine factors associated with CTX-M- producing E. coli infections among\r\npatients hospitalised in the Assistance Publique-HoÃ?â? pitaux de Paris, the largest hospital system in France (23 000 beds),\r\nthrough a prospective case-control-control study.\r\nMethods/Principal Findings: From November 2008 to June 2009, 152 inpatients with a clinical sample positive for CTX-Mproducing\r\nE. coli (cases), 152 inpatients with a clinical sample positive for non ESBL-producing E. coli on the day or within\r\nthe three days following case detection (controls C1), and 152 inpatients with culture-negative clinical samples since the\r\nbeginning of hospitalisation and until three days after case detection (controls C2) were included in ten hospitals of the\r\nParis area. Factors studied were related to patientââ?¬â?¢s origin, lifestyle and medical history as well as care during hospitalisation.\r\nThose independently associated with CTX-M-producing E. coli were determined. Three independent factors were common\r\nto the two case-control comparisons: birth outside of Europe (cases vs C1: OR1 = 2.4; 95%CI = [1.3ââ?¬â??4.5] and cases vs C2:\r\nOR2 = 3.1; 95%CI = [1.4ââ?¬â??7.0]), chronic infections (OR1 = 2.9; 95%CI = [1.3ââ?¬â??6.9] and OR2 = 8.7; 95%CI = [2.0ââ?¬â??39.7]), and antibiotic\r\ntreatment between hospital admission and inclusion (OR1 = 2.0; 95%CI = [1.0ââ?¬â??3.8] and OR2 = 3.3; 95%CI = [1.5ââ?¬â??7.2]). Cases\r\nwere also more likely to be (i) functionally dependent before hospitalisation than C2 (OR2 = 7.0; 95%CI = [2.1ââ?¬â??23.5]) and (ii)\r\nliving in collective housing before hospitalisation than C2 (OR2 = 15.2; 95%CI = [1.8ââ?¬â??130.7]) when CTX-M-producing E. coli\r\nwas present at admission.\r\nConclusion: For the first time, patientââ?¬â?¢s origin and lifestyle were demonstrated to be independently associated with\r\nisolation of CTX-M-producing E. coli, in addition to health care-related factors.
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