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Intensive Care Med. 2002;28:1718– 1723. 35 Eveillard M, Schmit JL, Eb F: Antimicrobial use prior to the acquisition of multiresistant bacteria. Infect Control Hosp Epidemiol 2002;23:155–158. 36 Ho PL, Chan WM, Tsang KW, Wong SS, Young K: Bacteremia caused by Escherichia coli producing extended-spectrum beta-lactamase: a case-control study of risk factors and outcomes. Scand J Infect Dis 2002;34:567–573. 37 Kim YK, Pai H, Lee HJ, et al: Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome.

Use of third-generation cephalosporins has been identified as a predisposing event in some [45], but not all studies [10]. In contrast to the situation in acute-care hospitals, use of orally administered antibiotics (ciprofloxacin and/or trimethoprim/ 24 Paterson · Doi sulfamethoxazole) may also be a risk for colonization with an ESBL-producing strain [10]. Nursing home residents would appear to have several additional risk factors for infection with ESBL-producing organisms: (1) they are prone to exposure to the microbial flora of other residents, especially if they are incontinent and require frequent contact with health care providers; (2) low rates of hand washing have been well documented among nursing home personnel [46]; (3) urinary catheterization and decubitus ulcers are frequent among residents [44] and have been associated with colonization of non-ESBL-producing, antibiotic-resistant Gram-negative bacilli [47, 48].

Infections with Organisms Producing Extended-Spectrum β-Lactamase 29 References 1 Bush K, Jacoby GA, Medeiros AA: A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995;39:1211–1233. 2 Mirelis B, Navarro F, Miro E, Mesa RJ, Coll P, Prats G: Community transmission of extended-spectrum beta-lactamase. Emerg Infect Dis. 2003;9:1024– 1025. 3 Colodner R, Rock W, Chazan B, et al: Risk factors for the development of extended-spectrum betalactamase-producing bacteria in nonhospitalized patients.

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