{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T07:08:36Z","timestamp":1782025716804,"version":"3.54.5"},"reference-count":46,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":2253,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2008,11]]},"abstract":"<jats:sec id=\"S0195941700027065_abs1\"><jats:title>Objectives.<\/jats:title><jats:p>To characterize healthcare-associated infections due to extended-spectrum<jats:italic>\u03b2<\/jats:italic>-lactamase (ESBL)-producing strains of<jats:italic>Escherichia coli<\/jats:italic>and<jats:italic>Klebsiella pneumoniae<\/jats:italic>that harbor multiple ESBL genes, as opposed to a single ESBL gene.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027065_abs2\"><jats:title>Methods.<\/jats:title><jats:p>All patients with a confirmed healthcare-associated infection due to an ESBL-producing strain of<jats:italic>E. coli<\/jats:italic>or<jats:italic>K. pneumoniae<\/jats:italic>were enrolled in the study. Molecular typing of isolates was performed, and the comparative risks and outcomes of patients were analyzed.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027065_abs3\"><jats:title>Results.<\/jats:title><jats:p>Among 71 patients with healthcare-associated infection due to an ESBL-producing strain of<jats:italic>E. coli<\/jats:italic>or<jats:italic>K. pneumoniae<\/jats:italic>, the gene for CTX-M, with or without other ESBL genes, was identified in all 51 (100%) of the patients infected with an<jats:italic>E. coli<\/jats:italic>strain and in 18 (90%) of the 20 patients infected with a<jats:italic>K. pneumoniae<\/jats:italic>strain. Of these 71 patients, 17 (24%) met the definition of healthcare-associated infection due to an ESBL-producing strain that harbored multiple genes; in multivariate analysis, previous exposure to 3 or more classes of antibiotics (adjusted odds ratio, 4.5 [95% confidence interval, 1.7-75.2]) was the sole risk factor for healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes. Isolates recovered from patients with healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes were more resistant to various antibiotic classes, and, compared with patients with healthcare-associated infection due to an ESBL-producing strain that harbored a single ESBL gene, they were more likely to have ineffective initial empirical antimicrobial therapy (52% vs 94%; odds ratio, 5.1 [95% confidence interval, 1.04-14.5]).<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027065_abs4\"><jats:title>Conclusions.<\/jats:title><jats:p>CTX-M ESBL is highly prevalent in Thailand. Patients with healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes were more likely to have had ineffective initial empirical antimicrobial therapy, and, given that antibiotic selection pressure was the only associated risk, we suggest focused antimicrobial stewardship programs to limit the emergence and spread of healthcare-associated infection due to ESBL-producing strains in this middle-income country.<\/jats:p><\/jats:sec>","DOI":"10.1086\/591864","type":"journal-article","created":{"date-parts":[[2008,10,9]],"date-time":"2008-10-09T14:13:45Z","timestamp":1223561625000},"page":"1026-1034","source":"Crossref","is-referenced-by-count":28,"title":["Clinical and Molecular Epidemiology of Healthcare-Associated Infections Due to Extended-Spectrum<i>\u03b2<\/i>-Lactamase (ESBL)\u2013Producing Strains of<i>Escherichia coli<\/i>and<i>Klebsiella pneumoniae<\/i>That Harbor Multiple ESBL Genes"],"prefix":"10.1017","volume":"29","author":[{"given":"Anucha","family":"Apisarnthanarak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pattarachai","family":"Kiratisin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M.","family":"Mundy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700027065_ref045","doi-asserted-by":"publisher","DOI":"10.1086\/313559"},{"key":"S0195941700027065_ref032","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkm448"},{"key":"S0195941700027065_ref008","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2007.10.011"},{"key":"S0195941700027065_ref004","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2004.08.008"},{"key":"S0195941700027065_ref018","doi-asserted-by":"publisher","DOI":"10.1086\/500325"},{"key":"S0195941700027065_ref035","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.39.1.175-182.2001"},{"key":"S0195941700027065_ref013","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.50.2.498-504.2006"},{"key":"S0195941700027065_ref039","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-136-11-200206040-00013"},{"key":"S0195941700027065_ref028","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkl035"},{"key":"S0195941700027065_ref019","unstructured":"Dejsirilert S , Apisarnthanarak A , Kitphati R , et al. The status of antimicrobial resistance in Thailand among gram-negative pathogens in bloodstream infections: NARST data, 2000-2003 [abstract FP-A-3]. In: Program and abstracts of the 9th Western Pacific Congress on Chemotherapy and Infectious Diseases (Bangkok). Bangkok: Medinfo GD, 2004:185."},{"key":"S0195941700027065_ref042","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00150-06"},{"key":"S0195941700027065_ref041","doi-asserted-by":"publisher","DOI":"10.1007\/s10156-007-0526-7"},{"key":"S0195941700027065_ref043","doi-asserted-by":"publisher","DOI":"10.1086\/502687"},{"key":"S0195941700027065_ref002","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/170.6.1622"},{"key":"S0195941700027065_ref020","doi-asserted-by":"publisher","DOI":"10.1016\/0196-6553(88)90053-3"},{"key":"S0195941700027065_ref033","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2007.08.004"},{"key":"S0195941700027065_ref030","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.11.3554-3560.2003"},{"key":"S0195941700027065_ref024","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.2.500-510.2002"},{"key":"S0195941700027065_ref029","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2007.05.008"},{"key":"S0195941700027065_ref017","doi-asserted-by":"publisher","DOI":"10.1086\/518725"},{"key":"S0195941700027065_ref022","doi-asserted-by":"publisher","DOI":"10.1086\/508877"},{"key":"S0195941700027065_ref021","doi-asserted-by":"publisher","DOI":"10.1086\/314079"},{"key":"S0195941700027065_ref016","doi-asserted-by":"publisher","DOI":"10.1053\/jhin.2002.1331"},{"key":"S0195941700027065_ref046","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01917-06"},{"key":"S0195941700027065_ref025","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.2.616-620.2001"},{"key":"S0195941700027065_ref027","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-003-1084-2"},{"key":"S0195941700027065_ref007","doi-asserted-by":"publisher","DOI":"10.1086\/429239"},{"key":"S0195941700027065_ref012","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2005.01358.x"},{"key":"S0195941700027065_ref010","doi-asserted-by":"publisher","DOI":"10.1086\/322667"},{"key":"S0195941700027065_ref015","doi-asserted-by":"publisher","DOI":"10.1086\/502310"},{"key":"S0195941700027065_ref023","unstructured":"CLSI. Performance standards for antimicrobial susceptibility testing: 17th informational supplement. CLSI document. Wayne, PA: CLSI, 2007: M100-S17."},{"key":"S0195941700027065_ref040","doi-asserted-by":"publisher","DOI":"10.1086\/498519"},{"key":"S0195941700027065_ref001","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.34.11.2193"},{"key":"S0195941700027065_ref026","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1128\/JCM.33.9.2233-2239.1995","article-title":"Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing","volume":"33","author":"Tenover","year":"1995","journal-title":"J Clin Microbiol"},{"key":"S0195941700027065_ref003","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/23.4.779"},{"key":"S0195941700027065_ref036","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2007.02.005"},{"key":"S0195941700027065_ref014","doi-asserted-by":"publisher","DOI":"10.1086\/503018"},{"key":"S0195941700027065_ref009","doi-asserted-by":"publisher","DOI":"10.1086\/499406"},{"key":"S0195941700027065_ref031","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2007.09.008"},{"key":"S0195941700027065_ref034","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/48.6.839"},{"key":"S0195941700027065_ref038","doi-asserted-by":"publisher","DOI":"10.1086\/500936"},{"key":"S0195941700027065_ref005","doi-asserted-by":"publisher","DOI":"10.1086\/319757"},{"key":"S0195941700027065_ref011","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2006.05.010"},{"key":"S0195941700027065_ref006","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-140-1-200401060-00008"},{"key":"S0195941700027065_ref044","doi-asserted-by":"publisher","DOI":"10.1086\/522657"},{"key":"S0195941700027065_ref037","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.43.7.3309-3313.2005"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0195941700027065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,5,9]],"date-time":"2020-05-09T01:35:18Z","timestamp":1588988118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0195941700027065\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,11]]},"references-count":46,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2008,11]]}},"alternative-id":["S0195941700027065"],"URL":"https:\/\/doi.org\/10.1086\/591864","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,11]]}}}