{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:58:03Z","timestamp":1760234283807,"version":"build-2065373602"},"reference-count":13,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>While Escherichia coli is a common cause of urinary tract infections and pyelonephritis, there are few documented cases of extended-spectrum \u03b2-lactamase (ESBL)-producing and extensively drug-resistant (XDR) isolates from the community resulting in infection requiring hospitalization, especially in individuals lacking risk factors. In the United States, exposure to ESBL-producing E. coli is typically nosocomial, whereas patients from developing countries often encounter ESBL-producing E. coli in the community through the consumption of contaminated food or water. Considering the rarity at which XDR E. coli isolates are encountered, there is also a scarcity of literature describing the successful treatment of ESBL-producing XDR E. coli. Here we present a case of an otherwise healthy 28-year-old female delicatessen worker infected with ESBL-producing and XDR E. coli without recent travel, antibiotic use, or healthcare contact, who required admission to the intensive care unit (ICU) with pyelonephritis and septic shock. Treatment with intravenous meropenem through a peripherally inserted central catheter (PICC) line at home was curative and follow up thereafter unremarkable. Given the patient\u2019s lack of obvious exposure to and risk factors for an ESBL-producing XDR E. coli infection and the specific lack of risk factors for severe pyelonephritis requiring hospitalization, this case represents a unique addition to the literature and is of value to clinicians by describing successful treatment.<\/jats:p>","DOI":"10.3390\/antibiotics10050533","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T11:06:01Z","timestamp":1620212761000},"page":"533","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Community-Acquired, Extended-Spectrum \u03b2-Lactamase-Producing and Extensively Drug-Resistant Escherichia coli in a 28-Year-Old Pyelonephritis Patient Lacking Risk Factors"],"prefix":"10.3390","volume":"10","author":[{"given":"Connor W.","family":"Evins","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8602-3526","authenticated-orcid":false,"given":"Caroline M.","family":"Sutton","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Prisma Health, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah T.","family":"Withers","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA"},{"name":"Department of Pharmacy, Prisma Health, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer T.","family":"Grier","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine M. G.","family":"Schammel","sequence":"additional","affiliation":[{"name":"Pathology Associates and Consultants, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven E.","family":"Fiester","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA"},{"name":"Pathology Associates and Consultants, Greenville, SC 29605, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.meegid.2018.04.005","article-title":"Current epidemiology, genetic evolution and clinical impact of extended-spectrum \u03b2-lactamase-producing Escherichia coli and Klebsiella pneumoniae","volume":"61","author":"Chong","year":"2018","journal-title":"Infect. Genet. Evol."},{"key":"ref_2","unstructured":"CDC (2021, March 01). Healthcare-Associated Infections (HAI)\u2014Diseases and Organisms. ESBL-Producing Enterobacteriaceae in Healthcare Settings, Available online: https:\/\/www.cdc.gov\/hai\/organisms\/ESBL.html."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.ajic.2015.02.030","article-title":"Risk factors for bloodstream infection caused by extended-spectrum \u03b2-lactamase-producing Escherichia coli and Klebsiella pneumoniae: A focus on antimicrobials including cefepime","volume":"43","author":"Chopra","year":"2015","journal-title":"Am. J. Infect. Control"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5131","DOI":"10.1128\/AAC.00607-13","article-title":"Correlations of antibiotic use and carbapenem resistance in enterobacteriaceae","volume":"57","author":"McLaughlin","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3109\/23744235.2015.1103895","article-title":"Epidemiological factors associated with ESBL- and non ESBL-producing E. coli causing urinary tract infection in general practice","volume":"48","author":"Hertz","year":"2016","journal-title":"Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1080\/23744235.2019.1654127","article-title":"Risk factors for community acquired urinary tract infections caused by extended spectrum \u03b2-lactamase (ESBL) producing Escherichia coli in children: A case control study","volume":"51","author":"Zhu","year":"2019","journal-title":"Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s13756-019-0599-y","article-title":"Risk factors and outcomes in non-transplant patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia: A retrospective study from 2013 to 2016","volume":"8","author":"Xiao","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1007\/s00134-002-1521-1","article-title":"Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: Risk factors and clinical outcome","volume":"28","author":"Du","year":"2002","journal-title":"Intensiv. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.3201\/eid2412.180500","article-title":"CTX-M-65 Extended-Spectrum \u03b2-Lactamase\u2013Producing Salmonella enterica Serotype Infantis, United States","volume":"24","author":"Brown","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20","DOI":"10.7326\/0003-4819-142-1-200501040-00008","article-title":"Risk factors associated with acute pyelonephritis in healthy women","volume":"142","author":"Scholes","year":"2005","journal-title":"Ann. Intern. Med."},{"key":"ref_11","first-page":"519","article-title":"Diagnosis and treatment of acute pyelonephritis in women","volume":"84","author":"Colgan","year":"2011","journal-title":"Am. Fam. Physician"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4065603","DOI":"10.1155\/2016\/4065603","article-title":"Multidrug Resistant and Extensively Drug Resistant Bacteria: A Study","volume":"2016","author":"Basak","year":"2016","journal-title":"J. Pathog."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ijid.2016.12.007","article-title":"Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: A case-control study","volume":"55","year":"2017","journal-title":"Int. J. Infect. Dis."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/5\/533\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:57:13Z","timestamp":1760162233000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/5\/533"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,5]]},"references-count":13,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["antibiotics10050533"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics10050533","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2021,5,5]]}}}