LAUSR

BACKGROUND Although it is essential to know the particular causes of antibiotic-resistant infections in the community, there is lack of evidence regarding risk factors for community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteremia in South Korea. Herein, we aimed to identify risk factors for community-onset ESBL-KP bacteremia. METHODS From May 2016 to April 2017, patients with community-onset KP bloodstream infection (BSI) (N=408) from six sentinel hospitals participating in the Global Antimicrobial Surveillance System in South Korea were included. Risk factors of ESBL-KP BSI were assessed. PCR and sequencing to identify genes encoding ESBLs and multilocus sequence typing were performed. RESULTS Of the 408 patients with community-onset KP BSI, 70 (17%) were ESBL-KP BSI patients. Admission to a long-term-care hospital within the previous 3 months (OR, 5.7; 95% CI, 2.1-15.6; p=0.001), previous use of trimethoprim-sulfamethoxazole (TMP/SMT, OR, 11.5; 95% CI, 2.7-48.6; p=0.001) or extended-spectrum cephalosporin (OR, 2.2; 95% CI, 1.2-3.9; p=0.01), and previous urinary catheter use (OR, 2.3; 95% CI, 1.1-4.5; p=0.02) were independent risk factors for community-onset ESBL-KP BSI. ESBL-KP isolates most frequently carried the CTX-M-1-group ESBL (74%, n=52). The most prevalent sequence type (ST) among the ESBL-KP isolates was ST48 (14%, n=10). Among non-ESBL-KP isolates, ST23 was most prevalent (21%, n=70). CONCLUSION Previous admission to a long-term-care hospital, urinary catheter use, and previous antibiotic use of TMP/SMT and extended-spectrum cephalosporin within the previous three months were identified as risk factors for community-onset ESBL-KP BSI. Strict antibiotic stewardship and infection control measures for long-term-care hospitals are needed.