Community-Acquired, Extended-Spectrum β-Lactamase-Producing and Extensively Drug-Resistant Escherichia coli in a...

Area of Science:

• Infectious Diseases
• Microbiology
• Antimicrobial Resistance

Background:

• Escherichia coli is a frequent cause of urinary tract infections (UTIs) and pyelonephritis.
• Extended-spectrum β-lactamase (ESBL)-producing and extensively drug-resistant (XDR) E. coli infections are uncommon in the community, particularly in healthy individuals without risk factors.
• Exposure to ESBL-producing E. coli is typically healthcare-associated in the US, while community acquisition is more common in developing countries via contaminated food or water.

Observation:

• A 28-year-old female delicatessen worker, with no recent travel, antibiotic use, or healthcare contact, developed pyelonephritis and septic shock.
• The patient was infected with an ESBL-producing and XDR E. coli isolate.
• This case represents a rare instance of community-acquired XDR E. coli infection in an immunocompetent individual without typical risk factors.

Findings:

• Intravenous meropenem administered via a peripherally inserted central catheter (PICC) line at home proved curative.
• The patient experienced a full recovery with no complications following treatment.
• This case demonstrates a successful therapeutic outcome for a challenging ESBL-producing XDR E. coli infection.

Implications:

• This case underscores the potential for community acquisition of highly resistant E. coli strains, even in healthy individuals.
• It highlights the need for increased awareness among clinicians regarding non-nosocomial sources and risk factors for XDR E. coli infections.
• The successful treatment with meropenem provides valuable clinical insight into managing severe infections caused by ESBL-producing XDR E. coli.