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Background  Increased resistance to third-generation cephalosporin (3GC) is a serious concern for community-onset  Escherichia coli  infection because this resistance easily delays effective treatment. This study surveyed the current antimicrobial resistance pattern among  E. coli  isolates that cause community-onset bacteremia, with a special focus on the prevalence of and the risk factors for 3GC resistance, and determined factors for poor outcomes among patients with community-onset  E. coli  bacteremia.    Methods  This retrospective study was conducted at a tertiary-care teaching hospital in Taiwan. All adult patients with community-onset  E. coli  bacteremia between January 1, 2015, and December 31, 2015 were enrolled and were divided into two groups depending on whether the  E. coli  isolate was susceptible to 3GCs. Risk factors for 3GC resistance, 14-day all-cause mortality, and length of hospital stay were analyzed.    Results  The overall rate of 3GC resistance among  E. coli  isolates causing community-onset bacteremia was 19.7%, whereas it was 9.6% if only isolates causing community-acquired bacteremia were considered. Independent risk factors for 3GC-resistant community-onset  E. coli  bacteremia were hospitalization within the past 1 year (odds ratio: 2.4, 95% confidence interval: 1.6–3.7,  P  < 0.001), exposure to antibiotics within the past 15 days (2.6, 1.4–4.9,  P  = 0.002), residence in nursing home or long-term care facility (3.6, 1.0–12.3,  P  = 0.044), presence of underlying genitourinary disease (1.9, 1.2–2.9,  P  = 0.005), and presence of indwelling implantable intravenous port (2.2, 1.1–4.1,  P  = 0.021). 3GC resistance was independently associated with increased length of hospital stays ( P  < 0.001).    Conclusion  In this study, the prevalence of 3GC resistance was high among both patients with community-onset and those with community-acquired  E. coli  bacteremia. 3GC resistance is a strong independent risk factor for length of hospital stay. The effectiveness of empirical antibiotic treatment would partially explain the impact of 3GC resistance, but more evidence is needed. The choice of appropriate empirical antibiotics for community-onset  E. coli  bacteremia might impact outcomes in terms of the length of hospital stay and need to be individualized according to the patient-specific risk for acquiring drug-resistant pathogens.

Prevalence of and risk factor for community-onset third-generation cephalosporin-resistant Escherichia coli bacteremia at a medical center in Taiwan