UTIs Caused by ESBL-Producing Enterobacteria
UTIs Caused by ESBL-Producing Enterobacteria
Aim: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.
Methods: Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system.
Results: A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥ 60 years. CI was 2.3 ± 1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p < 0.001), diabetes (p = 0.032), recurrent UTI (p = 0.032) and high comorbidity (p = 0.002). In addition, these infections were associated with more symptoms (p < 0.001) and longer admission (p = 0.004).
Conclusions: Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.
Urinary tract infections (UTI) are the second cause of community-acquired infection and nosocomial infection most prevalent in our setting being gram-negative bacilli (GNB) pathogens the most frequently implicated, particularly Escherichia coli.
Extended-spectrum beta-lactamases (ESBL) are enzymes produced by GNB (mainly E. coli and Klebsiella pneumoniae but also K. oxytoca, Proteus spp, Acinetobacter spp, and others) responsible for resistance against penicillins, cephalosporins and aztreonam. The spread of ESBL-producing bacteria worldwide has become a serious public health being a frequent cause of infection in healthcare centres and in the community: it is estimated that around 50% affect non-hospitalised patients although it may be difficult to establish boundaries between community and nosocomial cases. Risk factors for such infection include comorbidity, frequent use of health resources, prior use of antibiotics, recurrent UTI, older age and male sex. This is of clinical importance because these patients are at risk of receiving inappropriate empirical therapy, resulting in increased morbidity and mortality.
Few studies have assessed the specific risk of UTI caused by ESBL-producing GNB. The aim of this study was to describe the characteristics of UTI resulting from ESBL-producing bacteria in our HealthCare Area and to identify the risk factors associated with isolations of E. coli carrying ESBL in urine samples from hospitalised patients and to compare them with non-ESBL-carrying strains.
Abstract and Introduction
Abstract
Aim: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.
Methods: Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system.
Results: A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥ 60 years. CI was 2.3 ± 1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p < 0.001), diabetes (p = 0.032), recurrent UTI (p = 0.032) and high comorbidity (p = 0.002). In addition, these infections were associated with more symptoms (p < 0.001) and longer admission (p = 0.004).
Conclusions: Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.
Introduction
Urinary tract infections (UTI) are the second cause of community-acquired infection and nosocomial infection most prevalent in our setting being gram-negative bacilli (GNB) pathogens the most frequently implicated, particularly Escherichia coli.
Extended-spectrum beta-lactamases (ESBL) are enzymes produced by GNB (mainly E. coli and Klebsiella pneumoniae but also K. oxytoca, Proteus spp, Acinetobacter spp, and others) responsible for resistance against penicillins, cephalosporins and aztreonam. The spread of ESBL-producing bacteria worldwide has become a serious public health being a frequent cause of infection in healthcare centres and in the community: it is estimated that around 50% affect non-hospitalised patients although it may be difficult to establish boundaries between community and nosocomial cases. Risk factors for such infection include comorbidity, frequent use of health resources, prior use of antibiotics, recurrent UTI, older age and male sex. This is of clinical importance because these patients are at risk of receiving inappropriate empirical therapy, resulting in increased morbidity and mortality.
Few studies have assessed the specific risk of UTI caused by ESBL-producing GNB. The aim of this study was to describe the characteristics of UTI resulting from ESBL-producing bacteria in our HealthCare Area and to identify the risk factors associated with isolations of E. coli carrying ESBL in urine samples from hospitalised patients and to compare them with non-ESBL-carrying strains.
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