Management of Extended-Spectrum Beta-Lactamase Urinary Tract Infections: Diagnostic and Treatment Considerations for the Older Adult

Clifford, Kalin M.; Grelle, Jennifer L.; Tawwater, John C.; Ramanathan, Meenakshi; Duncan, Nakia

doi:10.4140/tcp.n.2019.645

Cited by 3 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fosfomycin is an antimicrobial drug used mainly in primary care, where low resistance rate is described [ 11 ]. However, in recent years, it has also been recommended for patients with MDR bacteria such as ESBL producing Enterobacteriaceae [ 4 , 37 ], especially in older patients [ 7 ]. The low resistance rate in our case (15.6%) corroborates its usefulness as empirical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Urinary tract infection (UTI) is among the most frequent causes of bacteremia and sepsis [ 5 ] and it is a very frequent cause of hospitalization due to infection in older adults [ 6 ]. Extended-spectrum beta-lactamases (ESBL) are enzymes produced by Escherichia coli and other bacteria that are common etiologies in UTI [ 7 ]. Simultaneous resistance to other antimicrobials is frequent since they are often encoded in the same plasmids that harbored the ESBL genes [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection

et al. 2021

View full text Add to dashboard Cite

Introduction Previous studies have described some risk factors for multidrug-resistant (MDR) bacteria in urinary tract infection (UTI). However, the clinical impact of MDR bacteria on older hospitalized patients with community-acquired UTI has not been broadly analyzed. We conducted a study in older adults with community-acquired UTI in order to identify risk factors for MDR bacteria and to know their clinical impact. Methods Cohort prospective observational study of patients of 65 years or older, consecutively admitted to a university hospital, diagnosed with community-acquired UTI. We compared epidemiological and clinical variables and outcomes, from UTI due to MDR and non-MDR bacteria. Independent risk factors for MDR bacteria were analyzed using logistic regression. Results 348 patients were included, 41.4% of them with UTI due to MDR bacteria. Median age was 81 years. Hospital mortality was 8.6%, with no difference between the MDR and non-MDR bacteria groups. Median length of stay was 5 [4–8] days, with a longer stay in the MDR group (6 [4–8] vs. 5 [4–7] days, p = 0.029). Inadequate empirical antimicrobial therapy (IEAT) was 23.3%, with statistically significant differences between groups (33.3% vs. 16.2%, p < 0.001). Healthcare-associated UTI variables, in particular previous antimicrobial therapy and residence in a nursing home, were found to be independent risk factors for MDR bacteria. Conclusions The clinical impact of MDR bacteria was moderate. MDR bacteria cases had higher IEAT and longer hospital stay, although mortality was not higher. Previous antimicrobial therapy and residence in a nursing home were independent risk factors for MDR bacteria.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Extended-spectrum beta-lactamases (ESBL) are a resistance mechanism that are increasingly common among these bacteria. ESBL are a version of beta-lactamase enzymes that hydrolyze additional beta-lactam antibiotics, including penicillins, many cephalosporins and aztreonam, affecting the effectiveness of the majority of beta-lactams but not carbapenems [ 8 ]. Development of other resistance mechanisms is frequent since they are often encoded in the same plasmids that contain the ESBL genes [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and the Impact of Multidrug-Resistant Bacteria on Community-Acquired Urinary Sepsis

Madrazo,

López-Cruz,

Piles

et al. 2023

Microorganisms

View full text Add to dashboard Cite

Risk factors for multidrug-resistant bacteria (MDRB) in nosocomial urinary tract infection (UTI) have been widely studied. However, these risk factors have not been analyzed in community-acquired urinary sepsis (US), nor have its outcomes been studied. The aim of our study is to determine risk factors for MDRB in community-acquired US and its influence on outcomes. Prospective observational study of patients with community-acquired US admitted to a university hospital. We compared epidemiological and clinical variables and outcomes of US due to MDRB and non-MDRB. Independent risk factors for MDRB were analyzed using logistic regression. A total of 193 patients were included, 33.7% of them with US due to MDRB. The median age of patients was 82 years. Hospital mortality was 17.6%, with no difference between the MDRB and non-MDRB groups. The length of hospital stay was 5 (4–8) days, with a non-significant tendency to longer hospital stays in the MDRB group (6 (4–10) vs. 5 (4–8) days, p = 0.051). Healthcare-associated US was found to be an independent risk factor for MDR bacteria by multivariate analysis. In conclusion, the impact of MDR bacteria on the outcomes of community-acquired urinary sepsis was mild. Healthcare-associated US was an independent risk factor for MDR bacteria.

show abstract

Recurrent Urinary Tract Infections in Older Adults Requiring Hospitalization in an Internal Medicine Ward

Artero,

López-Cruz,

Aguilera

et al. 2024

Microorganisms

View full text Add to dashboard Cite

Urinary tract infection (UTI) is a common cause of recurrent infections, especially among young women, but also in patients with infections related to the insertion of urological devices. The aim of this study was to determine the recurrent UTI readmission rate among older patients and the risk factors for recurrent UTI in a prospective cohort of patients admitted to the hospital with community-acquired UTI. We assessed the frequency of recurrent UTIs over a one-year follow-up period after discharge and compared the clinical and epidemiological characteristics between cases with and without recurrences. Out of a total of 462 patients included in this study, 35 (7.6%) had a readmission due to UTI. The patients in the overall series had a median age of 78 (69–86) years, and 50% were women. Recurrent UTIs were associated with healthcare-associated UTIs (OR 2.8, 95% CI 1.1–6.9) and Pseudomonas aeruginosa infections (OR 2.7, 95% CI 1.1–7.2) according to multivariate analysis. Patients with recurrent UTIs experienced longer hospital stays, with no significant difference in mortality rates. Half of the recurrent UTIs were caused by the same microorganisms as those in primary UTIs, but the prolonged period up to recurrence, with a median of 4 months, suggests that they were mostly reinfections. In conclusion, elderly patients admitted to the hospital with complicated UTIs had a low long-term risk of recurrent UTIs. However, this risk was higher in patients with healthcare-associated infection criteria and in those with P. aeruginosa UTIs. Identifying these risk groups may aid in the early detection of recurrent UTIs.

show abstract

Management of Extended-Spectrum Beta-Lactamase Urinary Tract Infections: Diagnostic and Treatment Considerations for the Older Adult

Cited by 3 publications

References 0 publications

Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection

Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection

Risk Factors and the Impact of Multidrug-Resistant Bacteria on Community-Acquired Urinary Sepsis

Recurrent Urinary Tract Infections in Older Adults Requiring Hospitalization in an Internal Medicine Ward

Contact Info

Product

Resources

About