Risk factors for community-onset urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli

Tuzun, Turkan; Kutlu, Selda Sayın; Kutlu, Murat; Kaleli, İlknur

doi:10.3906/sag-1902-24

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…The prevalence of ESBL-producing bacteria in UTIs has been reported in previous studies to range from 8.7 to 50.5% (12)(13)(14)(15)(16)(17). In the current study, the prevalence of ESBL-producing bacteria patients with APN gradually increased, from 6.3% in 2010 to 30% in 2018.…”

Section: Discussionsupporting

confidence: 62%

“…The weights for the ESBL group were the inverse of the propensity scores, and those for the non-ESBL group were the inverse of 1-the propensity scores (11). Variables that were considered potential confounders based on previous literature (11)(12)(13)(14)(15)(16)(17) or clinical relevance to the model, i.e., age, sex, Foley catheter indwelling, immunocompromised condition and nursing home residence were included. All statistical analyses were performed using R 4.0.0 (www.r-project.…”

Section: Methodsmentioning

confidence: 99%

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Impact of ESBL‑producing bacteria on patients with acute pyelonephritis: A study based on patient data from a single hospital

et al. 2021

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The present study investigated the microbial etiologies and clinical impact of extended-spectrum β-lactamase (ESBL)-producing bacteria according to urine and blood cultures from patients with acute pyelonephritis (APN). Data of all patients (age >15 years) who had been hospitalized at a single hospital with APN were collected between January, 2010 and December, 2018. Overall, 882 patients with APN were included. Patients were divided into an ESBL-producing and non-ESBL-producing group. In addition, each group was further stratified in accordance with positive ESBL cultures from a urine sample (U-ESBL group and U-non-ESBL group) or from either blood or urine samples (UB-ESBL group and UB-non-ESBL group). In 651 (74%) of these cases, bacteria were isolated from either urine or blood samples. The prevalence of ESBL-producing bacteria from either urine or blood samples (UB-ESBL) was found to steadily increase over the 9-year study period from 6.3 to 37.8%. The male sex [odds ratio (OR), 2.572; 95% confidence interval (CI), 1.295-5.108] and previous antibiotic exposure (OR, 2.275; 95% CI, 1.105-4.680) were significant risk factors for UB-ESBL in the multivariable analysis. The patients in the UB-ESBL group exhibited a significantly higher mortality rate (OR, 1.654; 95% CI, 1.106-2.474) and a higher continuous renal replacement therapy (CRRT) rate. By multivariable analysis, UB-ESBL and not U-ESBL was an independent prognostic indicator for mortality and recurrence. Consequently, the use of carbapenems as a first-line therapy for APN is expected to rapidly increase, and there is concern regarding the emergence of new antibiotic-resistance bacteria. Global efforts to reduce resistance bacteria and the development of novel treatment methods other than the use of antibiotics to treat bacteria are urgently required. In addition, the results of the present study emphasize the importance of blood culture tests, as well as urine culture tests for the successful treatment of APN.

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Section: Discussionsupporting

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Impact of ESBL‑producing bacteria on patients with acute pyelonephritis: A study based on patient data from a single hospital

et al. 2021

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“…Significant risk factors for ESBL-producing E. coli detection among community-acquired UTI cases were the use of antibiotics in the preceding six months, upper UTI, having multiple risk factors, etc. [ 4 ]. Another study on Korean female UTI patients found ESBL-producing E. coli in 17.7% of cases, with CTX-M 15 types being most common.…”

Section: Discussionmentioning

confidence: 99%

“…The study was carried out from mid-June to mid-August 2017. UTI was defined as “community-onset” when the infection occurred among non-hospitalized patients or less than 48 hours after hospitalization [ 3 , 4 ]. Urine specimens were obtained from all patients with a medical doctor or senior nurse; midstream urine was collected in a sterile container and processed in the laboratory within two hours of collection.…”

Section: Methodsmentioning

confidence: 99%

Increased Isolation of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli From Community-Onset Urinary Tract Infection Cases in Uttarakhand, India

Kumar¹,

Chatterjee²,

Deka³

et al. 2021

Cureus

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Background: Management of community-acquired urinary tract infection (CA-UTI) relies heavily on empirical antibiotic therapy. Knowledge of the proportion of drug-resistant isolates especially extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli ( E. coli ), and various risk factors for acquisition are essential. Method: Outpatient-treated CA-UTI cases were enrolled (continuously for three months), and microbiological analysis of urine sample was performed for significant bacterial growth followed by identification of conventional and matrix-assisted laser desorption/ionization-time of flight (MALDI-ToF) spectrometry method. Subsequent drug resistance and phenotypic ESBL detection were as per guidelines of the Clinical Laboratory Standard Institute (CLSI, USA). Univariate and multivariate analyses (logistic regression) of known and relevant risk factors of ESBL E. coli were performed as per standard statistical technique, using the SPSS computer package (IBM Corp., Armonk, NY). Results: Two hundred and forty-one samples (of 694 samples) yielded significant growth. Sixty-one of 131 (46.6%) E. coli isolates were found to be ESBL producers. Non-beta-lactam antibiotic resistance in ESBL producers was high compared to non-ESBL producers (e.g., 88.5% vs 42.3% for quinolone resistance, 80.3% vs 34.3% for gentamicin resistance, etc.). Multivariate analysis (after univariate analysis detected probable factors of a likely ESBL model) indicated significant associations of ESBL-producing E. coli with advancing age (>55 years), prior hospitalization in last one year, use of antibiotics in previous six months, and presence of comorbid illness such as diabetes mellitus and chronic lung disease. Conclusion: High proportion of our community-acquired uropathogens are ESBL-producing E. coli and likely resistant to important antimicrobial agents such as quinolones, gentamicin, etc. Factors like advancing age, prior hospitalization, and antibiotic use, as well as comorbidities such as diabetes and chronic lung disease, may be strongly associated with ESBL E. coli and should be remembered while administering or preparing guidelines for empiric management of CA-UTI subjects.

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“…The classification of antibiotics was very heterogeneous among selected studies ( Tables S1 and S2 ) [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. Overall antibiotic exposure (i.e., without specifying a drug or class) was analyzed as a risk factor in 77% (36/47) of studies, while cephalosporins, (fluoro)quinolones, and penicillins were frequently individualized, with various sub-classifica...…”

Section: Studies’ Epidemiological Key Points: Challenges Findings And...mentioning

confidence: 99%

From Pathophysiological Hypotheses to Case–Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections

et al. 2022

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Antimicrobial resistance is a global public health concern, at least partly due to the misuse of antibiotics. The increasing prevalence of antibiotic-resistant infections in the community has shifted at-risk populations into the general population. Numerous case–control studies attempt to better understand the link between antibiotic use and antibiotic-resistant community-onset infections. We review the designs of such studies, focusing on community-onset bloodstream and urinary tract infections. We highlight their methodological heterogeneity in the key points related to the antibiotic exposure, the population and design. We show the impact of this heterogeneity on study results, through the example of extended-spectrum β-lactamases producing Enterobacteriaceae. Finally, we emphasize the need for the greater standardization of such studies and discuss how the definition of a pathophysiological hypothesis specific to the bacteria–resistance pair studied is an important prerequisite to clarify the design of future studies.

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Risk factors for community-onset urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli

Cited by 12 publications

References 28 publications

Impact of ESBL‑producing bacteria on patients with acute pyelonephritis: A study based on patient data from a single hospital

Impact of ESBL‑producing bacteria on patients with acute pyelonephritis: A study based on patient data from a single hospital

Increased Isolation of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli From Community-Onset Urinary Tract Infection Cases in Uttarakhand, India

From Pathophysiological Hypotheses to Case–Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections

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