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Extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospital urinary tract infections: incidence and antibiotic susceptibility profile over 9 years

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Abstract

Purpose

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are an increasing concern regarding antibiotic resistance and their potential to cause serious infections which are difficult to treat. The purpose of this surveillance programme was to assess the incidence of ESBL in adults amongst urinary isolates, identify risk factors, and detail the antibiotic susceptibility profile in order to guide empirical treatment.

Methods

From 2006 to 2014, we reviewed 21,414 positive urine cultures for E. coli and Klebsiella sp. from a University hospital in the UK and found 1420 ESBL-positive specimens. Susceptibility testing was performed by British Society of Antimicrobial Chemotherapy disc diffusion testing. ESBL screening was performed on samples resistant to cefpodoxime and confirmed by double disc diffusion (Oxoid Ltd, Basingstoke, UK). Patient gender, age, inpatient status, and catheterisation were assessed as risk factors.

Results

ESBL production amongst E. coli urine cultures increased 44 %, from 4.6 to 6.6 % of all E. coli isolates. ESBL-positive organisms were associated with increases in drug resistance, particularly amongst fluoroquinolones, trimethoprim, and cephalexin. Multidrug resistance was a feature with 75 % of ESBL+ Klebsiella sp.-resistant ≥6 antibiotic classes. ESBL producers remained largely susceptible to carbapenems. Male gender, urinary catheterisation, inpatient status, and increasing age were identified as risk factors for ESBL infection or colonisation.

Conclusion

We demonstrate that the incidence of ESBL-producing E. coli in urine cultures is increasing and that such isolates are multidrug resistant. Carbapenems and nitrofurantoin for E. coli infections remain effective, which may guide empirical antibiotic therapy.

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Authors contribution

L. Toner contributed to protocol/project development, data collection and management, data analysis, manuscript writing, and editing. N. Papa contributed to data management, analysis and manuscript writing. S.H. Aliyu contributed to protocol/project development, data collection and management, manuscript writing, and editing. H. Dev collected and managed the data. N. Lawrentschuk wrote and edited the manuscript. S. Al-Hayek contributed to protocol/project development, data collection and management, manuscript writing, and editing.

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Correspondence to Liam Toner.

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Conflict of interest

Dr. Aliyu has received sponsorship to attend international conferences from Merck Sharpe and Dohme and Gilead Pharmaceuticals.

Ethical approval

Our study was deemed surveillance by the Health Research Authority, and as such, formal ethical review or NHS R&D approval was waived.

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Toner, L., Papa, N., Aliyu, S.H. et al. Extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospital urinary tract infections: incidence and antibiotic susceptibility profile over 9 years. World J Urol 34, 1031–1037 (2016). https://doi.org/10.1007/s00345-015-1718-x

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  • DOI: https://doi.org/10.1007/s00345-015-1718-x

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