Risk Factors for the Development of Extended-Spectrum Beta-Lactamase-Producing Bacteria in Nonhospitalized Patients
Although the risk factors for acquiring infection by extended-spectrum beta-lactamase (ESBL)-producing bacteria have been investigated in hospitalized patients, such risk factors have not been defined in the community setting. In this study, clinical data from a total of 311 nonhospitalized patients with community-acquired urinary tract infection (128 with ESBL-positive strains and 183 with ESBL-negative strains) were obtained. According to a multivariate analysis, the following were identified as independent risk factors: previous hospitalization in the past 3 months (OR=8.95, 95%CI, 3.77–21.25), antibiotic treatment in the past 3 months (OR=3.23, 95%CI, 1.76–5.91), age over 60 years (OR=2.65, 95%CI, 1.45–4.83), diabetes (OR=2.57, 95%CI, 1.20–5.51), male gender (OR=2.47, 95%CI, 1.22–5.01), Klebsiella pneumoniae infection (OR=2.31, 95%CI, 1.17–4.54), previous use of third-generation cephalosporins (P=0.014, OR=15.8, 95%CI, 1.7–143), previous use of second-generation cephalosporins (P<0.0001, OR=10.1, 95%CI, 4.2–24), previous use of quinolones (P=0.001, OR=4.1, 95%CI, 1.8–9.0), and previous use of penicillin (P=0.003, OR=4.0, 95%CI, 1.6–9.0).
The authors thank Idit Lavie for performing the statistical analysis. This work complies with the current laws of Israel regarding clinical trials.
- 1.Bush K (1996) Is it important to identify extended-spectrum beta-lactamase-producing isolates? Eur J Clin Microb Infect Dis 15:361–364Google Scholar
- 5.Quinn JP, Miyashiro D, Sahm D, Flamm R, Bush K (1989) Novel plasmid-mediated beta-lactamase (TEM-10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae. Antimicrob Agents Chemoter 33:1451–1456Google Scholar
- 6.Paterson DL, Mulazimoglu L, Casellas JM, Ko WC, Goossens H, Von Gottberg A, Mohapatra S, Trenholme GM, Klugman KP, McCormack JG, Yu VL (2000) Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum beta-lactamase production in Klebsiella pneumoniae isolates causing bacteremia. Clin Infect Dis 30:473–478CrossRefPubMedGoogle Scholar
- 7.Rice LB (1999) Successful interventions for gram-negative resistance to extended-spectrum beta-lactam antibiotics. Pharmacotheropy 19 (8 Pt 2):120S–128SGoogle Scholar
- 12.Colodner R, Keness Y, Chazan B, Raz R (2001) Antimicrobial susceptibility of community-acquired uropathogens in northern Israel. Int J Antimicrob Agents 18:189–192Google Scholar
- 13.Clarridge JE, Johnson JR, Pezzlo, AM (1998) Laboratory diagnosis of urinary tract infections. Cumitech 2B. American Society for Microbiology Press, Washington DCGoogle Scholar
- 14.National Committee for Clinical Laboratory Standards (2002) Performance standards for antimicrobial susceptibility testing. Twelfth informational supplement. Document M100-S12. NCCLS, Wayne, PA, p 39Google Scholar
- 15.Borer A, Gilad J, Menashe G, Peled N, Riesenberg K, Schlaeffer F (2002) Extended-spectrum beta-lactamase-producing Enterobacteriaceae strains in community-acquired bacteremia in southern Israel. Med Sci Monit 8:44–47Google Scholar
- 17.Bisson G, Fishman NO, Patel JB, Edelstein PH, Lautenbach E (2002) Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species: risk factors for colonization and impact of antimicrobial formulary interventions on colonization prevalence. Infect Control Hosp Epidemiol 23:254–260PubMedGoogle Scholar