Abstract
Purpose
To assess incidence rate, risk factors and susceptibility patterns associated with extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae in community-acquired urinary tract infections (CA-UTIs).
Methods
A prospective, case-control study was conducted at a tertiary teaching hospital from Jan 2015 to Dec 2016. The results of microbiology cultures were initially screened to include only patients with positive E. coli or K. pneumoniae urine cultures. Afterwards, clinical symptoms were assessed to confirm the UTI. To investigate the risk factors, patients with a positive urine culture for ESBL-producing isolates were assigned as cases, while patients with non-ESBL were assigned as controls.
Results
Out of 591 patients included in this study, 57.5% (n = 340) were included in the control group and 42.5% (n = 251) were in the case group. The incidence rate of ESBL-producing isolates was 3.465 cases per 1000-patient hospital admissions. Male gender (OR = 1.856, 95% CI = 1.192–2.889, p = 0.006), pediatrics (OR = 1.676, 95% CI = 1.117–2.517, p = 0.013), patients with comorbidity (OR = 1.542, 95% CI = 1.029–2.312, p = 0.036) and UTI in the previous 12 months (OR = 1.705, 95% CI = 1.106–2.628, p = 0.016) were independently associated with a higher risk of infection. The resistance rate for most commonly prescribed antibiotics was high.
Conclusions
Our results suggest that the incidence of ESBL producers among CA-UTIs is high. Male gender, pediatrics, comorbidity and UTI in the previous 12 months were associated with a higher risk for infection. Continuous surveillance and prudent antibiotic use by healthcare professionals are important factors for effective control of ESBL associated infections.
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References
Meier S, Weber R, Zbinden R, Ruef C, Hasse B. Extended-spectrum beta-lactamase-producing Gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy. Infection. 2011;39:333–40. https://doi.org/10.1007/s15010-011-0132-6.
Khadri H, Alzohairy M. High prevalence of multi-drug- resistance (MDR) and extended spectrum-lactamases (ESBL) producing bacteria among community-acquired urinary tract infections (CAUTI). J Bacteriol Res. 2009;1:105–10.
Dalgic N, Sancar M, Bayraktar B, Dincer E, Pelit S. Ertapenem for the treatment of urinary tract infections caused by extended-spectrum beta-lactamase-producing bacteria in children. Scand J Infect Dis. 2011;43:339–43. https://doi.org/10.3109/00365548.2011.553241.
Fan NC, Chen HH, Chen CL, Ou LS, Lin TY, Tsai MH, et al. Rise of community-onset urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli in children. J Microbiol Immunol Infect. 2014;47:399–405. https://doi.org/10.1016/j.jmii.2013.05.006.
Kung CH, Ku WW, Lee CH, Fung CP, Kuo SC, Chen TL, et al. Epidemiology and risk factors of community-onset urinary tract infection caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae in a medical center in Taiwan: a prospective cohort study. J Microbiol Immunol Infect. 2015;48:168–74. https://doi.org/10.1016/j.jmii.2013.08.006.
Nimri L. Community-acquired urinary tract infections in a rural area in Jordan: predominant uropathogens, and their antimicrobial resistance. Webmed Central Microbiol. 2010;1:1–10.
Ozcakar ZB, Yalcinkaya F, Kavaz A, Kadioglu G, Elhan AH, Aysev D, et al. Urinary tract infections owing to ESBL-producing bacteria: microorganisms change—clinical pattern does not. Acta Paediatr. 2011;100:e61–4. https://doi.org/10.1111/j.1651-2227.2011.02262.x.
Chen PC, Chang LY, Lu CY, Shao PL, Tsai IJ, Tsau YK, et al. Drug susceptibility and treatment response of common urinary tract infection pathogens in children. J Microbiol Immunol Infect. 2014;47:478–83. https://doi.org/10.1016/j.jmii.2013.07.011.
Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008;8:159–66. https://doi.org/10.1016/S1473-3099(08)70041-0.
Oteo J, Perez-Vazquez M, Campos J. Extended-spectrum [beta]-lactamase producing Escherichia coli: changing epidemiology and clinical impact. Curr Opin Infect Dis. 2010;23:320–6.
Tratselas A, Iosifidis E, Ioannidou M, Saoulidis S, Kollios K, Antachopoulos C, et al. Outcome of urinary tract infections caused by extended spectrum beta-lactamase-producing Enterobacteriaceae in children. Pediatr Infect Dis J. 2011;30:707–10. https://doi.org/10.1097/INF.0b013e31820d7ec4.
Briongos-Figuero LS, Gómez-Traveso T, Bachiller-Luque P, Domínguez-Gil González M, Gómez-Nieto A, Palacios-Martín T, González-Sagrado M, Dueñas-Laita A, Pérez-Castrillón JL. Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract. 2012;66:891–6. https://doi.org/10.1111/j.1742-1241.2012.02991.x.
Dayan N, Dabbah H, Weissman I, Aga I, Even L, Glikman D. Urinary tract infections caused by community-acquired extended-spectrum beta-lactamase-producing and nonproducing bacteria: a comparative study. J Pediatr. 2013;163:1417–21. https://doi.org/10.1016/j.jpeds.2013.06.078.
Goulenok T, Ferroni A, Bille E, Lecuyer H, Join-Lambert O, Descamps P, et al. Risk factors for developing ESBL E. coli: can clinicians predict infection in patients with prior colonization? J Hosp Infect. 2013;84:294–9. https://doi.org/10.1016/j.jhin.2013.04.018.
Moor CT, Roberts SA, Simmons G, Briggs S, Morris AJ, Smith J, et al. Extended-spectrum beta-lactamase (ESBL)-producing enterobacteria: factors associated with infection in the community setting, Auckland, New Zealand. J Hosp Infect. 2008;68:355–62. https://doi.org/10.1016/j.jhin.2008.02.003.
Azap OK, Arslan H, Serefhanoglu K, Colakoglu S, Erdogan H, Timurkaynak F, et al. Risk factors for extended-spectrum beta-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections. Clin Microbiol Infect. 2010;16:147–51. https://doi.org/10.1111/j.1469-0691.2009.02941.x.
Yilmaz E, Akalin H, Ozbey S, Kordan Y, Sinirtas M, Gurcuoglu E, et al. Risk factors in community-acquired/onset urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. J Chemother. 2008;20:581–5. https://doi.org/10.1179/joc.2008.20.5.581.
Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; Twenty-Third Informational Supplement. Document M100-S23. Wayne: PA; 2013.
Al-Bakri AG, Bustanji Y, Yousef AM. Community consumption of antibacterial drugs within the Jordanian population: sources, patterns and appropriateness. Int J Antimicrob Agents. 2005;26:389–95.
Kader AA, Angamuthu K. Extended-spectrum beta-lactamases in urinary isolates of Escherichia coli, Klebsiella pneumoniae and other gram-negative bacteria in a hospital in Eastern Province, Saudi Arabia. Saudi Med J. 2005;26:956–9.
Ben-Ami R, Rodriguez-Bano J, Arslan H, Pitout JD, Quentin C, Calbo ES, et al. A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing enterobacteriaceae in nonhospitalized patients. Clin Infect Dis. 2009;49:682–90. https://doi.org/10.1086/604713.
Fernando MM, Luke WA, Miththinda JK, Wickramasinghe RD, Sebastiampillai BS, Gunathilake MP, et al. Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern—a hospital based cross sectional study. BMC Infect Dis. 2017;17:138. https://doi.org/10.1186/s12879-017-2250-y.
Hayajneh WA, Hajj A, Hulliel F, Sarkis DK, Irani-Hakimeh N, Kazan L, et al. Susceptibility trends and molecular characterization of Gram-negative bacilli associated with urinary tract and intra-abdominal infections in Jordan and Lebanon: SMART 2011–2013. Int J Infect Dis. 2015;35:56–61. https://doi.org/10.1016/j.ijid.2015.04.011.
Topaloglu R, Er I, Dogan BG, Bilginer Y, Ozaltin F, Besbas N, et al. Risk factors in community-acquired urinary tract infections caused by ESBL-producing bacteria in children. Pediatr Nephrol. 2010;25:919–25. https://doi.org/10.1007/s00467-009-1431-3.
Funding
This study was supported by a grant from Deanship of Research at Jordan University of Science and Technology, Irbid, Jordan.
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Almomani, B.A., Hayajneh, W.A., Ayoub, A.M. et al. Clinical patterns, epidemiology and risk factors of community-acquired urinary tract infection caused by extended-spectrum beta-lactamase producers: a prospective hospital case-control study. Infection 46, 495–501 (2018). https://doi.org/10.1007/s15010-018-1148-y
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DOI: https://doi.org/10.1007/s15010-018-1148-y