Abstract
BackgroundPrevalence of extended-spectrum beta-lactamase-producing-Enterobacteriaceae (ESBL-E) has risen in patients with urinary tract infections. The objective of this study was to determine explore the risk factors of ESBL-E infection in hospitalized patients and establish a predictive model.MethodsThis retrospective study included all patients with an Enterobacteriaceae-positive urine sample at the first affiliated hospital of Jinan university from January 2018 to December 2019. Antimicrobial susceptibility patterns of ESBL-E were analyzed, and multivariate analysis of related factors was performed. From these, a nomogram was established to predict the possibility of ESBL-E infection. Simultaneously, susceptibility testing of a broad array of carbapenem antibiotics was performed on ESBL-E cultures to explore possible alternative treatment options.ResultsOf the total 874 patients with urinary tract infections (UTIs), 272 (31.1%) were ESBL-E positive. In the predictive analysis, five variables were identified as independent risk factors for ESBL-E infection: male gender (OR = 1.607, 95% CI 1.066–2.416), older age (OR = 4.100, 95% CI 1.678–12.343), a hospital stay in preceding 3 months (OR = 1.872, 95% CI 1.141–3.067), invasive urological procedure (OR = 1.810, 95% CI 1.197–2.729), and antibiotic use within the previous 3 months (OR = 1.833, 95% CI 1.055–3.188). In multivariate analysis, the data set was divided into a training set of 611 patients and a validation set of 263 patients The model developed to predict ESBL-E infection was effective, with the AuROC of 0.650 (95% CI 0.577–0.725). Among the antibiotics tested, several showed very high effectiveness against ESBL-E: amikacin (85.7%), carbapenems (83.8%), tigecycline (97.1%) and polymyxin (98.2%).ConclusionsThe nomogram is useful for estimating a UTI patient’s likelihood of infection with ESBL-E. It could improve clinical decision making and enable more efficient empirical treatment. Empirical treatment may be informed by the results of the antibiotic susceptibility testing.
Highlights
Prevalence of extended-spectrum beta-lactamase-producing-Enterobacteriaceae (ESBL-E) has risen in patients with urinary tract infections
In a study of antimicrobial resistance trends from 2010 to 2013, ESBL-E was frequently detected in China and Southeast Asia, and the ESBL production rate of E. coli and K. pneumoniae in some Asian countries was as high as 60% [6]
A study by Vachvanichsanong estimated that ESBL-E represented one-third of all E. coli and K. pneumoniae urinary tract infections (UTIs) episodes [7]
Summary
Prevalence of extended-spectrum beta-lactamase-producing-Enterobacteriaceae (ESBL-E) has risen in patients with urinary tract infections. The objective of this study was to determine explore the risk factors of ESBL-E infection in hospitalized patients and establish a predictive model. Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) are a diverse family of Gramnegative bacteria, mainly Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), which express. ESBL-E hydrolysis of carbapenem antibiotics is low, so carbapenem antibiotics are often used as the first choice in clinical treatment of ESBL-E infections. UTIs are the most common class of infectious disease, and antibiotics are their main means of treatment. In a study of antimicrobial resistance trends from 2010 to 2013, ESBL-E was frequently detected in China and Southeast Asia, and the ESBL production rate of E. coli and K. pneumoniae in some Asian countries was as high as 60% [6]. Data from the CHINET antimicrobial resistance monitoring project shows that the ESBL-producing isolates resistant to 3rd generation of cephalosporins increasing from 52.2 to 63.2% between 2005 and 2014 in China [8]
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