Abstract
Objective: To describe the causal agents, prevalence of antimicrobial resistance, and risk factors associated with extended spectrum beta-lactamase (ESBL)-producing agents in urinary tract infections (UTIs).
 Materials and methods: A retrospective study was conducted at a tertiary care hospital in Monterrey, Mexico. Inclusion criteria were patients that clinically presented with a UTI and had a positive urine culture, within the time frame of March to October 2017. The association with ESBL-producing agents was determined through the Χ2 test for categorical variables. Statistical significance was set at a p <0.05, utilizing SPSS version 20.0 software.
 Results: A total of 353 positive urine cultures were confirmed. ESBL production was found in 21.5% of the strains. There was a high level of resistance (>50%) to amoxicillin-clavulanate, ciprofloxacin, levofloxacin, fosfomycin, and trimethoprim-sulfamethoxazole and moderate resistance (10-50%) to gentamicin and ceftriaxone. Amikacin, ertapenem, nitrofurantoin, and colistin had the lowest resistance rates (<10%). The ESBL-producing agents were associated with complicated UTI (p≤0.0001). The comorbidities associated with ESBL-positive UTIs were diabetes mellitus (p=0.02) and immunodeficiency (p=0.008), as was having undergone radiotherapy (p=0.025) and previous antibiotic use (p≤0.001).
 Limitations: The clonal relationship of isolates, especially of E. coli, was not analyzed. We could not establish whether there was a high level of genetic diversity between the isolates or whether independent acquisition or cross-transmission occurred.
 Value: We evaluated the epidemiologic characteristics of the ESBL-producing agents in UTIs at a Mexican tertiary care hospital.
 Conclusions: One out of every five UTIs was caused by ESBLs in our study population. There was a high level of resistance to the antibiotics used as first-line empiric therapy in the patients studied.
Highlights
Urinary tract infections (UTIs) are among the most prevalent community-acquired and hospital-acquired infections.[1]
The most common agent causing UTIs is Escherichia coli (E. coli). [1,4] complicated UTIs are caused by a greater variety of agents with higher antibiotic resistance rates, and a higher frequency of failure to empiric treatment.[5,6] In recent years, increased drug resistance has been reported worldwide, including the emergence of extended spectrum β-lactamase (ESBL)-producing agents in Enterobacteriaceae, mainly E. coli and Klebsiella pneumoniae.[7,8] extended spectrum beta-lactamase (ESBL) confer resistance to penicillins, cephalosporins, and aztreonam.[9,10]
We evaluated the epidemiologic characteristics of ESBL-producing agents in UTIs, acquired either in the hospital or the community, in patients at a tertiary care hospital
Summary
Urinary tract infections (UTIs) are among the most prevalent community-acquired and hospital-acquired infections.[1]. [1,4] complicated UTIs are caused by a greater variety of agents with higher antibiotic resistance rates, and a higher frequency of failure to empiric treatment.[5,6] In recent years, increased drug resistance has been reported worldwide, including the emergence of extended spectrum β-lactamase (ESBL)-producing agents in Enterobacteriaceae, mainly E. coli and Klebsiella pneumoniae.[7,8] ESBLs confer resistance to penicillins, cephalosporins, and aztreonam.[9,10]. Few studies have reported the risk factors associated with UTIs caused by ESBL-producing E. coli, such as diabetes, recurrent UTIs, urinary catheterization, genitourinary pathology, previous bacterial infection, intravenous antibiotic treatment, hospitalization, and previous antibiotic therapy.[11,12,13]. The aim of the present study was to determine the etiologic agents, antimicrobial resistance rates (including ESBL-producing bacteria), and risk factors associated with ESBL-positive UTIs at a tertiary care hospital in Northern Mexico
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