Abstract
This is a retrospective study about the prevalence of ESBL-producing Escherichia coli (EEC) in urinary specimens from patients from the Comunitat Valenciana from January 2007 to December 2008. Data were retrieved from RedMIVA, and Bayesian generalized linear mixed models were considered to study the prevalence of EEC with regard to demographical and microbiological factors. The total number of infections considered was 164,502, the amount of urinary isolates was 70,827 belonging to 49,304 different patients, and 5,161 (7.3%) of the urinary isolates were EEC. Three out of four E. coli were isolated in women (76.8%), men showed higher rates of EEC (9.7% in men vs. 6.5% in women). EEC patients were, in average, 10.8 years older, and hospitalization was more frequent (9.9% vs. 6.9%). Resistance to non-β-lactams antimicrobials was higher in EEC. The rates of ciprofloxacin and co-trimoxazol resistance in EEC were 75.5% and 52.0%, respectively, whereas it ranged between 1.4-12.4% for the rest of antimicrobials. Prior EEC infection and hospitalization were the most relevant risk factors and increased the expected EEC probability approximately 400% and 50% respectively. Other infections played an important and positive role too, Enterobacteriaceae, P. aeruginosa and other bacteria being the most relevant elements. Female gender was a protective factor and reduced the risk by approximately 25% while age was an additive risk factor. Finally, an open-access web-based software was constructed to compute the probability that an E. coli in a urinary infection be an EEC from a specific combination of risk factors. This pharmacovigilance tool should prove useful to monitor and control antimicrobial resistance spread.
Highlights
Resistance to non-β-lactams antimicrobials was higher in Escherichia coli (EEC)
Surveillance for EEC at every level –i.e., national, regional, local or within the hospital- is critical in order to adequately design recommendations, for epidemiological and spread control purposes, as well as for an empirical treatment of infections caused by this microorganism, especially due to the complications derived from an inadequate antibiotherapy [2,7,10]
The major findings of this study are: i) the correlation between EEC and higher resistance levels to non-β-lactams antimicrobials, especially ciprofloxacin; ii) a higher proportion of EEC in men, older individuals, hospitalized patients and its association with previous infections, especially previous ECC; and iii) that the probability that an E. coli in a urinary infection be an EEC can be predicted for an individual with a specific combination of risk factors
Summary
Resistance to non-β-lactams antimicrobials was higher in EEC. The rates of ciprofloxacin and co-trimoxazol resistance in EEC were 75.5% and 52.0%, respectively, whereas it ranged between 1.4-12.4% for the rest of antimicrobials. Prior EEC infection and hospitalization were the most relevant risk factors and increased the expected EEC probability approximately 400% and 50% respectively. An open-access web-based software was constructed to compute the probability that an E. coli in a urinary infection be an EEC from a specific combination of risk factors. This pharmacovigilance tool should prove useful to monitor and control antimicrobial resistance spread
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