Abstract
Recurrent UTIs are associated with increased hospitalisation and antibiotic use. We investigated patients with recurrent ESBL versus non-ESBL UTIs to identify risk factors and potential treatments. A30 month retrospective case-control study was performed in patients with recurrent EBSL versus non-ESBL UTI. Definition :1) > three in a year (>two weeks apart) or 2) > two in six months (>one week apart) with the same profile. 3) ESBL UTIs were Enterobacteriaceae resistant to cefalexin AND ceftazadime/ceftriaxone. 281/1449 “recurrent UTI” patients were ESBLs. Patients were more likely to be older, male, with associated bacteraemia, colonisation with carbapenemase-producing Enterobacteriaceae (CPE) and higher resistance rates to non beta-lactam antibiotics. 75% of renal patients were transplant cases, 81% of urology patients had a tube insertion. Recurrent ESBL UTIRecurrent non-ESBL UTIp value Number (%)Number (%)(Chi-squared test) Patients 281 1168 Organism Klebsiella spp (%)42 (14.9) 10 (0.8) <0.001 E coli (%)199 (70.8)811 (69.4)0.665 Demographics Age (mean, SD)64.1, 19 58.7, 22 <0.001 Male 137 (48.8)328 (28) <0.001 Associations Gram negative bacteraemia 35 (12.4) 37 (3.1) 0.001 Colonisation with CPE 21 (7.5) 31 (2.7) <0.001 Speciality Renal 84 (30.0) 196 (16.8)<0.001 Urology 47 (16.7) 104 (8.9) <0.001 Resistance Trimethoprim 219 (77.9)354 (30.3)<0.001 Ciprofloxacin 214 (76.2)160 (13.7)<0.001 Gentamicin135 (48). 64 (5.5) <0.001 ESBL infection is associated with worse outcomes and significant premorbid conditions. The oral crossover resistance prevented long term prophylaxis. Options are needed to reduce colonisation burden of resistant organisms such as faecal microbiota transplantation.
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