Clinical profile and outcome of urinary tract infection caused by extended spectrum beta-lactamase producing Escherichia coli in critically ill patients in a tertiary care hospital in South India:a case control study

Abstract

Background: Infections with Extended spectrum beta-lactamase (ESBL) producing organisms have been associated with poor outcome. Our aim of this study is to compare clinical profile of Urinary tract infection (UTI) caused by ESBL producing Escherichia coli ( E. coli ) with Non-ESBL producing E. coli. Methods: Retrospective analysis of patients admitted in Intensive care unit in a tertiary care hospital was done. 50 Patients with ESBL producing E. coli infection were assigned as cases; 50 Patients with Non-ESBL producing E. coli were assigned as controls. Clinical characteristics of UTI caused by both ESBL & non-ESBL producing E. coli in critically ill patients and their clinical outcome were observed. Mortality risk on admission was calculated using sepsis scoring system. Results: Most patients in both groups were in 6 th and 7 th decade. Male to female ratio in both groups were almost similar. Incidence of complications was higher in ESBL group. Mortality rate was 10% in ESBL group; 4% in Non-ESBL group. Mean duration of ICU stay was 4.2 days (ESBL) and 3.1 days (Non-ESBL). APACHE IV and SOFA scoring system mortality prediction accuracy was 60% in both groups. Conclusions: Initiation of empirical therapy with carbapenem antibiotics on admission in critically ill with UTI showed significant impact on mortality. Mean duration of ICU stay in ESBL group was longer than non-ESBL group which is statistically significant. Mortality risk was predicted by APACHE IV & SOFA scores on admission with good accuracy.