Factors Associated with Acute Community-Acquired Pyelonephritis Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli.

Mónica Romero Nieto ,Sara Maestre Verdú ,Vicente Gil ,C Pérez Barba ,José Antonio Quesada Rico ,Reyes Pascual Pérez

doi:10.3390/jcm10215192

Mónica Romero Nieto , Sara Maestre Verdú + Show 4 more

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https://doi.org/10.3390/jcm10215192

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This study aimed to identify the factors associated with the presence of extended-spectrum ß-lactamase-(ESBL) in patients with acute community-acquired pyelonephritis (APN) caused by Escherechia coli (E. coli), with a view of optimising empirical antibiotic therapy in this context. We performed a retrospective analysis of patients with community-acquired APN and confirmed E. coli infection, collecting data related to demographic characteristics, comorbidities, and treatment. The associations of these factors with the presence of ESBL were quantified by fitting multivariate logistic models. Goodness-of-fit and predictive performance were measured using the ROC curve. We included 367 patients of which 51 presented with ESBL, of whom 90.1% had uncomplicated APN, 56.1% were women aged ≤55 years, 33.5% had at least one mild comorbidity, and 12% had recently taken antibiotics. The prevalence of ESBL-producing E. coli was 13%. In the multivariate analysis, the factors independently associated with ESBL were male sex (OR 2.296; 95% CI 1.043–5.055), smoking (OR 4.846, 95% CI 2.376–9.882), hypertension (OR 3.342, 95% CI 1.423–7.852), urinary incontinence (OR 2.291, 95% CI 0.689–7.618) and recurrent urinary tract infections (OR 4.673, 95% CI 2.271–9.614). The area under the ROC curve was 0.802 (IC 95% 0.7307–0.8736), meaning our model can correctly classify an individual with ESBL-producing E. coli infection in 80.2% of cases.

Highlights

Acute pyelonephritis (APN) accounts for a large proportion of community-acquired and hospital-acquired urinary tract infections [1]
The prevalence of ESBL-producing E. coli in cases of APN caused by E. coli was 13.9%
APN caused by E. coli was 13.9%, considering that we studied 367 APN of which 51 were

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Introduction

Acute pyelonephritis (APN) accounts for a large proportion of community-acquired and hospital-acquired urinary tract infections [1]. Though less common than cystitis, APN is associated with significant morbidity and can lead to serious complications, including death. Evidence regarding the aetiology of this infection is mostly extrapolated from studies on cystitis [4]. European studies have reported an increase in antibiotic resistance in Gram-negative bacilli, especially. The increasing presence of extended-spectrum ß-lactamase (ESBL)producing E. coli strains in urine culture isolates of people with community-acquired APN is serious problem that leads to considerable use of healthcare resources [7,8,9]. Population ageing, increasing immunosuppression and the growing frequency of urinary catheterisation, among other factors, have given rise to multidrug-resistant microorganisms [10]

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