Risk factors for community-onset urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli

Türkan Tüzün,Selda Sayin Kutlu,Murat Kutlu,Ilknur Kaleli̇

doi:10.3906/sag-1902-24

Abstract

Background/aimCommunity-onset urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli have increased in many parts of the world. This study aimed to determine the prevalence and risk factors for community-onset UTI caused by ESBL-producing E. coli.Materials and methodsThis prospective cohort study was conducted between January 2012 and March 2014 in cases of community-onset UTI caused by E. coli. Patients with UTI due to ESBL-producing E. coli and patients with UTI due to non-ESBL-producing E. coli were compared to identify risk factors for ESBL-producing E. coli in the community.ResultsA total of 305 patients (116 males [46.4%]; mean age: 57.76 ± 18.06 years) were included in the study. Among these patients, 154 (50.5%) were infected with ESBL-producing E. coli. In multivariate analysis, the healthcare-associated UTI (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.02–3.18; P = 0.041), upper urinary tract infection (OR: 3.05; 95% CI: 1.76–5.29; P < 0.0001), use of antibiotics in the preceding 6 months (OR: 2.28; 95% CI: 1.21–4.30; P = 0.011), and having two or more risk factors (OR: 4.03; 95% CI: 1.73–9.35; P = 0.001) were the significant factors associated with increased risk of community-onset UTIs due to ESBL-producing E. coli. ConclusionThe increasing prevalence ofESBL-producing E. coli makes it difficult to decide the empirical therapy in UTIs, especially in patients with two or more of the risk factors. A better understanding of the epidemiology and risk factors associated with community-onset UTIs due to ESBL-producing E. coli may have significant implications in decision-making for empirical antimicrobial treatment.

Highlights

Urinary tract infections (UTIs) are the most common community-onset infections in the adult population in many parts of the world
The healthcare-associated UTI, upper urinary tract infection (OR: 3.05; 95% CI: 1.76–5.29; P < 0.0001), use of antibiotics in the preceding 6 months (OR: 2.28; 95% CI: 1.21–4.30; P = 0.011), and having two or more risk factors (OR: 4.03; 95% CI: 1.73–9.35; P = 0.001) were the significant factors associated with increased risk of community-onset UTIs due to ESBL-producing E. coli
The increasing prevalence of ESBL-producing E. coli makes it difficult to decide the empirical therapy in UTIs, especially in patients with two or more of the risk factors

Summary

Introduction

Urinary tract infections (UTIs) are the most common community-onset infections in the adult population in many parts of the world. The major UTI pathogen is Escherichia coli, and there is increasing multidrug resistance in the isolates from community-onset infections. Multidrug resistance of these isolates is frequently associated with the presence of extended-spectrum β-lactamase (ESBL) genes [3,4]. Multidrug resistance of ESBL-positive E. coli makes it more difficult to decide the antibiotic treatment in community-onset UTI and increases the risk of treatment failure. Initiation of appropriate empirical therapy reduces mortality, especially in life-threatening UTIs [6]. A better understanding of the risk factors for community-onset UTIs caused by ESBL-positive E. coli will guide clinicians in choosing appropriate empirical therapy. It will ensure that measures are taken to reduce risk factors for these resistant infections

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