Korean J Urol.  2010 Jul;51(7):492-497.

Prevalence and Risk Factors for Extended Spectrum Beta-Lactamase-Producing Uropathogens in Patients with Urinary Tract Infection

• Lee DS
• Lee CB
• Lee SJ

Abstract

PURPOSE
The aim of this study was to determine the prevalence and risk factors of extended spectrum beta-lactamase (ESBL)-producing microorganisms in urinary tract infection.
MATERIALS AND METHODS
total of 2,312 patients older than 25 years and diagnosed from January 2007 to December 2009 as having urinary tract infection were studied. The prevalence of ESBL-producing microorganisms including Escherichia coli and the antimicrobial susceptibility of E. coli were examined. Univariate analyses were performed with gender, age, inpatient status, previous hospitalization, recent history of urinary catheterization, recent exposure to specific antibiotics, and past history of urogenital organ operation as risk factors for the emergence of ESBL-producing microorganisms. Then, multivariate analysis was performed with all significant variables.
RESULTS
In outpatient urinary tract infection, the antimicrobial susceptibility of E. coli to each of the third-generation cephalosporins, cefotaxime, ceftazidime, and ceftriaxone, was 87.6%, 93.4%, and 87.7%, respectively, and the prevalence of ESBL-producing E. coli was 12.1%. In inpatient urinary tract infection, the susceptibility of E. coli was 78%, 84.5%, and 76.9%, respectively, and the prevalence was 23.1%.
CONCLUSIONS
The overall prevalence of ESBL-producing microorganism was 12.6% and the risk appeared to be increased in cases with a previous hospitalization, a recent history of urinary catheterization, inpatient status, cefaclor medication, cefminox administration, and female gender.

Keyword

Beta-lactamases; Cephalosporins; Prevalence; Risk factors

MeSH Terms

Anti-Bacterial Agents
beta-Lactamases
Cefaclor
Cefotaxime
Ceftazidime
Ceftriaxone
Cephalosporins
Escherichia coli
Female
Hospitalization
Humans
Inpatients
Multivariate Analysis
Outpatients
Prevalence*
Risk Factors*
Urinary Catheterization
Urinary Catheters
Urinary Tract Infections*
Anti-Bacterial Agents
Cefaclor
Cefotaxime
Ceftazidime
Ceftriaxone
Cephalosporins
beta-Lactamases

Reference

1. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Infectious Diseases Society of America (IDSA). Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Clin Infect Dis. 1999. 29:745–758.

2. Colodner R, Kometiani I, Chazan B, Raz R. Risk factors for community-acquired urinary tract infection due to quinolone-resistant E. coli. Infection. 2008. 36:41–45.

3. National Institute of Public Health and the Environment. European Antimicrobial Resistance Surveillance System (EARSS) annual report 2008. 2009. Bilthoven: The Institue.

4. Karlowsky JA, Jones ME, Thornsberry C, Critchley I, Kelly LJ, Sahm DF. Prevalence of antimicrobial resistance among urinary tract pathogens isolated from female outpatients across the US in 1999. Int J Antimicrob Agents. 2001. 18:121–127.

5. Zhanel GG, Hisanaga TL, Laing NM, DeCorby MR, Nichol KA, Palatnik LP, et al. Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). Int J Antimicrob Agents. 2005. 26:380–388.

6. Neu HC. The crisis in antibiotic resistance. Science. 1992. 257:1064–1073.

7. Baraff LJ, Ablon WD. Cefaclor versus ampicillin for outpatient treatment of urinary tract infections. Am J Emerg Med. 1984. 2:327–330.

8. Naber KG. Cefotaxime in urinary tract infections. Infection. 1989. 17:425–428.

9. Knothe H, Shah P, Krcmery V, Antal M, Mitsuhashi S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection. 1983. 11:315–317.

10. Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother. 1995. 39:1211–1233.

11. Coque TM, Baquero F, Canton R. Increasing prevalence of ESBL-producing Enterobacteriaceae in Europe. Euro Surveill. 2008. 13.

12. Stamm WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med. 1991. 91:65S–71S.

13. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004. 32:470–485.

14. Ryu KH, Kim MK, Jeong YB. A recent study on the antimicrobial sensitivity of the organisms that cause urinary tract infection. Korean J Urol. 2007. 48:638–645.

15. Lee SJ, Lee SD, Cho IR, Sim BS, Lee JG, Kim CS, et al. Antimicrobial susceptibility of uropathogens causing acute uncomplicated cystitis in female outpatients in South Korea: a multicentre study in 2002. Int J Antimicrob Agents. 2004. 24:Suppl 1. S61–S64.

16. Kim ME, Ha US, Cho YH. Prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in female outpatients in South Korea: a multicentre study in 2006. Int J Antimicrob Agents. 2008. 31:Suppl 1. S15–S18.

17. Lee SJ. Current status of antimicrobial resistance among bacterial pathogens causing urinary tract infection in Korea. Korean J Urogenital Tract Infect Inflamm. 2009. 4:37–44.

18. Naber KG, Schito G, Botto H, Palou J, Mazzei T. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. Eur Urol. 2008. 54:1164–1175.

19. Kader AA, Kumar A. Prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a general hospital. Ann Saudi Med. 2005. 25:239–242.

20. Rodriguez-Bano J, Pascual A. Clinical significance of extended-spectrum beta-lactamases. Expert Rev Anti Infect Ther. 2008. 6:671–683.

21. Calbo E, Romani V, Xercavins M, Gomez L, Vidal CG, Quintana S, et al. Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum betalactamases. J Antimicrob Chemother. 2006. 57:780–783.

22. Ortega M, Marco F, Soriano A, Almela M, Martinez JA, Munoz A, et al. Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob Chemother. 2009. 63:568–574.

23. Azap OK, Arslan H, Serefhanoglu K, Colakoglu S, Erdogan H, Timurkaynak F, et al. Risk factors for extended-spectrum betalactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections. Clin Microbiol Infect. 2010. 16:147–151.

24. Rodriguez-Bano J, Navarro MD, Romero L, Martinez-Martinez L, Muniain MA, Perea EJ, et al. Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients. J Clin Microbiol. 2004. 42:1089–1094.

25. Siegel JD, Rhinehart E, Jackson M, Chiarello L. Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control. 2007. 35:10 Suppl 2. S165–S193.

26. Goossens H, Ferech M, Vander Stichele R, Elseviers M. ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005. 365:579–587.

27. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005. 40:643–654.

28. Platt R, Polk BF, Murdock B, Rosner B. Risk factors for nosocomial urinary tract infection. Am J Epidemiol. 1986. 124:977–985.

29. Bukhari SS, Sanderson PJ, Richardson DM, Kaufman ME, Aucken HM, Cookson BD. Endemic cross-infection in an acute medical ward. J Hosp Infect. 1993. 24:261–271.

30. Tenke P, Kovacs B, Bjerklund Johansen TE, Matsumoto T, Tambyah PA, Naber KG. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents. 2008. 31:Suppl 1. S68–S78.