Investig Clin Urol.  2019 Jan;60(1):46-53. 10.4111/icu.2019.60.1.46.

Investigation of risk factors for community-acquired urinary tract infections caused by extended-spectrum beta-lactamase Escherichia coli and Klebsiella species

• Koksal E
• Tulek N
• Sonmezer M
• Temocin F
• Bulut C
• Hatipoglu
• Erdinc FS
• Ertem G

• KMID: 2434625
• DOI: http://doi.org/10.4111/icu.2019.60.1.46

Abstract

PURPOSE
The aim of this study was to determine the prevalence and risk factors for community-acquired urinary tract infections (CA-UTIs) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella species.
MATERIALS AND METHODS
The patients diagnosed with CA-UTIs caused by E. coli or Klebsiella spp. were included in the study. All of the patients were compared to demographic characteristics, underlying diseases, urinary tract pathology, history of hospitalization, use of antibiotics according to ESBL positivity.
RESULTS
A total of 322 urine isolates were studied. Sixty-six patients (37.1%) of a total of 178 patients were ESBL positive E. coli and Klebsiella spp. Being over the age of sixty (odds ratio [OR], 1.90; p=0.03), history of renal stone (OR, 3.00; p=0.03), urinary tract anatomical of physiological disorder (OR, 2.17; p=0.01), urologic intervention (OR, 3.43; p < 0.001), history of urinary tract surgery (OR, 3.10; p=0.01), history of urinary catheterization (OR, 3.43; p < 0.001), and hospitalization for last 1 year (OR, 3.70; p=0.01) and antibiotic usage in the last 3 months (OR, 1.90; p=0.04) were found as significant risk factors for the producing of ESBL. However, gender and underlying disease were not related for ESBL production.
CONCLUSIONS
In present study, high rate of ESBL positivity was detected in CA-UTIs. The increasing of infections caused by ESBL positive E. coli and Klebsiella spp. are bringing together a lot of the problem, such as antibiotic resistance and reducing treatment options for outpatients. Identification of underlying risk factors would be important for the development of preventive strategies.

Keyword

Community-acquired urinary tract infections; Escherichia coli; Extended-spectrum beta-lactamase; Klebsiella species

MeSH Terms

Anti-Bacterial Agents
beta-Lactamases*
Drug Resistance, Microbial
Escherichia coli*
Escherichia*
Hospitalization
Humans
Klebsiella*
Outpatients
Pathology
Prevalence
Risk Factors*
Urinary Catheterization
Urinary Catheters
Urinary Tract Infections*
Urinary Tract*
Urologic Diseases
Anti-Bacterial Agents
beta-Lactamases

Figure

• 

  Fig. 1 Double disk synergy method. Use amoxicillin clavulanate in proximity to cephalosporin discs. The distance between discs is critical. Any distorsion of zones indicates extended-spectrum β-lactamase.

• 

  Fig. 2 Detection of extended-spectrum β-lactamase (ESBL) with an E-test. Ceftazidime (CAZ) MIC against Escherichia coli isolate in A is >32 µg/mL in the absence of clavulanate and 0.125 µg/mL in the presence of clavulanate. As the ratio of CAZ with and without clavulanate is ≥8, the isolates were phenotypically determined as ESBL producers.

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