Ann Clin Microbiol.  2021 Mar;24(1):11-20. 10.5145/ACM.2021.24.1.2.

Risk Factors Associated with Recurrent Urinary Tract Infection Caused by Escherichia coli

• Kim YA
• Kang EW
• Seo YH
• Lee K

• KMID: 2514046
• DOI: http://doi.org/10.5145/ACM.2021.24.1.2

Abstract

Background
The purpose of this study was to analyze the clinical and microbiological characteristics of recurrent urinary tract infection (UTI) caused by Escherichia coli— the most common etiological agent.
Methods
Cases of recurrent and single episodes of UTI caused by E. coli were evaluated retrospectively for a period of 6 months (January-June 2019) to analyze the clinical and molecular characteristics of this disease.
Results
Healthcare-associated UTI, E. coli bacteremia, and poor microbial clearance 7 days post infection were associated more with the recurrent episodes of infection. E. coli isolates from subjects with recurrent UTIs showed higher rates of antimicrobial resistance and extended-spectrum β-lactamase (ESBL) production. The E. coli clone— sequence type 131 was detected in similar proportions in isolates, recovered from subjects in both groups— recurrent episodes and single episode of UTI.
Conclusion
The control of antimicrobial-resistant ESBL-producing E. coli strains may be difficult using antimicrobial therapy and subsequently delay the clearance of the etiologic agent. This could play a major role in the development of recurrent UTIs.

Keyword

Escherichia coli; Extended-spectrum β-lactamases; Recurrent urinary tract infection; Risk factors; Sequence type 131

Figure

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  Fig. 1. Antimicrobial resistance rates of Escherichia coli. Total UTI (n = 124) included both recurrent episodes (n = 62) and single episodes (n = 62).Abbreviations: rUTI, recurrent urinary tract infection; sUTI, single episode of urinary tract infection; N, number, Amp, ampicillin; Sam, ampicillin-sulbactam; Pip, piperacillin; Tzp, piperacillin-tazobactam; Amc, amoxicillin-clavulanic acid; Cxm, cefuroxime; Ctx, cefotaxime; Caz, ceftazidime; Fep, cefepime; Fox, cefoxitin; Atm, aztreonam; Dor, doripenem; Mem, meropenem; Imp, imipenem; Lev, levofloxacin; Cip, ciprofloxacin; Gen, gentamicin; Tob, tobramycin; Amk, amikacin; Mno, minocycline; Tet, tetracycline; Sxt, trimethoprim-sulfamethoxazole; Fos, fosfomycin; Tgc, tigecycline; Col, colistin.

• 

  Fig. 2. Dendrogram of XbaI-restricted DNA of Escherichia coli isolated from urinary tract infection (n=122). PFGE was performed with size marker, Lambda Ladders (Promega, Fitchburg, WI, USA).Abbreviations: ESBL, extended-spectrum β-lactamase; ST, sequence type; rUTI, recurrent urinary tract infection; sUTI, single episode of E. coli urinary tract infection.

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