Extended-spectrum β-lactamase-producing Gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy
- 25 June 2011
- journal article
- research article
- Published by Springer Science and Business Media LLC in Infection
- Vol. 39 (4), 333-340
- https://doi.org/10.1007/s15010-011-0132-6
Abstract
Extended-spectrum β-lactamases (ESBLs) are an increasing challenge in the treatment of urinary tract infections (UTIs), and also in the community. We aimed to investigate the characteristics of patients with UTIs due to ESBL-producing Escherichia coli and to assess the risk factors for ESBLs in community-acquired isolates. We performed a retrospective study from January 1, 2007 to December 31, 2009 at a tertiary care teaching hospital in Switzerland, comparing patients with community-acquired versus healthcare-associated UTIs due to ESBL-producing E. coli. Additionally, we investigated the antimicrobial susceptibility of these isolates. A total of 123 patients were studied, of whom 79 (64%) had community-acquired and 44 (36%) had healthcare-associated UTIs. Community-acquired isolates were associated with acute uncomplicated UTIs (odds ratio [OR] 6.62, 95% confidence interval [CI] 1.83-36.5, P < 0.001). Risk factors were recurrent UTI (OR 3.04, 95% CI 1.14-9.14, P = 0.022) and female sex (OR 2.46, 95% CI 1.01-6.08). Community-acquired ESBL-producing E. coli urinary isolates showed high resistance rates to most of the currently used oral antimicrobial agents, including β-lactam antibiotics (amoxicillin-clavulanic acid, 69.6% resistance), quinolones (ciprofloxacin, 84.8% resistance; norfloxacin, 83.9% resistance), and trimethoprim-sulfamethoxazole (75.9% resistance), except for nitrofurantoin (15% resistance) and fosfomycin (0% resistance). UTI due to ESBL-producing E. coli are emerging, and also in a country with low antibiotic use. Because of increasing antibiotic resistance rates of E. coli to current standard therapy and because of the resistance patterns of ESBL-producing E. coli, guidelines for the management of UTIs must be revised. Fosfomycin or nitrofurantoin are recommended for the first-line empirical oral treatment of community-acquired uncomplicated UTIs.Keywords
This publication has 26 references indexed in Scilit:
- Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological studyThe Lancet Infectious Diseases, 2010
- Oral Treatment Options for Ambulatory Patients with Urinary Tract Infections Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coliAntimicrobial Agents and Chemotherapy, 2010
- Current therapy of acute uncomplicated cystitisInternational Journal of Urology, 2010
- Risk factors for extended-spectrum β-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infectionsClinical Microbiology & Infection, 2010
- A Multinational Survey of Risk Factors for Infection with Extended‐Spectrum β‐Lactamase–Producing Enterobacteriaceae in Nonhospitalized PatientsClinical Infectious Diseases, 2009
- Prospective Evaluation of Colonization with Extended-Spectrum β-Lactamase (ESBL)–Producing Enterobacteriaceae Among Patients at Hospital Admission and of Subsequent Colonization with ESBL-Producing Enterobacteriaceae Among Patients During HospitalizationInfection Control & Hospital Epidemiology, 2009
- Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concernThe Lancet Infectious Diseases, 2008
- Extended-Spectrum β-Lactamases of the CTX-M Type Now in SwitzerlandAntimicrobial Agents and Chemotherapy, 2007
- Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in TurkeyJournal of Antimicrobial Chemotherapy, 2005
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987