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Clinical and molecular characterization of community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae
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Sep 28 2016
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Source: Infect Control Hosp Epidemiol. 37(12):1433-1439.
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Alternative Title:Infect Control Hosp Epidemiol
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Personal Author:
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Description:Objectives
We sought to evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a United States health system.
Methods
A case-control study was conducted from 2010 through 2013. All patients presenting to the Emergency Department (ED) or outpatient practices with EB UTIs were included. Case patients had ESC-R EB UTIs. Control patients had ESC-susceptible EB UTIs and were matched 1:1 on study year. Risk factors for ESC-R EB UTI were assessed using multivariable conditional logistic regression. A subset of case isolates was evaluated for extended-spectrum beta-lactamases (ESBLs).
Results
302 patients with community-onset EB UTI were included, of which 151 were cases. On multivariable analysis, risk factors for ESC-R EB UTI included: trimethoprim-sulfamethoxazole use in the prior 6 months (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.22–4.70; P=0.011), older age (OR, 1.03; 95% CI, 1.01–1.04; P<0.001), diabetes (OR, 2.91; 95% CI, 1.32–6.41; P=0.008), and presentation to the ED (OR, 2.42; 95% CI, 1.31–4.46; P=0.005). The prevalence of ESBLs among 120 case isolates were: 52% CTX-M, 29% TEM, 20% OXA, and 13% SHV. The prevalence of AmpC was 25%. Pulsed-field gel electrophoresis of the CTX-M E. coli isolates showed no distinct clusters.
Conclusions
We found that use of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the ED were associated with community-onset ESC-R EB UTI. There was a high prevalence of CTX-M among our community isolates. Further studies are needed to determine strategies to limit emergence of these organisms in the community.
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Pubmed ID:27678022
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Pubmed Central ID:PMC5440186
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