Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department

Background: Urinary tract infections (UTIs) are one of the most seen infection among community. Objectives: In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI). Methods: Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied. Results: In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. Escherichia coli (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times. Conclusion: Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI. Keywords: Urinary tract infection; community acquired; multidrug-resistant; male; multiple antibiotic usage; advanced age.

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Risk factors for aquiring multidrug-resistant organisms in urinary tract infections: A systematic literature review

Saudi Pharmaceutical Journal ◽

10.1016/j.jsps.2018.02.023 ◽

2018 ◽

Vol 26 (5) ◽

pp. 678-684 ◽

Cited By ~ 25

Author(s):

Justin Tenney ◽

Nicholas Hudson ◽

Hazar Alnifaidy ◽

Justin Ting Cheung Li ◽

Kathy Harriet Fung

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Literature Review ◽

Urinary Tract Infections ◽

Systematic Literature Review ◽

Multidrug Resistant ◽

Multidrug Resistant Organisms ◽

Tract Infections

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Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department

CJEM ◽

10.2310/8000.2012.120666 ◽

2012 ◽

Vol 14 (05) ◽

pp. 295-305 ◽

Cited By ~ 17

Author(s):

Lyne Filiatrault ◽

Rachel M. McKay ◽

David M. Patrick ◽

Diane L. Roscoe ◽

Grahame Quan ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Antibiotic Resistance ◽

Risk Factor ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Tertiary Care ◽

Antibiotic Use ◽

Adult Females ◽

Tract Infections

ABSTRACTIntroduction:We sought to determine the antibiotic susceptibility of organisms causing community-acquired urinary tract infections (UTIs) in adult females attending an urban emergency department (ED) and to identify risk factors for antibiotic resistance.Methods:We reviewed the ED charts of all nonpregnant, nonlactating adult females with positive urine cultures for 2008 and recorded demographics, diagnosis, complicating factors, organism susceptibility, and risk factors for antibiotic resistance. Odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors were calculated.Results:Our final sample comprised 327 UTIs: 218 were cystitis, of which 22 were complicated cases and 109 were pyelonephritis, including 22 complicated cases.Escherichia coliaccounted for 82.3% of all UTIs, whereasStaphylococcus saprophyticusaccounted for 5.2%. In uncomplicated cystitis, 9.5% of all isolates were resistant to ciprofloxacin and 24.0% to trimethoprim-sulfamethoxazole (TMP-SMX). In uncomplicated pyelonephritis, 19.5% of isolates were resistant to ciprofloxacin and 36.8% to TMP-SMX. In UTI (all types combined), any antibiotic use within the previous 3 months was a significant risk factor for resistance to both ciprofloxacin (OR 3.34, 95% CI 1.16–9.62) and TMP-SMX (OR 4.02, 95% CI 1.48–10.92). Being 65 years of age or older and having had a history of UTI in the previous year were risk factors only for ciprofloxacin resistance.Conclusions:E. coliwas the predominant urinary pathogen in this series. Resistance to ciprofloxacin and TMP-SMX was high, highlighting the importance of relevant, local antibiograms. Any recent antibiotic use was a risk factor for both ciprofloxacin and TMP-SMX resistance in UTI. Our findings should be confirmed with a larger prospective study.

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Multidrug Resistant Urinary Tract Infections in Children Presenting to the Pediatric Emergency Department

10.1542/peds.141.1_meetingabstract.418 ◽

2018 ◽

Author(s):

Ashley Roberts ◽

Karen Ng ◽

Jennifer Kendrick ◽

Peter Tilley ◽

Joseph Y. Ting ◽

...

Keyword(s):

Emergency Department ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Multidrug Resistant ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Tract Infections

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Resistance and Virulence Properties of Extraintestinal Pathogenic E. Coli Causing Nosocomial-and Community-Acquired Urinary Tract Infections in Hospitalized Patients in Rio de Janeiro, Brazil

10.20944/preprints202009.0655.v1 ◽

2020 ◽

Author(s):

Ana Carolina da C. Campos ◽

Nathália Andrade ◽

Julio C. D. Correal ◽

Carla C. Santos ◽

Marines du Teil Espina ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

High Risk ◽

Urinary Tract Infections ◽

Asymptomatic Bacteriuria ◽

Multidrug Resistant ◽

Hospitalized Patients ◽

E Coli ◽

Tract Infections ◽

Resistance Rates

Background: Extraintestinal pathogenic Escherichia coli (ExPEC) is the most common cause of urinary tract infections (UTIs). They are often multidrug-resistant (MDR), making them challenging to treat. Additionally, virulence mechanisms as biofilm formation are associated with persistent UTIs. Aims: To reveal a possible association between patients’ risk factors and UTIs caused by MDR or biofilm-forming ExPECs and characterize ExPECs causing asymptomatic bacteriuria, community- (CA), or hospital-acquired (HA) UTIs in hospitalized patients in Brazil. Methods: Bacterial DNA was extracted from the urine of 63 hospitalized patients and sequenced using short-read sequencing. Antibiotic susceptibility was evaluated using VITEK-2, and the biofilm-forming, adhesion, and invasion abilities were quantitatively assessed. Results: Antibiotic resistance rates were high, and the majority of UTIs were complicated CA-UTIs. Most MDR- and ESBL-producing E. coli isolates belonged to high-risk lineages and were associated with UTIs in patients with comorbidities and over 60 years of age. The mortality rate of patients infected with MDR-isolates was higher than of those infected with non-MDR isolates. Most isolates were biofilm-forming, but no association with patients’ risk factors was found. Conclusions: Complicated UTIs caused by MDR- and biofilm-forming bacteria are frequently found in hospitalized patients in Brazil suffering from a UTI and are associated with high-risk lineages.

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Third-generation cephalosporin-resistant urinary tract infections in children presenting to the paediatric emergency department

Paediatrics & Child Health ◽

10.1093/pch/pxy175 ◽

2019 ◽

Vol 25 (3) ◽

pp. 166-172

Author(s):

Kristopher T Kang ◽

Karen Ng ◽

Jennifer Kendrick ◽

Peter Tilley ◽

Joseph Ting ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Urinary Tract ◽

Antibiotic Therapy ◽

Urinary Tract Infections ◽

Generation Cephalosporin ◽

Third Generation ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Tract Infections

Abstract Background The incidence of antibiotic-resistant urinary tract infections (UTIs) in children is increasing. The purpose of this study was to describe the incidence, clinical characteristics, and risk factors for third-generation cephalosporin-resistant UTIs presenting to the paediatric emergency department (ED). Methods This was a retrospective cohort study conducted at British Columbia Children’s Hospital. Children aged 0 to 18 years old presenting to the ED between July 1, 2013 and June 30, 2014 and were found to have UTI due to Enterobacteriaceae and Pseudomonas species were included. Patient demographics, clinical features, laboratory findings, and outcomes were compared using standard statistical analyses. Risk factors for resistant UTIs were analyzed using multiple logistic regression analysis. Results There were 294 eligible patients. The median age was 27.4 months. A third-generation cephalosporin-resistant organism was identified in 36 patients (12%). Patients with resistant UTI had lower rates of appropriate empiric antibiotic therapy (25% versus 95.3%, P<0.05), higher rates of hospitalization (38.9% versus 21.3%, P<0.05), higher rates of undergoing a voiding cystourethrogram (19.4% versus 5.0%, P<0.05), and higher rates of UTI recurrence within 30 days (13.9% versus 4.7%, P<0.05). In multivariate analysis, recent hospitalization (odds ratio [OR] 4.3, confidence interval [CI] 1.2 to 16) and antibiotic therapy (OR 3.5, CI 1.5 to 8.5) within the previous 30 days were risk factors for resistant UTI. Conclusions Third-generation cephalosporin-resistant organisms account for a significant proportion of community-acquired paediatric UTIs. Recent hospitalization and antibiotic use are associated with increased risk of resistant UTI.

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Clinical and Molecular Characterization of Community-Onset Urinary Tract Infections Due to Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.225 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1433-1439 ◽

Cited By ~ 4

Author(s):

Judith A. Anesi ◽

Ebbing Lautenbach ◽

Irving Nachamkin ◽

Charles Garrigan ◽

Warren B. Bilker ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Older Age ◽

Beta Lactamases ◽

Extended Spectrum ◽

Extended Spectrum Beta Lactamases ◽

Tract Infections ◽

Community Onset

OBJECTIVETo evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a US health system.DESIGNCase-control study.PARTICIPANTSAll patients presenting to the emergency department or outpatient practices with EB UTIs from December 21, 2010, through April 22, 2013, were included. Case patients had ESC-R EB UTIs. Control patients had ESC-susceptible EB UTIs and were matched 1:1 on study year.METHODSRisk 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.RESULTSA total of 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, 2.40 [95% CI, 1.22–4.70];P=.01), older age (1.03 [1.01–1.04];P<.001), diabetes (2.91 [1.32–6.41];P=.008), and presentation to the emergency department ( 2.42 [1.31–4.46];P=.005). The prevalence of extended-spectrum beta-lactamases among 120 case isolates was 52% CTX-M, 29% TEM, 20% OXA, and 13% SHV. The prevalence of AmpC was 25%. Pulsed-field gel electrophoresis of the CTX-MEscherichia coliisolates showed no distinct clusters.CONCLUSIONSUse of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the emergency department 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.Infect Control Hosp Epidemiol2016;1433–1439

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The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2020/2967260 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Maria G. Zavala-Cerna ◽

Midrori Segura-Cobos ◽

Ricardo Gonzalez ◽

Isidro G. Zavala-Trujillo ◽

Silvia F. Navarro-Perez ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Multidrug Resistant ◽

Clinical Variable ◽

Microbiological Analysis ◽

Cross Sectional ◽

E Coli ◽

Tract Infections ◽

Esbl Producers

Background. Urinary tract infections (UTIs) affect up to 150 million individuals annually worldwide, mainly due to Escherichia coli (E. coli) and Klebsiella. The emergence and spread of multidrug-resistant (MDR) bacteria are increasing, representing one of the biggest threats for human health. The objective of our study was to describe antimicrobial patterns of resistance and identify risk factors associated with MDR uropathogens. Methods. We conducted a cross-sectional study in 296 patients with community-acquired UTI who underwent clinical and microbiologic analysis, and clinical associations to MDR uropathogens were investigated. Findings. Microbiological analysis included E. coli (55%), ESBL-E. coli (26%), Enterococcus (6%), Klebsiella (5%), and others (8%). Higher frequencies of MDR bacteria were found among ESBL-E. coli, with resistance to ampicillin (100%), ceftriaxone (96%), gentamicin (57%), ciprofloxacin (89%), and TMP/SMX (53%). However, they were sensitive to fosfomycin (6.6%), nitrofurantoin (1.3%), and carbapenems (0%). Fosfomycin MIC90 for ESBL-E. coli was 5.78 μg/mL. The only clinical variable with significant association to ESBL producers was the presence of comorbidities: hypertension and type 2 diabetes mellitus with an OR (95%CI) of 2.51.3−4.9p<0.01 and 2.81.2−6.7p<0.05, respectively. Conclusions. In the majority of cases, resistance rates to commonly prescribed antimicrobials in UTIs were high, except for fosfomycin, nitrofurantoin, and carbapenems. To provide appropriate treatment, both the identification of risk factors and the uropathogen would be important. An active surveillance in UTIs in the community is required since the proportion of ESBL producers is increasing.

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Multidrug resistance and risk factors associated with community-acquired urinary tract infections caused by Escherichia coli in Venezuela

Biomédica ◽

10.7705/biomedica.v39i2.4030 ◽

2019 ◽

Vol 39 ◽

pp. 96-107 ◽

Cited By ~ 1

Author(s):

Militza Guzmán ◽

Elsa Salazar ◽

Vicmaris Cordero ◽

Ana Castro ◽

Andreína Villanueva ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Urinary Tract ◽

Urinary Tract Infections ◽

High Frequency ◽

Multidrug Resistant ◽

E Coli ◽

Regional Health Authorities ◽

Tract Infections

Introduction: The treatment of urinary tract infections has become more challenging due to the increasing frequency of multidrug-resistant Escherichia coli in human populations.Objective: To characterize multidrug-resistant E. coli isolates causing community-acquired urinary tract infections in Cumaná, Venezuela, and associate possible risk factors for infection by extended-spectrum beta-lactamases (ESBL)-producing isolates.Materials and methods: We included all the patients with urinary tract infections attending the urology outpatient consultation and emergency unit in the Hospital de Cumaná, Estado Sucre, Venezuela, from January through June, 2014. blaTEM, blaSHV and blaCTX-M genes detection was carried out by PCR.Results: We found a high prevalence of multidrug-resistant E. coli (25.2%) with 20.4% of the isolates producing ESBL. The ESBL-producing isolates showed a high frequency (66.7%) of simultaneous resistance to trimethoprim-sulphamethoxazole, fluoroquinolones and aminoglycosides compared to non-producing isolates (2.4%). Of the resistant isolates, 65.4% carried the blaTEM gene, 34.6% the blaCTX-M and 23.1% the blaSHV. The blaCTX-M genes detected belonged to the CTX-M-1 and CTX-M-2 groups. Plasmid transfer was demonstrated by in vitro conjugation in 17 of the 26 ESBL-producing isolates. All three genes detected were transferred to the transconjugants. Age over 60 years, complicated urinary tract infections and previous use of a catheter predisposed patients to infection by ESBL-producing E. coli.Conclusions: The high frequency of multidrug-resistant ESBL-producing isolates should alert the regional health authorities to take measures to reduce the risk of outbreaks caused by these types of bacteria in the community.

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