scholarly journals A clinical prediction tool for extended-spectrum β-lactamase-producing Enterobacteriaceae urinary tract infection

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hui Liu ◽  
Suishan Qiu ◽  
Minghao Chen ◽  
Jun Lyu ◽  
Guangchao Yu ◽  
...  

Abstract Background Prevalence of extended-spectrum beta-lactamase-producing-Enterobacteriaceae (ESBL-E) has risen in patients with urinary tract infections. The objective of this study was to determine explore the risk factors of ESBL-E infection in hospitalized patients and establish a predictive model. Methods This retrospective study included all patients with an Enterobacteriaceae-positive urine sample at the first affiliated hospital of Jinan university from January 2018 to December 2019. Antimicrobial susceptibility patterns of ESBL-E were analyzed, and multivariate analysis of related factors was performed. From these, a nomogram was established to predict the possibility of ESBL-E infection. Simultaneously, susceptibility testing of a broad array of carbapenem antibiotics was performed on ESBL-E cultures to explore possible alternative treatment options. Results Of the total 874 patients with urinary tract infections (UTIs), 272 (31.1%) were ESBL-E positive. In the predictive analysis, five variables were identified as independent risk factors for ESBL-E infection: male gender (OR = 1.607, 95% CI 1.066–2.416), older age (OR = 4.100, 95% CI 1.678–12.343), a hospital stay in preceding 3 months (OR = 1.872, 95% CI 1.141–3.067), invasive urological procedure (OR = 1.810, 95% CI 1.197–2.729), and antibiotic use within the previous 3 months (OR = 1.833, 95% CI 1.055–3.188). In multivariate analysis, the data set was divided into a training set of 611 patients and a validation set of 263 patients The model developed to predict ESBL-E infection was effective, with the AuROC of 0.650 (95% CI 0.577–0.725). Among the antibiotics tested, several showed very high effectiveness against ESBL-E: amikacin (85.7%), carbapenems (83.8%), tigecycline (97.1%) and polymyxin (98.2%). Conclusions The nomogram is useful for estimating a UTI patient’s likelihood of infection with ESBL-E. It could improve clinical decision making and enable more efficient empirical treatment. Empirical treatment may be informed by the results of the antibiotic susceptibility testing.

2021 ◽  
Author(s):  
Hui Liu ◽  
Suishan Qiu ◽  
Minghao Chen ◽  
Jun lyu ◽  
Guangchao Yu ◽  
...  

Abstract Background To explore the risk factors of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) infection through urine samples of hospitalized patients and establish a predictive model to improve treatment outcomes.MethodsThis retrospective study included all patients with an Enterobacteriaceae-positive urine sample at the first affiliated hospital of Jinan university from January 2018 to December 2019. Antimicrobial susceptibility patterns of ESBL-PE were analyzed, and multivariate analysis of related factors was performed. From these, a nomogram was established to predict the possibility of ESBL-PE infection. Simultaneously, susceptibility testing of a broad array of carbapenem antibiotics was performed on ESBL-PE cultures to explore possible alternative treatment options.ResultsOf the total 874 patients with urinary tract infections (UTIs), 272 (31.1%) were ESBL-PE positive. In the predictive analysis, five variables were identified as independent risk factors for ESBL-PE infection: male gender (OR=1.607, 95% CI 1.066-2.416), older age (OR=4.100, 95% CI 1.678-12.343), a hospital stay in preceding 3 months (OR=1.872, 95% CI 1.141-3.067), invasive urological procedure (OR=1.810, 95% CI 1.197-2.729), and antibiotic use within the previous 3 months (OR 0.546, 95% CI 0.314-0.948). In multivariate analysis, the data set was divided into a training set of 611 patients and a validation set of 263 patients The model developed to predict ESBL-PE infection was effective, with the AuROC of 0.650 (95% CI 0.577-0.725). Among the antibiotics tested, several showed very high effectiveness against ESBL-PE: amikacin (85.7%), carbapenems (83.8%), tigecycline (97.1%) and polymyxin (98.2%). ConclusionsThe nomogram is useful for estimating a bacteremic patient’s likelihood of infection with ESBL-PE. It could improve clinical decision making and enable more efficient empirical treatment. Empirical treatment may be informed by the results of the antibiotic susceptibility testing.


BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022137 ◽  
Author(s):  
Allison S Letica-Kriegel ◽  
Hojjat Salmasian ◽  
David K Vawdrey ◽  
Brett E Youngerman ◽  
Robert A Green ◽  
...  

MotivationCatheter-associated urinary tract infections (CAUTI) are a common and serious healthcare-associated infection. Despite many efforts to reduce the occurrence of CAUTI, there remains a gap in the literature about CAUTI risk factors, especially pertaining to the effect of catheter dwell-time on CAUTI development and patient comorbidities.ObjectiveTo examine how the risk for CAUTI changes over time. Additionally, to assess whether time from catheter insertion to CAUTI event varied according to risk factors such as age, sex, patient type (surgical vs medical) and comorbidities.DesignRetrospective cohort study of all patients who were catheterised from 2012 to 2016, including those who did and did not develop CAUTIs. Both paediatric and adult patients were included. Indwelling urinary catheterisation is the exposure variable. The variable is interval, as all participants were exposed but for different lengths of time.SettingUrban academic health system of over 2500 beds. The system encompasses two large academic medical centres, two community hospitals and a paediatric hospital.ResultsThe study population was 47 926 patients who had 61 047 catheterisations, of which 861 (1.41%) resulted in a CAUTI. CAUTI rates were found to increase non-linearly for each additional day of catheterisation; CAUTI-free survival was 97.3% (CI: 97.1 to 97.6) at 10 days, 88.2% (CI: 86.9 to 89.5) at 30 days and 71.8% (CI: 66.3 to 77.8) at 60 days. This translated to an instantaneous HR of. 49%–1.65% in the 10–60 day time range. Paraplegia, cerebrovascular disease and female sex were found to statistically increase the chances of a CAUTI.ConclusionsUsing a very large data set, we demonstrated the incremental risk of CAUTI associated with each additional day of catheterisation, as well as the risk factors that increase the hazard for CAUTI. Special attention should be given to patients carrying these risk factors, for example, females or those with mobility issues.


2018 ◽  
Vol 10 (4) ◽  
pp. 222 ◽  
Author(s):  
Sundaram Balasubramanian ◽  
Dhanalakshmi Kuppuswamy ◽  
Swathi Padmanabhan ◽  
Vaishnavi Chandramohan ◽  
Sumanth Amperayani

2010 ◽  
Vol 139 (6) ◽  
pp. 955-961 ◽  
Author(s):  
P. RATTANAUMPAWAN ◽  
P. TOLOMEO ◽  
W. B. BILKER ◽  
N. O. FISHMAN ◽  
E. LAUTENBACH

SUMMARYPast studies exploring risk factors for fluoroquinolone (FQ) resistance in urinary tract infections (UTIs) focused only on UTIs caused by Gram-negative pathogens. The epidemiology of FQ resistance in enterococcal UTIs has not been studied. We conducted a case-control study at two medical centres within the University of Pennsylvania Health System in order to identify risk factors for FQ resistance in enterococcal UTIs. Subjects with positive urine cultures for enterococci and meeting CDC criteria for healthcare-acquired UTI were eligible. Cases were subjects with FQ-resistant enterococcal UTI. Controls were subjects with FQ-susceptible enterococcal UTI and were frequency matched to cases by month of isolation. A total of 136 cases and 139 controls were included from 1 January 2003 to 31 March 2005. Independent risk factors [adjusted OR (95% CI)] for FQ resistance included cardiovascular diseases [2·24 (1·05–4·79), P=0·037], hospitalization within the past 2 weeks [2·08 (1·05–4·11), P=0·035], hospitalization on a medicine service [2·15 (1·08–4·30), P<0·030], recent exposure to β-lactamase inhibitors (BLIs) [14·98 (2·92–76·99), P<0·001], extended spectrum cephalosporins [9·82 (3·37–28·60), P<0·001], FQs [5·36 (2·20–13·05), P<0·001] and clindamycin [13·90 (1·21–10·49), P=0·035]. Use of BLIs, extended spectrum cephalosporins, FQs and clindamycin was associated with FQ resistance in enterococcal uropathogens. Efforts to curb FQ resistance should focus on optimizing use of these agents.


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