Identifying clinical risk factors for antibiotic resistances in urinary tract infections and optimizing empirical treatment: a retrospective study.

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.

Download Full-text

Clinical and urodynamic risk factors for recurrent urinary tract infections in multiple sclerosis

10.26226/morressier.5b7578605aff7400151f3140 ◽

2018 ◽

Author(s):

paloma Montero ◽

Vanesa Pytel

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Recurrent Urinary Tract Infections ◽

Tract Infections

Download Full-text

Urinary Tract Infections Caused by Multi-Drug Resistant Proteus mirabilis: Risk Factors and Clinical Outcomes

Infection ◽

10.1007/s15010-009-8460-5 ◽

2009 ◽

Vol 38 (1) ◽

pp. 41-46 ◽

Cited By ~ 38

Author(s):

K. Cohen-Nahum ◽

L. Saidel-Odes ◽

K. Riesenberg ◽

F. Schlaeffer ◽

A. Borer

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Clinical Outcomes ◽

Urinary Tract Infections ◽

Proteus Mirabilis ◽

Drug Resistant ◽

Tract Infections

Download Full-text

Risk factors and clinical impact of levofloxacin or cefazolin nonsusceptibility or ESBL production among uropathogens in adults with community-onset urinary tract infections

Journal of Microbiology Immunology and Infection ◽

10.1016/j.jmii.2012.09.001 ◽

2014 ◽

Vol 47 (3) ◽

pp. 197-203 ◽

Cited By ~ 21

Author(s):

Yi-Hui Wu ◽

Po-Lin Chen ◽

Yuan-Pin Hung ◽

Wen-Chien Ko

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Clinical Impact ◽

Esbl Production ◽

Tract Infections ◽

Community Onset

Download Full-text

Risk factors, demographic profiles, and management of uncomplicated recurrent urinary tract infections

Menopause ◽

10.1097/gme.0000000000001791 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Amanda Ingram ◽

Tasha Posid ◽

Aroh Pandit ◽

Justin Rose ◽

Sabrina Amin ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Demographic Profiles ◽

Recurrent Urinary Tract Infections ◽

Tract Infections

Download Full-text

RECOMMENDATIONS FOR THE THERAPEUTIC MANAGEMENT OF NON COMPLICATED URINARY TRACT INFECTIONS IN ADULTS

Urogynaecologia ◽

10.4081/uij.2003.103 ◽

2010 ◽

Vol 17 (3) ◽

pp. 103

Author(s):

L. CERSOSIMO ◽

F. CATANZARO ◽

E. IMPARATO ◽

M. MESCHIA ◽

T. MAZZEI ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Warning Signal ◽

Therapeutic Management ◽

Human Species ◽

Bacterial Diseases ◽

Frequent Relapses ◽

Tract Infections ◽

Male Subjects

Non complicated acute urinary tract infections (UTI) are among the most common bacterial diseases in the human species. More than 150 million UTIs (non complicated/complicated) are, in fact, annually diagnosed and treated worlwide (Sobel Kaye, 1990; Stamm and Hooton, 1993; Stamm, 1998; Stamm and Norrby, 2001; Foxman, 2002). UTI include cystitis and pyelonephritis (the latter is not discussed in this paper) that occur in individuals without morphological-functional alterations of the excretory tract. This disease is more common in female and/or in menopause patients. 25-50% of the individuals in this population, aged between 20 and 40 years, can be affected by UTI at least once in a lifetime and can be prone to more or less frequent relapses. (Johnson, 1998; Stamm, 2001). Male subjects are less frequently affected by UTI, but when affected, they experience more serious episodes often representing a warning signal of anatomical alterations of the urinary apparatus or the presence of risk factors.......

Download Full-text

Infeções do Trato Urinário numa Coorte de Transplantados Renais

Acta Médica Portuguesa ◽

10.20344/amp.4959 ◽

2014 ◽

Vol 27 (3) ◽

pp. 364 ◽

Cited By ~ 2

Author(s):

Ana Bispo ◽

Milene Fernandes ◽

Cristina Toscano ◽

Teresa Marques ◽

Domingos Machado ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Hospital Admissions ◽

Female Gender ◽

Tract Infections

Introduction: Urinary tract infection is the most common infectious complication following renal transplantation and its frequency is insufficiently studied in Portugal. The aim of this study was to characterize the incidence of urinary tract infections and recurrent urinary tract infections in renal transplant recipients. Material and Methods: This was a retrospective cohort observational study, obtained from clinical files of all patients who received a renal transplant at the Hospital of Santa Cruz, from January 2004 to December 2005, with a mean follow-up period of five years or until date of graft loss, death or loss of follow-up. After a descriptive analysis of the population, we used bivariate tests to identify risk factors for urinary tract infections. Results: A total of 127 patients were included, with a 593 patients.year follow-up. We detected 53 patients (41.7%) presenting with at least one episode of urinary tract infection; 21 patients (16.5%) had recurrent urinary tract infection. Female gender was the only risk factor associated with the occurrence of urinary tract infections (p < 0.001, OR = 7.08, RR = 2.95) and recurrent urinary tract infections (p < 0.001, OR = 4.66, RR = 2.83). Escherichia coli (51.6%), Klebsiella pneumoniae (15.5%) and Enterobacter spp (9.9%) were the most frequently identified pathogens. Patients did not reveal an increased mortality or allograft loss. However, urinary tract infections were the most important cause of hospital admissions. Discussion: Female gender was the only risk factor for urinary tract infections in this population. Escherichia coli was the most frequent agent isolated. Conclusion: Despite preventive measures, urinary tract infections remain an important cause of morbidity and hospital admissions. Keywords: Urinary Tract Infections; Postoperative Complications; Risk Factors; Kidney Transplantation; Portugal.

Download Full-text