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

  • Judith A. Anesi (a1), Ebbing Lautenbach (a1) (a2) (a3), Irving Nachamkin (a4), Charles Garrigan (a4), Warren B. Bilker (a2) (a3), Mary Wheeler (a2) (a3), Pam Tolomeo (a2) (a3) and Jennifer H. Han (a1) (a2) (a3)...

Abstract

OBJECTIVE

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 US health system.

DESIGN

Case-control study.

PARTICIPANTS

All 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.

METHODS

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.

RESULTS

A 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-M Escherichia coli isolates showed no distinct clusters.

CONCLUSIONS

Use 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 Epidemiol 2016;1433–1439

Copyright

Corresponding author

Address correspondence to Judith A. Anesi, MD, Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, 3 Silverstein, Ste E, Philadelphia, PA 19104 (judith.anesi@uphs.upenn.edu).

Footnotes

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Presented in part: IDWeek 2015; San Diego, California; October 10, 2015, abstract 1803.

Footnotes

References

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1. Tenover, FC. Development and spread of bacterial resistance to antimicrobial agents: an overview. Clin Infect Dis 2001;33:S108S115.
2. Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:11621171.
3. Schwaber, MJ, Navon-Venezia, S, Kaye, KS, Ben-Ami, R, Schwartz, D, Carmeli, Y. Clinical and economic impact of bacteremia with extended- spectrum-beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2006;50:12571262.
4. Bradford, PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933951.
5. Pfeifer, Y, Cullik, A, Witte, W. Resistance to cephalosporins and carbapenems in gram-negative bacterial pathogens. Int J Med Microbiol 2010;300:371379.
6. Simonsen, L, Conn, LA, Pinner, RW, Teutsch, S. Trends in infectious disease hospitalizations in the United States, 1980-1994. Arch Intern Med 1998;158:19231928.
7. Talan, DA, Krishnadasan, A, Abrahamian, FM, Stamm, WE, Moran, GJ; EMERGEncy ID NET Study Group. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis 2008;47:11501158.
8. Talan, DA, Stamm, WE, Hooton, TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA 2000;283:15831590.
9. Pitout, JD, Nordmann, P, Laupland, KB, Poirel, L. Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community. J Antimicrob Chemother 2005;56:5259.
10. Calbo, E, Romani, V, Xercavins, M, et al. Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum beta-lactamases. J Antimicrob Chemother 2006;57:780783.
11. Colodner, R, Rock, W, Chazan, B, et al. Risk factors for the development of extended-spectrum beta-lactamase-producing bacteria in nonhospitalized patients. Eur J Clin Microbiol Infect Dis 2004;23:163167.
12. Apisarnthanarak, A, Kiratisin, P, Mundy, LM. Predictors of mortality from community-onset bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae . Infect Control Hosp Epidemiol 2008;29:671674.
13. Apisarnthanarak, A, Kiratisin, P, Saifon, P, Kitphati, R, Dejsirilert, S, Mundy, LM. Clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase-producing Escherichia coli infections in Thailand: a case-case-control study. Am J Infect Control 2007;35:606612.
14. Kronenberg, A, Hilty, M, Endimiani, A, Muhlemann, K. Temporal trends of extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in in- and outpatients in Switzerland, 2004 to 2011. Euro Surveill 2013;18.
15. Ben-Ami, R, Rodriguez-Bano, J, Arslan, H, et al. A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in nonhospitalized patients. Clin Infect Dis 2009;49:682690.
16. Azap, OK, Arslan, H, Serefhanoglu, K, et al. Risk factors for extended-spectrum beta-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections. Clin Microbiol Infect 2010;16:147151.
17. Rodriguez-Bano, J, Alcala, J, Cisneros, JM, et al. Escherichia coli producing SHV-type extended-spectrum beta-lactamase is a significant cause of community-acquired infection. J Antimicrob Chemother 2009;63:781784.
18. Yilmaz, E, Akalin, H, Ozbey, S, et al. Risk factors in community-acquired/onset urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae . J Chemother 2008;20:581585.
19. Rodriguez-Bano, J, Alcala, JC, Cisneros, JM, et al. Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli . Arch Intern Med 2008;168:18971902.
20. Moor, CT, Roberts, SA, Simmons, G, et al. Extended-spectrum beta-lactamase (ESBL)-producing enterobacteria: factors associated with infection in the community setting, Auckland, New Zealand. J Hosp Infect 2008;68:355362.
21. Banerjee, R, Strahilevitz, J, Johnson, JR, et al. Predictors and molecular epidemiology of community-onset extended-spectrum beta-lactamase-producing Escherichia coli infection in a Midwestern community. Infect Control Hosp Epidemiol 2013;34:947953.
22. Rogers, BA, Ingram, PR, Runnegar, N, et al. Community-onset Escherichia coli infection resistant to expanded-spectrum cephalosporins in low-prevalence countries. Antimicrob Agents Chemother 2014;58:21262134.
23. Laupland, KB, Church, DL, Vidakovich, J, Mucenski, M, Pitout, JD. Community-onset extended-spectrum beta-lactamase (ESBL) producing Escherichia coli: importance of international travel. J Infect 2008;57:441448.
24. Rodriguez-Bano, J, Navarro, MD, Romero, L, et al. Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients. J Clin Microbiol 2004;42:10891094.
25. Briongos-Figuero, LS, Gomez-Traveso, T, Bachiller-Luque, P, et al. Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract 2012;66:891896.
26. Centers for Disease Control and Infection (CDC). CDC/NHSN surveillance definitions for specific types of infections. CDC website. http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Published January 2016. Accessed September 8, 2016.
27. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. Wayne, PA: CLSI; 2010:M100-S20.
28. McGettigan, SE, Hu, B, Andreacchio, K, Nachamkin, I, Edelstein, PH. Prevalence of CTX-M beta-lactamases in Philadelphia, Pennsylvania. J Clin Microbiol 2009;47:29702974.
29. Pérez-Pérez, FJ, Hanson, ND. Detection of plasmid-mediated AmpC beta-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol 2002;40:21532162.
30. McGettigan, SE, Andreacchio, K, Edelstein, PH. Specificity of ertapenem susceptibility screening for detection of Klebsiella pneumoniae carbapenemases. J Clin Microbiol 2009;47:785786.
31. Lautenbach, E, Fishman, NO, Metlay, JP, et al. Phenotypic and genotypic characterization of fecal Escherichia coli isolates with decreased susceptibility to fluoroquinolones: results from a large hospital-based surveillance initiative. J Infect Dis 2006;194:7985.
32. Sabbuba, NA, Mahenthiralingam, E, Stickler, DJ. Molecular epidemiology of Proteus mirabilis infections of the catheterized urinary tract. J Clin Microbiol 2003;41:49614965.
33. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
34. Mickey, RM, Greenland, S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125137.
35. Hu, KK, Boyko, EJ, Scholes, D, et al. Risk factors for urinary tract infections in postmenopausal women. Arch Intern Med 2004;164:989993.
36. Muller, LM, Gorter, KJ, Hak, E, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 2005;41:281288.
37. Woodford, N, Ward, ME, Kaufmann, ME, et al. Community and hospital spread of Escherichia coli producing CTX-M extended-spectrum beta-lactamases in the UK. J Antimicrob Chemother 2004;54:735743.
38. Munday, CJ, Whitehead, GM, Todd, NJ, Campbell, M, Hawkey, PM. Predominance and genetic diversity of community- and hospital-acquired CTX-M extended-spectrum beta-lactamases in York, UK. J Antimicrob Chemother 2004;54:628633.
39. Ho, PL, Poon, WW, Loke, SL, et al. Community emergence of CTX-M type extended-spectrum beta-lactamases among urinary Escherichia coli from women. J Antimicrob Chemother 2007;60:140144.
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