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Poor clinical outcomes associated with community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae

Published online by Cambridge University Press:  30 October 2018

Judith A. Anesi*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Charles Garrigan
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jacqueline Omorogbe
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Lois Dankwa
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Mary K. Wheeler
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Pam Tolomeo
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jennifer H. Han
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
for the CDC Prevention Epicenters Program
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Judith A. Anesi, MD, Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 719 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104. Email: judith.anesi@uphs.upenn.edu

Abstract

Objective

Resistance to extended-spectrum cephalosporins (ESC) among Enterobacteriaceae (EB) is increasingly prevalent. We sought to determine the clinical outcomes associated with community-onset ESC-resistant (ESC-R) EB urinary tract infections (UTIs) in a US health system.

Design

Retrospective cohort study.

Patients

All patients presenting to the emergency departments (EDs) or outpatient practices with EB UTIs between 2010 and 2013 were included. Exposed patients had ESC-R EB UTIs. Unexposed patients had ESC-susceptible EB UTIs and were matched to exposed subjects 1:1 on study year. Multivariable logistic regression analyses were performed to evaluate the association between ESC-R EB UTI and the outcomes of clinical failure and inappropriate initial antibiotic therapy (IIAT).

Results

A total of 302 patients with community-onset EB UTI were included, with 151 exposed and unexposed. On multivariable analyses, UTI due to an ESC-R EB was significantly associated with clinical failure (odds ratio [OR], 7.07; 95% confidence interval [CI], 3.16–15.82; P<.01). Other independent risk factors for clinical failure included infection with Citrobacter spp and need for hemodialysis. UTI due to an ESC-R EB was also significantly associated with IIAT (OR, 4.40; 95% CI, 2.64–7.33; P<.01).

Conclusions

Community-onset UTI due to an ESC-R EB organism is significantly associated with clinical failure, which may be due in part to IIAT. Further studies are needed to determine which patients in the community are at high risk for drug-resistant infection to help inform prompt diagnosis and appropriate antibiotic prescribing for ESC-R EB.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Anesi J, et al. (2018). Poor clinical outcomes associated with community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae. Infection Control & Hospital Epidemiology 2018, 39, 1431–1435. doi: 10.1017/ice.2018.254

References

1. Pitout, JD, Hanson, ND, Church, DL, Laupland, KB. Population-based laboratory surveillance for Escherichia coli–producing extended-spectrum beta-lactamases: importance of community isolates with blaCTX-M genes. Clin Infect Dis 2004;38:17361741.Google Scholar
2. Canton, R, Novais, A, Valverde, A, et al. Prevalence and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Europe. Clin Microbiol Infect 2008;14 Suppl 1:144153.Google Scholar
3. Rodriguez-Bano, J, Navarro, MD, Romero, L, et al. Bacteremia due to extended-spectrum beta-lactamase–producing Escherichia coli in the CTX-M era: a new clinical challenge. Clin Infect Dis 2006;43:14071414.Google Scholar
4. Ben-Ami, R, Schwaber, MJ, Navon-Venezia, S, et al. Influx of extended-spectrum beta-lactamase–producing enterobacteriaceae into the hospital. Clin Infect Dis 2006;42:925934.Google Scholar
5. 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.Google Scholar
6. 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.Google Scholar
7. 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.Google Scholar
8. 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.Google Scholar
9. 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.Google Scholar
10. 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.Google Scholar
11. 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.Google Scholar
12. 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.Google Scholar
13. 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.Google Scholar
14. Yang, YS, Ku, CH, Lin, JC, et al. Impact of Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae on the outcome of community-onset bacteremic urinary tract infections. J Microbiol Immunol Infect 2010;43:194199.Google Scholar
15. Melzer, M, Petersen, I. Mortality following bacteraemic infection caused by extended spectrum beta-lactamase (ESBL)–producing E. coli compared to non–ESBL-producing E. coli . J Infect 2007;55:254259.Google Scholar
16. Kang, CI, Song, JH, Chung, DR, et al. Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli . Int J Antimicrob Agents 2010;36:284287.Google Scholar
17. MacVane, SH, Tuttle, LO, Nicolau, DP. Impact of extended-spectrum beta-lactamase-producing organisms on clinical and economic outcomes in patients with urinary tract infection. J Hosp Med 2014;9:232238.Google Scholar
18. Esteve-Palau, E, Solande, G, Sanchez, F, et al. Clinical and economic impact of urinary tract infections caused by ESBL-producing Escherichia coli requiring hospitalization: a matched cohort study. J Infect 2015;71:667674.Google Scholar
19. CDC/NHSN. CDC/NHSN Surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Published 2016. Accessed September 20, 2018.Google Scholar
20. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, M100-S20. CLSI; 2010.Google Scholar
21. Hyle, EP, Lipworth, AD, Zaoutis, TE, Nachamkin, I, Bilker, WB, Lautenbach, E. Impact of inadequate initial antimicrobial therapy on mortality in infections due to extended-spectrum beta-lactamase–producing enterobacteriaceae: variability by site of infection. Arch Intern Med 2005;165:13751380.Google Scholar
22. Tumbarello, M, Sali, M, Trecarichi, EM, et al. Bloodstream infections caused by extended-spectrum-beta-lactamase–producing Escherichia coli: risk factors for inadequate initial antimicrobial therapy. Antimicrob Agents Chemother 2008;52:32443252.Google Scholar
23. Tumbarello, M, Spanu, T, Di Bidino, R, et al. Costs of bloodstream infections caused by Escherichia coli and influence of extended-spectrum-beta-lactamase production and inadequate initial antibiotic therapy. Antimicrob Agents Chemother 2010;54:40854091.Google Scholar
24. Lindberg, F, Westman, L, Normark, S. Regulatory components in Citrobacter freundii ampC beta-lactamase induction. Proc Natl Acad Sci U S A 1985;82:46204624.Google Scholar
25. Minnaganti, VR, Cunha, BA. Infections associated with uremia and dialysis. Infect Dis Clin North Am 2001;15:406.Google Scholar
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