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Poor clinical outcomes associated with 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), Jacqueline Omorogbe (a2), Lois Dankwa (a2), Mary K. Wheeler (a2), Pam Tolomeo (a2), Jennifer H. Han (a1) (a2) (a3) and for the CDC Prevention Epicenters Program (a1) (a2) (a3) (a4)...



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.


Retrospective cohort study.


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).


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).


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.


Corresponding author

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:


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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



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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
19. CDC/NHSN. CDC/NHSN Surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. Published 2016. Accessed September 20, 2018.
20. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, M100-S20. CLSI; 2010.
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.
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.
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.
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.
25. Minnaganti, VR, Cunha, BA. Infections associated with uremia and dialysis. Infect Dis Clin North Am 2001;15:406.
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