Evaluation of Extended-Spectrum Beta-Lactamase Production and 28-Day Mortality Predictors in Urine Cultures of Hospitalized Elderly Patients
Abstract
Introduction: This study aimed to evaluate the associated factors for extended-spectrum beta-lactamase (ESBL) production in Enterobacterales isolated from urine cultures of hospitalized elderly patients and to identify independent predictors of ESBL positivity and 28-day mortality.
Methods: A retrospective observational study was conducted at Soma State Hospital involving 261 patients aged 65 years and older hospitalized between January 1, 2025 and January 1, 2026. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK 2 automated system in accordance with EUCAST guidelines. Risk factors for ESBL production and mortality were determined using multivariate logistic regression models.
Results: The median age of the cohort was 81 years, and 64.0% (n = 167) of the isolates were ESBL-positive. While Escherichia coli was the most frequently isolated pathogen overall (48.7%), Klebsiella pneumoniae was the most common organism in the ESBL-positive group (53.3%). Multivariate analysis identified urinary catheter use (aOR = 2.044, 95% CI: 1.178-3.548, p = 0.011) and length of stay of ≥7 days (aOR = 1.905, 95% CI: 1.083-3.352, p = 0.025) as independent risk factors for ESBL positivity. Independent predictors of 28-day mortality included age (aOR = 1.082, p < 0.001), urinary catheter use (aOR = 1.941, p = 0.023), and higher C-reactive protein (CRP) levels (aOR = 1.035, p = 0.036). Notably, ESBL positivity was not significantly associated with…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 261 participants or records.
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