Case-control study of recurrent Extended-Spectrum Beta Lactamase Enterobacteriaceae Urinary Tract Infections (ESBL UTIs): the management challenges
Abstract
Recurrent UTIs are associated with increased hospitalisation and antibiotic use. We investigated patients with recurrent ESBL versus non-ESBL UTIs to identify risk factors and potential treatments. A30 month retrospective case-control study was performed in patients with recurrent EBSL versus non-ESBL UTI. Definition :1) > three in a year (>two weeks apart) or 2) > two in six months (>one week apart) with the same profile. 3) ESBL UTIs were Enterobacteriaceae resistant to cefalexin AND ceftazadime/ceftriaxone. 281/1449 “recurrent UTI” patients were ESBLs. Patients were more likely to be older, male, with associated bacteraemia, colonisation with carbapenemase-producing Enterobacteriaceae (CPE) and higher resistance rates to non beta-lactam antibiotics. 75% of renal patients were transplant cases, 81% of urology patients had a tube insertion. Recurrent ESBL UTIRecurrent non-ESBL UTIp value Number (%)Number (%)(Chi-squared test) Patients 281 1168 Organism Klebsiella spp (%)42 (14.9) 10 (0.8) <0.001 E coli (%)199 (70.8)811 (69.4)0.665 Demographics Age (mean, SD)64.1, 19 58.7, 22 <0.001 Male 137 (48.8)328 (28) <0.001 Associations Gram negative bacteraemia 35 (12.4) 37 (3.1) 0.001 Colonisation with CPE 21 (7.5) 31 (2.7) <0.001 Speciality Renal 84 (30.0) 196 (16.8)<0.001 Urology 47 (16.7) 104 (8.9) <0.001 Resistance Trimethoprim 219 (77.9)354 (30.3)<0.001 Ciprofloxacin 214 (76.2)160 (13.7)<0.001 Gentamicin135 (48). 64 (5.5) <0.001 ESBL infection is associated with worse outcomes…
How strong is the evidence?
Evidence Hub reads this as a case-control. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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