Etiology and prevalence of ESBLs in adult community-onset urinary tract infections in East China: a prospective multicenter study
Abstract
OBJECTIVES
Community onset urinary tract infections (COUTIs) drew attention recently owing to their increased prevalence and associations with resistant pathogens. The study is aimed at investigating the etiology of COUTIs as well as prevalence and the related risk factors of extended-spectrum β-lactamase (ESBL) in COUTIs in China.
METHODS
The prospective study was performed in nineteen hospitals during November 1, 2017 and August 31, 2019. Non-duplicated isolates from COUTIs were included. The ESBL phenotypic confirmation test was performed and whole genomes were sequenced for all the ESBL-positive bacteria for further analysis. The risk factors for ESBL-producing bacteria infections were analyzed using binary logistic regression.
RESULTS
A total of 1760 COUTI cases were included in this study. Escherichia coli (1332, 75.7%), Klebsiella pneumoniae (110, 6.3%) and Enterococcus faecalis (52, 3.0%) were the top three common pathogens of COUTIs in China. The overall positive rate of ESBLs in Enterobacterales was 37.2% (562/1512). The age (OR=1.007, P=0.041), solid malignant tumor (OR=1.668, P=0.016), prostate diseases (OR=2.035, P=0.010), history of lithotripsy for urinary calculi (OR=2.009, P=0.030), history of urological surgery (OR=1.869, P=0.009) and cephalosporin use within 3 months (OR=1.503, P=0.025) were independent risk factors for ESBL-producing organisms causing COUTIs. The predominant ESBL types were CTX-Ms, among which CTX-M-14, CTX-M-55 and CTX-M-27 were the most…
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