Impact of Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae on the Outcome of Community-onset Bacteremic Urinary Tract Infections

• Published in: Journal of microbiology, immunology and infection immunology and infection, 2010-06, Vol.43 (3), p.194-199
• Main Authors: Yang, Ya-Sung, Ku, Chih-Hung, Lin, Jung-Chung, Shang, Shih-Ta, Chiu, Chun-Hsiang, Yeh, Kuo-Ming, Lin, Chu-Chun, Chang, Feng-Yee
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; APACHE; bacteremia; beta-Lactamases - metabolism; community; Community-Acquired Infections - drug therapy; Community-Acquired Infections - microbiology; Community-Acquired Infections - mortality; Critical Care; Escherichia coli - drug effects; Escherichia coli - enzymology; Escherichia coli Infections - drug therapy; Escherichia coli Infections - microbiology; Escherichia coli Infections - mortality; extended-spectrum β-lactamase; Female; Humans; Infectious Disease; Klebsiella Infections - drug therapy; Klebsiella Infections - microbiology; Klebsiella Infections - mortality; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - enzymology; Length of Stay; Male; Medical Education; Middle Aged; Risk Factors; Urinary Catheterization; urinary tract infection; Urinary Tract Infections - drug therapy; Urinary Tract Infections - microbiology; Urinary Tract Infections - mortality
• ISSN: 1684-1182; 1995-9133
• DOI: 10.1016/S1684-1182(10)60031-X

Background/Purpose The number of community-onset bacteremic urinary tract infections (UTIs) caused by Escherichia coli and Klebsiella pneumoniae is increasing. However, the impact of extended-spectrum β-lactamase (ESBL)-producing E. coli and K. pneumoniae (ESBL-EK) on bacteremic UTI outcomes is unknown. The aim of this study was to retrospectively analyze the impact of ESBL-EK on community-onset bacteremic UTIs. Methods Of the 58 patients enrolled, 12 suffered from ESBL-EK-caused community-onset bacteremic UTIs. Patients were categorized into ESBL ( n =12) and non-ESBL ( n =46) groups. Diagnosis was based on findings of concurrent bacteremia and bacteriuria caused by the same pathogen on admission. Results The ESBL group had significantly more male patients (66.7% vs. 23.9%; p =0.005), indwelling urinary catheters (41.7% vs. 6.5%; p =0.002), patients admitted from other healthcare facilities (50.0% vs. 8.7%; p =0.001), and patients with higher Acute Physiology and Chronic Health Evaluation II scores (23.3±7.1 vs . 15.9±6.3; p =0.001) and intensive care unit admissions (41.7% vs. 4.4%; p =0.003) than the non-ESBL group. Multiple logistic regression analysis revealed that male gender (odds ratio=9.2; 95%, confidence interval=1.7–50.6) and healthcare facility residency (odds ratio=15.5; 95% confidence interval=2.4–98.9) were independent risk factors for ESBL-producer infections among bacteremic UTIs. Although the mortality rate of both groups was similar (8.3% vs. 4.4%; p =0.403), the ESBL group had longer hospital stays (16.3±9.3 days vs. 7.9±5.2 days; p =0.010) and higher antibiotic costs (615.1±423.5 USD vs. 252.8±269.2 USD, p =0.014). Conclusion Male gender and healthcare facility residency are risk factors for ESBL-producer infections among patients with community-onset bacteremic UTIs. Patients with bacteremic UTIs caused by ESBL-EK also have prolonged hospital stays and higher antibiotic costs. Early detection of ESBLs and appropriate antibiotic coverage are likely to shorten hospital stays and reduce medical costs.