title: Impact of Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae on the outcome of community-onset bacteremic urinary tract infections.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Ya-Sung
authors.initials: YS
authors.lastname: Yang
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Ku
authors.forename: Jung-Chung
authors.initials: JC
authors.lastname: Lin
authors.forename: Shih-Ta
authors.initials: ST
authors.lastname: Shang
authors.forename: Chun-Hsiang
authors.initials: CH
authors.lastname: Chiu
authors.forename: Kuo-Ming
authors.initials: KM
authors.lastname: Yeh
authors.forename: Chu-Chun
authors.initials: CC
authors.lastname: Lin
authors.forename: Feng-Yee
authors.initials: FY
authors.lastname: Chang
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D003422:Critical Care; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014546:Urinary Catheterization; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases