[Emergence of resistance to third generation cephalosporins by Enterobacteriaceae causing community-onset urinary tract infections in hospitals in Colombia].
BACKGROUND
Urinary tract infection (UTI) is a common disease in the community, and a matter of concern due to the increasing resistance of microorganisms to first line antibiotics and the emergence of multiresistant strains producing extended spectrum beta lactamases (ESBL) in the community.


METHODS
An analytical case-control study was conducted over twelve months in 9 hospitals in Colombia. We collected isolates of E. coli, Klebsiella spp. and Proteus spp. from patients with community-onset UTI. The presence of ESBL, AmpC and KPC beta-lactamases were characterized by microbiological and molecular methods. The aim of this study was to determine factors related to the presence of these mechanisms of the resistance to third generation cephalosporins.


RESULTS
A total of 325 isolates (287 E. coli, 29 Klebsiella spp. and 9 Proteus spp.) were included. The most frequent comorbidities among the patients were hypertension (n=82; 25.2%) and diabetes mellitus (n=68; 20.9%). Previous use of antimicrobials was found in 23% of patients, and 29% had a previous UTI. Resistance to third and fourth generation cephalosporins varied between 3.4% and 6.3% in E. coli and between 6.9% and 17.8% in K. pneumoniae. Seven (2.4%) CTX-M-15 ESBL-producing E. coli isolates were detected; four of them belonged to ST 131 clone. In K. pneumoniae we detected three KPC-3 carbapenemases (10.3%).


CONCLUSIONS
This study confirms the emergence of resistance to third generation cephalosporins enterobacteriaceae as a cause of community-onset UTI. We emphasize the presence of ST 131 clone and KPC carbapenemases circulating in Colombia outside the hospital environment.
Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. allealc@unal.edu.co
Aura Lucía
AL
Leal
Jorge Alberto
JA
Cortés
Gerson
G
Arias
María Victoria
MV
Ovalle
Sandra Yamile
SY
Saavedra
Giancarlo
G
Buitrago
Javier Antonio
JA
Escobar
Betsy Esperanza
BE
Castro
D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins; D016022:Case-Control Studies; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology* / Q000627:therapeutic use*; D003105:Colombia; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D004926:Escherichia coli / Q000187:drug effects*; D005260:Female; D006761:Hospitals; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011513:Proteus mirabilis / Q000187:drug effects*; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D001618:beta-Lactamases
D001426:Bacterial Proteins; D002511:Cephalosporins; D001618:beta-Lactamases; C063912:carbapenemase