Epidemiology and risk factors of community-onset urinary tract infection caused by extended-spectrum β-lactamase-producing Enterobacteriaceae in a medical center in Taiwan: a prospective cohort study.
BACKGROUND
Extended-spectrum β-lactamase (ESBL)-producing pathogens have been increasingly identified in community-onset urinary tract infection (UTI). This study was conducted to determine the epidemiology and risk factors of community-onset UTI caused by ESBL-producing pathogens, and to determine the correlation of antimicrobial resistance with ESBL detected by phenotypic and genotypic methods.


METHODS
The study was conducted from December 2010 to January 2012. Patients with community-onset UTI caused by Enterobacteriaceae were enrolled from the emergency department. The production of ESBL was determined by the phenotypic method (using the combined disk test) or by the genotypic method (using polymerase chain reaction detection). The patients' medical records were reviewed and risk factors were analyzed by multivariate analysis.


RESULTS
A total of 376 patients were enrolled and 393 isolates from urine culture were analyzed. Escherichia coli was the most commonly isolated species (259/393 isolates; 65.9%), followed by Klebsiella pneumoniae (42/393 isolates; 10.7%). Fifty-three (13.5%) isolates were phenotypically positive for ESBL production. Nine (2.3%) isolates were phenotypically positive for both ESBL and AmpC β-lactamase (AmpC) production. Nasogastric tube placement [odds ratio (OR) 2.230; 95% confidence interval (CI) 1.244-3.997; p = 0.007] and hospitalization within the previous 3 months (OR 2.567, 95% CI 1.448-4.551, p = 0.001) were independently associated with the acquisition of ESBL-producing pathogens in community-onset UTI. The ESBL phenotype had a better correlation with resistance to third-generation cephalosporins, compared to the ESBL-positive genotype.


CONCLUSIONS
In our study, nasogastric tube placement and hospitalization within the previous 3 months were significantly associated with the acquisition of ESBL-producing pathogens in community-onset UTI.
Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan.
Che-Hsuan
CH
Kung
Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan.
Wen-Wei
WW
Ku
Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.
Chi-Hung
CH
Lee
Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chang-Phone
CP
Fung
Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
Shu-Chen
SC
Kuo
Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Te-Li
TL
Chen
Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: s851009@yahoo.com.tw.
Yi-Tzu
YT
Lee
D000046:Academic Medical Centers; D000328:Adult; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology*; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000453:epidemiology*; D004926:Escherichia coli; D005260:Female; D006801:Humans; D007711:Klebsiella pneumoniae; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
D001618:beta-Lactamases
Community-onset; Extended-spectrum β-lactamase; Urinary tract infection