Extended-spectrum beta-lactamase-positive Escherichia coli causing complicated upper urinary tract infection: Urologist should act in time.
OBJECTIVE
Recently, many articles reported increased incidence of urinary tract infection (UTI) due to Extended-Spectrum Beta-Lactamase (ESBL)-producing E. coli. No data are available to date regarding patients presenting with complicated upper ESBL-positive E. coli UTI and sepsis. We report the clinical presentation, management, and outcomes in seven cases.


METHODS
This prospective study was carried out between January 2008 and September 2011. Follow-ups varied in patients according to their disease presentation and clinical outcomes. All strains were cultured and identified by the Clinical Microbiology Laboratory and were recovered from blood and urine cultures. In-vitro presence of ESBL was confirmed with Clinical and Laboratory Standard Institute double disc method.


RESULTS
In the study period, 49 patients needed hospitalization for upper UTI. Overall, in 25 patients (51%), cultures were negative. In the remaining, seven patients (14.3%) presented positive blood and urine-culture for ESBL + E. coli. Of these, four were female and three were male. Their median age was 73 years (range 66-84). The median hospital stay of these patients was 23 days (range 13 to 45 days).


CONCLUSIONS
The current situation of multiple bacterial antibiotic resistance has become a worrisome issue in UTI. Multi-drug-resistant E. coli can be readily encountered in hospital settings during daily clinical practice, and urologist should act timely. The management of such infections is extremely important for the future, with particular reference to prevention of new antibiotic resistance patterns.
Department of Urology, Service Section of Microbiology, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097-San Donato Milanese, Milan, Italy.
Stefano C M
SC
Picozzi
Department of Urology, Service Section of Microbiology, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097-San Donato Milanese, Milan, Italy.
Stefano
S
Casellato
Department of Urology, Service Section of Microbiology, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097-San Donato Milanese, Milan, Italy.
Mattia
M
Rossini
Department of Laboratory Medicine Service - Section of Microbiology, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097-San Donato Milanese, Milan, Italy.
Gaia
G
Paola
Department of Laboratory Medicine Service - Section of Microbiology, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097-San Donato Milanese, Milan, Italy.
Milvana
M
Tejada
Department of Laboratory Medicine Service - Section of Microbiology, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097-San Donato Milanese, Milan, Italy.
Elena
E
Costa
Department of Urology, Service Section of Microbiology, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097-San Donato Milanese, Milan, Italy.
Luca
L
Carmignani
Escherichia coli; Extended-spectrum beta-lactamase positive; hydronephrosis; infection; pyonephrosis; sepsis