title: Clinical spectrum of urine cultures positive for ESBL-producing Escherichia coli in hospitalized patients and impact on antibiotic use.
abstract: OBJECTIVE
  We wanted to describe the clinical features associated with urinalysis positive for ESBL-producing Escherichia coli and their impact on antibiotic use.
  
  
  METHODS
  We performed a prospective observational study in 13 French hospitals of the Paris area for 3 consecutive months. We included all patients with urine cultures positive for ESBL-producing E. coli.
  
  
  RESULTS
  One hundred and seventeen of the 218 patients (54%) presented with asymptomatic bacteriuria, 31 (14%) with cystitis, and 70 (32%) with a parenchymal infection. Nineteen patients with asymptomatic bacteriuria (16%) received antibiotics. Forty-one with parenchymal infections (59%) received a carbapenem. A carbapenem alternative could have been used in every patient treated with a carbapenem, according to antibiotic susceptibility testing results.
  
  
  CONCLUSIONS
  Urinary tract infections accounted for 46% of E. coli ESBL positive urinalysis. Fifty percent of parenchymal infections were treated with a carbapenem.
authors.affiliation: Unité transversale de traitement des infections, département de virologie, bactériologie-hygiène, parasitologie-mycologie, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France. Electronic address: raphael.lepeule@hmn.aphp.fr.
authors.forename: R
authors.initials: R
authors.lastname: Lepeule
authors.affiliation: Service de microbiologie, hôpital Beaujon, hôpitaux universitaires Paris Nord Val-de-Seine, AP-HP, Clichy, France.
authors.forename: V
authors.initials: V
authors.lastname: Leflon-Guibout
authors.affiliation: Unité de contrôle des infections, institut Curie, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Vanjak
authors.affiliation: Unité de prévention et de lutte contre les infections nosocomiales, CHU d'Angers - Université d'Angers, Angers, France.
authors.forename: J-R
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: Unité d'intervention en infectiologie, hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Lafaurie
authors.affiliation: Service de microbiologie clinique, hôpital Européen Georges-Pompidou, AP-HP, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Besson
authors.affiliation: Service de médecine interne, hôpital Beaujon, hôpitaux universitaires Paris Nord Val-de-Seine, AP-HP, Clichy, France; IAME, UMR1137, université Paris-Diderot, Sorbonne Paris Cité, Paris, France; EA3964, faculté de médecine Xavier-Bichat, université Paris-Diderot, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Lefort
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000378:metabolism; D001437:Bacteriuria / Q000188:drug therapy; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy; D004926:Escherichia coli / Q000201:enzymology / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000652:urine*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010297:Paris; D011446:Prospective Studies; D012307:Risk Factors; D013379:Substrate Specificity; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology; D014556:Urine / Q000382:microbiology*; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases
keywords: Carbapenem; Carbapénème; ESBL-producing Escherichia coli; Escherichia coli BLSE; Infection urinaire; Urinary tract infection