title: Risk factors for extended-spectrum β-lactamases-producing Escherichia coli urinary tract infections in a tertiary hospital.
abstract: OBJECTIVE
  To assess the risks factors for urinary tract infections (UTIs) caused by Extended-Spectrum Beta-Lactamases (ESBLs)-producing E. coli and the molecular characterization of ESBLs.
  
  
  METHODS
  A case-control study was performed to identify risk factors in consecutively recruited patients with UTIs caused by ESBLs or non-ESBLs-producing E. coli in a tertiary hospital in Mexico.
  
  
  RESULTS
  ESBLs-producing E. coli were isolated from 22/70 (31%) patients with E. coli UTIs over a three month period. All isolates were resistant to cephalosporins and quinolones but susceptible to carbapenems, amikacin and nitrofurantoin. Prior antibiotic treatment with more than two antibiotic families (OR=6.86; 95%CI 1.06-157.70; p=0.028), recurrent symptomatic UTIs (OR=5.60; 95%CI 1.88-17.87; p=0.001) and previous hospitalization (OR=5.06; 95%CI 1.64-17.69; p=0.002) were significant risk factors. Sixteen isolates harbored the beta-lactamase (bla)CTX-M-15 gene and five the blaTEM-1 gene.
  
  
  CONCLUSIONS
  One of every three patients presented UTIs with ESBLs-producing beta-lactams and fluoroquinolone resistant E. coli. Risk factors and resistance patterns must be taken into account for developing antibiotic use policies in these settings.
authors.affiliation: Facultad de Medicina, Universidad Nacional Autónoma de México, México, Distrito Federal, México.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Alcántar-Curiel
authors.affiliation: Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Celia Mercedes
authors.initials: CM
authors.lastname: Alpuche-Aranda
authors.affiliation: Hospital General Naval de Alta Especialidad, Secretaría de Marina Armada de México, México, Distrito Federal, México.
authors.forename: Héctor Javier
authors.initials: HJ
authors.lastname: Varona-Bobadilla
authors.affiliation: Facultad de Medicina, Universidad Nacional Autónoma de México, México, Distrito Federal, México.
authors.forename: Catalina
authors.initials: C
authors.lastname: Gayosso-Vázquez
authors.affiliation: Facultad de Medicina, Universidad Nacional Autónoma de México, México, Distrito Federal, México.
authors.forename: Ma Dolores
authors.initials: MD
authors.lastname: Jarillo-Quijada
authors.affiliation: Universidad Estatal de Sonora, Hermosillo, Sonora, México.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Frías-Mendivil
authors.affiliation: Hospital General Naval de Alta Especialidad, Secretaría de Marina Armada de México, México, Distrito Federal, México.
authors.forename: Lucio
authors.initials: L
authors.lastname: Sanjuan-Padrón
authors.affiliation: Facultad de Medicina, Universidad Nacional Autónoma de México, México, Distrito Federal, México.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Santos-Preciado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization; D004926:Escherichia coli / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases; C034413:beta-lactamase TEM-1