title: [Prevalence and risk factors for extended-spectrum β-lactamase-producing Escherichia coli causing community-onset urinary tract infections in Colombia].
abstract: BACKGROUND
  Urinary tract infections (UTI) are common in the community. However, information of resistant isolates in this context is limited in Latin America. This study aims to determine the prevalence and risk factors associated with community-onset UTI (CO-UTI) caused by extended-spectrum β-lactamase (ESBL)-Producing Escherichia coli in Colombia.
  
  
  METHODS
  A case-control study was conducted between August and December of 2011 in three Colombian tertiary-care institutions. All patients who were admitted to the Emergency Department with a probable diagnosis of CO-UTI were invited to participate. All participating patients were asked for a urine sample. ESBL confirmatory test, antibiotic susceptibility, and molecular epidemiology were performed in these E.coli isolates (Real Time-PCR for bla genes, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] and virulence factors by PCR). Clinical and epidemiological information was recorded, and a statistical analysis was performed.
  
  
  RESULTS
  Of the 2124 recruited patients, 629 had a positive urine culture, 431 of which grew E.coli; 54 were positive for ESBL, of which 29 were CTX-M-15. The majority of ESBL isolates were susceptible to ertapenem, phosphomycin and amikacin. Complicated UTI was strongly associated with ESBL-producing E.coli infections (OR=3.89; 95%CI: 1.10-13.89; P=.03). CTX-M-15-producing E.coli showed 10 different pulsotypes, 65% were PT1 or PT4, and corresponded to ST131. Most of these isolates had 8 out of the 9 analysed virulence factors.
  
  
  CONCLUSIONS
  E.coli harbouring blaCTX-M-15associated with ST131 is still frequent in Colombia. The presence of complicated CO-UTI increases the risk of ESBL-producing E.coli, and must be taken into account in order to provide an adequate empirical therapy.
authors.affiliation: Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM, Cali, Colombia; Fundación Clínica Valle del Lili, Cali, Colombia; Universidad ICESI, Cali, Colombia.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Blanco
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio, Estados Unidos.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Maya
authors.affiliation: Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM, Cali, Colombia.
authors.forename: Adriana
authors.initials: A
authors.lastname: Correa
authors.affiliation: Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM, Cali, Colombia.
authors.forename: Marcela
authors.initials: M
authors.lastname: Perenguez
authors.affiliation: Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM, Cali, Colombia.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Muñoz
authors.affiliation: Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM, Cali, Colombia.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Motoa
authors.affiliation: Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM, Cali, Colombia; Hospital Universitario del Valle Evaristo García «E. S. E.», Cali, Colombia.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Pallares
authors.affiliation: Fundación Clínica Valle del Lili, Cali, Colombia; Universidad ICESI, Cali, Colombia.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rosso
authors.affiliation: Clínica Universitaria Rafael Uribe Uribe, Cali, Colombia.
authors.forename: Lorena
authors.initials: L
authors.lastname: Matta
authors.affiliation: Laboratorio de Salud Pública, Secretaría de Salud de Bogotá, Bogotá, Colombia.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Celis
authors.affiliation: Hospital El Tunal, Bogotá, Colombia.
authors.forename: Martha
authors.initials: M
authors.lastname: Garzon
authors.affiliation: Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM, Cali, Colombia. Electronic address: mariavirginia.villegas@gmail.com.
authors.forename: María V
authors.initials: MV
authors.lastname: Villegas
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003105:Colombia / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003430:Cross-Sectional Studies; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D056689:Uropathogenic Escherichia coli / Q000201:enzymology*; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases
keywords: Betalactamasas; CTX-M-15; Colombia; Escherichia coli; Factores de riesgo; Infecciones del tracto urinario; Prevalence; Prevalencia; Risk factors; Urinary Tract Infections; β-Lactamases