Clinical and Molecular Characterization of Community-Onset Urinary Tract Infections Due to Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae.
OBJECTIVE To evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a US health system. DESIGN Case-control study. PARTICIPANTS All patients presenting to the emergency department or outpatient practices with EB UTIs from December 21, 2010, through April 22, 2013, were included. Case patients had ESC-R EB UTIs. Control patients had ESC-susceptible EB UTIs and were matched 1:1 on study year. METHODS Risk factors for ESC-R EB UTI were assessed using multivariable conditional logistic regression. A subset of case isolates was evaluated for extended-spectrum beta-lactamases. RESULTS A total of 302 patients with community-onset EB UTI were included, of which 151 were cases. On multivariable analysis, risk factors for ESC-R EB UTI included trimethoprim-sulfamethoxazole use in the prior 6 months (odds ratio, 2.40 [95% CI, 1.22-4.70]; P=.01), older age (1.03 [1.01-1.04]; P<.001), diabetes (2.91 [1.32-6.41]; P=.008), and presentation to the emergency department ( 2.42 [1.31-4.46]; P=.005). The prevalence of extended-spectrum beta-lactamases among 120 case isolates was 52% CTX-M, 29% TEM, 20% OXA, and 13% SHV. The prevalence of AmpC was 25%. Pulsed-field gel electrophoresis of the CTX-M Escherichia coli isolates showed no distinct clusters. CONCLUSIONS Use of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the emergency department were associated with community-onset ESC-R EB UTI. There was a high prevalence of CTX-M among our community isolates. Further studies are needed to determine strategies to limit emergence of these organisms in the community. Infect Control Hosp Epidemiol 2016;1433-1439.
1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
Judith A
JA
Anesi
1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
Ebbing
E
Lautenbach
4Department of Pathology and Laboratory Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
Irving
I
Nachamkin
4Department of Pathology and Laboratory Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
Charles
C
Garrigan
2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
Warren B
WB
Bilker
2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
Mary
M
Wheeler
2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
Pam
P
Tolomeo
1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
Jennifer H
JH
Han
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004636:Emergency Service, Hospital; D004755:Enterobacteriaceae / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006092:Gram-Negative Facultatively Anaerobic Rods / Q000302:isolation & purification; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
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