title: Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: a case-control study.
abstract: OBJECTIVE
  There has been a sustained and dramatic increase in community-acquired urinary tract infections (CA-UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria over recent years. Despite this, no studies have been performed in low- or middle-income countries. The main objective of this case-control study was to describe ESBL CA-UTI and its risk factors.
  
  
  METHODS
  Outpatients with CA-UTI seen at the Hospital Cayetano Heredia during 2015 were identified. Patients were contacted by telephone. After consent had been obtained, a questionnaire concerning previously identified risk factors was applied. Univariate and multivariate analyses were conducted using Stata version 13.
  
  
  RESULTS
  The overall frequency of ESBL-producing Escherichia coli was 40.85%. Sixty-seven cases and 105 controls were included in this study. The following main risk factors were identified on multivariate analysis: previous antibiotic use (odds ratio (OR) 3.09), previous hospitalization (OR 2.92), and previous surgery (OR 2.75). Chronic corticosteroid use (OR 24.32, 95% confidence interval 2.39-246.92) was also identified as a risk factor.
  
  
  CONCLUSIONS
  ESBL E. coli accounted for more than 40% of CA-UTIs during 2015. A history of previous hospitalization, surgery, and antibiotic use should be considered when treating this type of infection. Action should be taken to confirm these worrisome results and avoid the major consequences for public health.
authors.affiliation: CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima, Peru.
authors.forename: Franco
authors.initials: F
authors.lastname: Castillo-Tokumori
authors.affiliation: CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima, Peru.
authors.forename: Claudia
authors.initials: C
authors.lastname: Irey-Salgado
authors.affiliation: CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima, Peru; Departamento de Medicina, Hospital Cayetano Heredia, San Martín de Porres, Lima, Peru. Electronic address: gmalaga01@gmail.com.
authors.forename: Germán
authors.initials: G
authors.lastname: Málaga
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification* / Q000378:metabolism; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010568:Peru / Q000453:epidemiology; D011634:Public Health; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: Community-acquired infection; ESBL; Escherichia coli; Urinary tract infection