Comparison of community‐onset healthcare‐associated and hospital‐acquired urinary infections caused by extended‐spectrum beta‐lactamase‐producing Escherichia coli and antimicrobial activities. Issue 7 (16th February 2015)

• Record Type: Journal Article
• Authors: Saltoglu, N.; Karali, R.; Yemisen, M.; Ozaras, R.; Balkan, I. I.; Mete, B.; Tabak, F.; Mert, A.; Hondur, N.; Ozturk, R.
• Is Part Of: International journal of clinical practice. Volume 69:Issue 7(2015)
• Page Start: 766
• Page End: 770
• Publication Date: 2015-02-16
• Subjects: Clinical medicine -- Periodicals; Medicine -- Periodicals; 610.5
• DOI: 10.1111/ijcp.12608
• Languages: English
• ISSNs: 1368-5031

Abstract

<abstract abstract-type="main" id="ijcp12608-abs-0001"> <title>Summary</title> <sec id="ijcp12608-sec-0001" sec-type="section"> <title>Objective</title> <p>We aimed to compare community‐onset healthcare‐associated (CO‐HCA) and hospital‐acquired (HA) urinary tract infections (UTIs) caused by extended‐spectrum beta‐lactamase (ESBL)‐producing <italic>Escherichia coli</italic> in terms of epidemiology, clinical outcomes and antimicrobial activities.</p> </sec> <sec id="ijcp12608-sec-0002" sec-type="section"> <title>Methods</title> <p>Patients from both groups with ESBL‐producing <italic>E. coli</italic> detected by urine culture between January 2009 and January 2011 were included in this retrospective study. Relevant demographical, microbiologic and clinical data were obtained from case records.</p> </sec> <sec id="ijcp12608-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 173 patients (mean age of 58 years, 74% female) were included, of whom 75 (43.4%) had a CO‐HCA UTI and 98 (56.6%) had an HA UTI. Eighty (46.2%) patients had more than one comorbid disease, of whom 57 (32.5%) had urological problems. The most common clinical manifestations were pyelonephritis (43.9%) and urosepsis (16.2%). An age of > 65 years (p = 0.005) in addition to urinary catheterisation (p = 0.001), urosepsis (p = 0.001) and mortality (p = 0.001) were significantly more common in the HA UTI group. Acute cystitis (p = 0.027), complicated cystitis (p = 0.001) and non‐urologic neoplasm (p = 0.032) were significantly more common in the CO‐HCA UTI group. No isolate was resistant to carbapenems or fosfomycin. Sensitivities to nitrofurantoin, amikacin, trimethoprim sulfamethoxazole‐trimoxazole and quinolones were 97.6%, 89%, 29.4% and 17.9% respectively. Both groups showed similar rates of antibiotic resistance.</p> </sec> <sec id="ijcp12608-sec-0004" sec-type="section"> <title>Conclusion</title> <p>ESBL‐producing <italic>E. coli</italic> should be taken into consideration in patients with a CO HCA UTI, not only in hospital settings but also in outpatient settings. We suggest ertapenem as a first‐line empirical treatment for patients with an upper UTI and fosfomycin and nitrofurantoin for those with a lower UTI when ESBL‐producing <italic>E. coli</italic> is suspected.</p> </sec> </abstract>