1593. Prevalence and Risk Factors for Extended Spectrum Beta-Lactamase Producing Organisms among Patients with Complicated Urinary Tract Infections
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Prevalence and RF cUTI poster.pdf (829.3 kB)
  • Background: Clinically correlated data on ESBL isolates in the Philippines are limited and outdated. We aimed to determine the prevalence, risk factors and genotype of ESBL-producing isolates among patients with complicated urinary tract infection (cUTI) and their impact on clinical outcome in a tertiary government hospital.

    Methods: We prospectively included patients with cUTI admitted from 2011-12 and collected data on demographic and clinical outcome.  The urine isolates were screened for ESBL as outlined in the CLSI.  Susceptibility patterns were confirmd using VITEK 2. Multiplex PCR and sequencing were done to determine the prevalent genotype.

    Results: Of 170 patients analyzed, 30% had ESBL-producing isolates. E. coli (43%) and K pneumoniae (43%) were the most common organisms. On univariate analysis, risk factors significantly associated with ESBL development were transfer from another facility (OR 4.6; 95% CI 1.3-16.4), hospitalization within the past 3 months (OR 2.8; 95% 1.3-6.0), antibiotic use in the past 3 months (OR 3.8; 95% CI 1.9-7.6), presence of indwelling catheter (OR 2.9; 95% CI 1.3-6.8), nosocomial UTI (OR 4.6; 95% CI 2.3-9.2) and duration of hospital stay (OR 1.04; 95% CI 1.01-1.06).  On multivariate analysis, history of antibiotic use (OR 2.3; 95% CI 1.0-5.1) and nosocomial UTI (OR 2.7; 95% CI 1.2-6.2) remained significant.  On subgroup analysis of antibiotics used, previous use of third generation cephalosporin was significant (OR 5.0; 95% CI 1.3-19.1). The phenotypes identified were: ESBL + carbapenemase (7.8%), ESBL + cephamycin impermeability (7.8%) and ESBL + high level cephalosporinase AmpC (11.8%).  The most common genes detected were CTX-M (37%) followed by OXA and TEM. No NDM was detected; one had KPC and two with VIM gene. Sensitivity to carbapenem was 100% for ESBL producing E. coli and 99% for K. pneumoniae. No significant difference in mortality among ESBL-negative and ESBL-positive patients was found (9.2% vs 9.8%).

    Conclusion: E. coli remained the most common pathogen in cUTI but with ESBL emergence at 30%.  Modifiable risk factors independently associated with ESBL development were previous exposure to third generation cephalosporin and nosocomial UTI. Multiple resistance mechanisms were seen among the ESBL-producing isolates. Strategies for antibiotic stewardship and infection control are clearly needed.

    Rosally Zamora, MD1, Karen Marie Gregorio, MD1, Raul Destura, MD2,3 and Marissa Alejandria, MD4, (1)University of the Philippines-Philippine General Hospital, Manila, Philippines, (2)National Institutes of Health - University of the Philippines Manila, Manila, Philippines, (3)Medicine, UP - Philippine General Hospital, Manila, Philippines, (4)Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines


    R. Zamora, None

    K. M. Gregorio, None

    R. Destura, None

    M. Alejandria, None

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