1803. Clinical and Molecular Characterization of Community-Onset Urinary Tract Infections due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae
Session: Poster Abstract Session: Resistant Gram-Negative Infections: Epidemiology
Saturday, October 10, 2015
Room: Poster Hall
  • Community_Onset_ESBL_UTI.pdf (887.4 kB)
  • Background: The increasing prevalence of extended-spectrum β–lactamase-producing Enterobacteriaceae (ESBL-EB) in the community presents a significant therapeutic challenge. The objective of this study was to evaluate epidemiologic risk factors and molecular characteristics of ESBL-EB urinary tract infections (UTIs) in the community.   Methods: A case-control study was conducted within a university health system from 2009 to 2013. All patients presenting to the Emergency Department (ED) or outpatient clinics with UTIs due to Enterobacteriaceae were included. Case patients were those with cultures positive for Enterobacteriaceae demonstrating resistance to an extended-spectrum cephalosporin (minimum inhibitory concentration >1 µg/mL). Control patients were randomly selected from among all subjects with non-ESBL-EB UTIs and matched to cases in a 1:1 ratio based on study year. Multivariable conditional logistic regression analyses were performed to evaluate risk factors for ESBL-EB UTI.   Results: A total of 302 patients with community-onset UTI were included. The most common pathogens were Escherichia coli (76%), Klebsiella spp. (13%), and Enterobacter spp. (9%). On multivariable analyses, presentation to the ED (vs an outpatient practice) significantly increased the risk of ESBL-EB UTI (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.31-4.46; P=0.005). Other factors associated with an ESBL-producing uropathogen were older age (OR, 1.03; 95% CI, 1.01-1.04; P<0.001), diabetes (OR, 2.91; 95% CI, 1.32-6.41; P=0.008), and receipt of trimethoprim-sulfamethoxazole within the previous 6 months (OR, 2.40; 95% CI, 1.22-4.70; P=0.01). The prevalence of specific ESBLs among 120 characterized case isolates were as follows: 52% with CTX-M, 29% with TEM, 20% with OXA, and 13% with SHV. Five (4%) isolates were positive for Klebsiella pneumoniae carbapemenase (KPC).   Conclusion: We found that age, diabetes, and recent use of trimethoprim-sulfamethoxazole conferred an increased risk of community-onset UTI with ESBL-EB. Future studies will need to focus on outcomes associated with infections due to ESBL-EB, as well as infection control strategies to limit the spread of these increasingly common organisms in the community.
    Jennifer Han, MD, MSCE1, Irving Nachamkin, DrPH, MPH, FIDSA2, Charles Garrigan, MB2, Warren Bilker, PhD3, Mary K. Wheeler, MBE3, Pam Tolomeo, MPH3, Ebbing Lautenbach, MD, MPH, MSCE, FIDSA, FSHEA4 and for the CDC Prevention Epicenters Program, (1)Division of Infectious Diseases, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (2)Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (3)Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (4)University of Pennsylvania School of Medicine, Philadelphia, PA


    J. Han, None

    I. Nachamkin, None

    C. Garrigan, None

    W. Bilker, None

    M. K. Wheeler, None

    P. Tolomeo, None

    E. Lautenbach, None

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