Internal Medicine Service, Rio Hortega University Hospital, Valladolid, Spain.
Int J Clin Pract. 2012 Sep;66(9):891-6. doi: 10.1111/j.1742-1241.2012.02991.x.
Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.
Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system.
A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥60years. CI was 2.3±1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p<0.001), diabetes (p=0.032), recurrent UTI (p=0.032) and high comorbidity (p=0.002). In addition, these infections were associated with more symptoms (p<0.001) and longer admission (p=0.004).
Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.
由耐药菌引起的尿路感染（UTI）越来越普遍。我们研究了产超广谱β-内酰胺酶（ESBL）肠杆菌引起的 UTI 的特征和相关危险因素。
对 2009 年和 2010 年成人产 ESBL 肠杆菌尿路感染的尿培养进行回顾性研究。我们纳入了 400 例患者和 103 例对照（非 ESBL 大肠埃希菌引起的 UTI）。临床和人口统计学信息来自病历。使用 Charlson 指数（CI）评估合并症。使用 VITEK 2 系统鉴定菌株。
共获得 400 株分离株（93%为大肠埃希菌，7%为克雷伯菌属）。2009 年，6%的培养物为产 ESBL 大肠埃希菌，2010 年为 7%。37%的患者为男性，81%的患者年龄≥60 岁。CI 为 2.3±1.8（高合并症：42.8%）。41.5%的菌株对阿莫西林-克拉维酸敏感，85.8%对磷霉素敏感，15.5%对环丙沙星敏感。住院期间总共有 97 例 ESBL 大肠埃希菌阳性尿培养，与 103 例对照相比，住院患者中 ESBL 大肠埃希菌引起的 UTI 的危险因素是疗养院居住（p<0.001）、糖尿病（p=0.032）、复发性 UTI（p=0.032）和高合并症（p=0.002）。此外，这些感染与更多症状相关（p<0.001），住院时间更长（p=0.004）。
ESBL 引起的尿路感染是一个严重的问题，确定危险因素有助于早期发现和改善预后。男性、住院、住院、糖尿病、复发性 UTI 和合并症是危险因素，与更多症状和更长的住院时间相关。
