Goyal Dheeraj, Dean Nathan, Neill Sarah, Jones Peter, Dascomb Kristin
Division of Infectious Diseases, University of Utah Health, Salt Lake City, Utah.
Division of Pulmonary and Critical Care Medicine, Intermountain Healthcare, Murray, Utah.
Open Forum Infect Dis. 2019 Jan 3;6(2):ofy357. doi: 10.1093/ofid/ofy357. eCollection 2019 Feb.
Community-acquired extended-spectrum beta-lactamase-producing (ESBL) infections are an evolving public health problem. Identifying predictive risk factors may improve patient management.
We identified 251 adult inpatients admitted to a 22-hospital system with an ESBL urinary tract infection (UTI) between 2001 and 2016. Cases were matched 1:1 with controls who had a UTI at admission with non-ESBL . Cases with a history of ESBL infections or hospitalization within 3 months of index admission were excluded. Univariate and multiple logistic regression were used to identify risk factors associated with ESBL UTIs.
In univariate analysis, history of repeated UTIs, neurogenic bladder, urinary catheter presence at admission, and exposure to outpatient third-generation cephalosporins or fluoroquinolones within 3 months were associated with higher risk of ESBL UTIs. When controlling for severity of illness and comorbid conditions, history of repeated UTIs (adjusted odds ratio [aOR], 6.40; 95% confidence interval [CI], 3.42-12.66; < .001), presence of urinary catheter at admission (aOR, 2.36; 95% CI, 1.15-4.98; < .05), and prior antibiotic exposure (aOR, 7.98; 95% CI, 2.92-28.19; < .001) remained associated with risk of ESBL infection.
Patients in the community with indwelling urinary catheters, history of recurrent UTIs, or recent antimicrobial use are at higher risk for de novo ESBL UTIs.
社区获得性产超广谱β-内酰胺酶（ESBL）感染是一个不断演变的公共卫生问题。识别预测性风险因素可能改善患者管理。
我们确定了2001年至2016年间在一个拥有22家医院的系统中因ESBL尿路感染（UTI）入院的251名成年住院患者。病例与入院时患有非ESBL UTI的对照按1:1匹配。排除在索引入院前3个月内有ESBL感染或住院史的病例。采用单因素和多因素逻辑回归来识别与ESBL UTI相关的风险因素。
在单因素分析中，反复UTI病史、神经源性膀胱、入院时存在导尿管以及在3个月内接触门诊第三代头孢菌素或氟喹诺酮类药物与ESBL UTI的较高风险相关。在控制疾病严重程度和合并症后，反复UTI病史（调整优势比[aOR]，6.40；95%置信区间[CI]，3.42 - 12.66；P <.001）、入院时存在导尿管（aOR，2.36；95% CI，1.15 - 4.98；P <.05）和既往抗生素暴露（aOR，7.98；95% CI，2.92 - 28.19；P <.001）仍与ESBL感染风险相关。
社区中留置导尿管、有复发性UTI病史或近期使用抗菌药物的患者发生新发ESBL UTI的风险较高。
