Larramendy Stéphanie, Deglaire Valentine, Dusollier Paul, Fournier Jean-Pascal, Caillon Jocelyne, Beaudeau François, Moret Leïla
Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France.
IRS 2 Laboratoire de Thérapeutique Expérimentale et Clinique des Infections, EA3826, University of Nantes, Nantes 44400, France.
Infect Drug Resist. 2020 Nov 3;13:3945-3955. doi: 10.2147/IDR.S269033. eCollection 2020.
The prevalence of extended-spectrum beta-lactamase-producing (ESBL-EC) has been increasing worldwide since the early 2000s. is found in 70-90% of community-acquired urinary tract infections (CA-UTIs). We performed a systematic literature review to determine the risk factors for CA-UTI caused by ESBL-EC.
We searched the MEDLINE, Cochrane Library, Embase and Web of Science databases without language or date restriction up to March 2019. Two independent reviewers selected studies with quantified risk factors for CA-UTI due to ESBL-EC, and assessed their quality using the Newcastle-Ottawa Scale.
Among the 5,597 studies identified, 16 observational studies (n=12,138 patients) met the eligibility criteria. The included studies were performed in various countries, and 14/16 were published after 2012. The most relevant risk factors for CA-UTI due to ESBL-EC identified were prior use of antibiotics (odds ratio (OR) from 2.2 to 21.4), previous hospitalization (OR: 1.7 to 3.9), and UTI history (OR: 1.3 to 3.8). Two risk factors were related to environmental contamination: travelling abroad, and swimming in freshwater.
Our findings could allow adapting empiric antibiotic treatments according to the patient profile. Further studies are needed to quantify the relationships between CA-UTI due to ESBL-EC and the environment.
自21世纪初以来，产超广谱β-内酰胺酶的大肠埃希菌（ESBL-EC）在全球的流行率一直在上升。在70%-90%的社区获得性尿路感染（CA-UTI）中可发现该菌。我们进行了一项系统的文献综述，以确定由ESBL-EC引起的CA-UTI的危险因素。
我们检索了MEDLINE、Cochrane图书馆、Embase和科学网数据库，检索时间截至2019年3月，无语言或日期限制。两名独立的评审员选择了具有ESBL-EC所致CA-UTI量化危险因素的研究，并使用纽卡斯尔-渥太华量表评估其质量。
在检索到的5597项研究中，16项观察性研究（n=12138例患者）符合纳入标准。纳入的研究在不同国家进行，16项中有14项于2012年后发表。确定的与ESBL-EC所致CA-UTI最相关的危险因素是既往使用抗生素（比值比（OR）为2.2至21.4）、既往住院（OR：1.7至3.9）和UTI病史（OR：1.3至3.8）。有两个危险因素与环境污染有关：出国旅行和在淡水中游泳。
我们的研究结果有助于根据患者情况调整经验性抗生素治疗。需要进一步研究来量化ESBL-EC所致CA-UTI与环境之间的关系。
