Extended-spectrum beta-lactamase Escherichia coli and Klebsiella pneumoniae urinary tract infections (original) (raw)
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Extended - spectrum beta - lactamase E. coli and K. pneumoniae urinary tract infections
2020
Background: The prevalences of extended-spectrum beta-lactamase (ESBL) Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) urinary tract infections (UTI) in children are increasing worldwide. We aimed to investigate the prevalence, clinical findings, impact and risk factors of ESBL E. coli / K. pneumoniae UTI. Methods: The medical records of children with UTI aged <15 years admitted to Prince of Songkla University Hospital were reviewed. Results: Theirty-seven boys and 46 girls had ESBL in 102 UTI episodes; 85 boys and 103 girls had non-ESBL in all of their 222 UTI episodes. The median age at presentation was 1.5 (0.7-4.8) years for the ESBL group and 1.3 (0.6-3.9) for the non-ESBL group (p=0.2). Age and gender were not significantly different between the two groups. The prevalence of ESBL rose between 2004 and 2008 before plateauing at around 30-40% per year. The prevalences in first and recurrent UTI were 27.3% and 46.5%, respectively (p=0.003). Fever prior to UTI diagnosis was found in 78.4% of episodes in the non-ESBL group and 61.8% of episodes in the ESBL group (p=0.003). Multivariate analysis, children without fever (OR=2.14, 95% CI: 1.23-3.74) and those with recurrent UTI (OR=2.67, 95% CI: 1.37-5.19) were more likely to have ESBL UTI. The presence of CAKUT had no effect on ESBL UTI. Conclusions: ESBL was found in one-third of E. coli/K. pneumoniae UTI episodes. No clinical condition nor imaging study could predict ESBL. Recurrent UTI was the only independent risk factor.
BIRDEM Medical Journal, 2017
Background: Urinary tract infection (UTI) due to extended-spectrum beta-lactamase (ESBL) producing organisms are increasing. This study was designed to evaluate the frequency of ESBL-positive Escherichia coli and Klebsiella pneumoniae causing UTI, their antibiotic sensitivity pattern and possible risk factors. Methods: This case-control study was done in BIRDEM General Hospital, Dhaka, Bangladesh from January to March 2016. Patients with UTI due to ESBL-positive E. coli and K. pneumoniae were cases and non-ESBL organisms were controls. Results: Total 98 patients with UTI due to E. coli (84) and K. pneumoniae (14) were eligible for analysis. Twothirds of E. coli (56/84, 66.7%) and two-fifths of K. pneumoniae (6/14, 42.9%) were ESBL-positive (cases, 62) and rest 36 patients were controls (UTI due to non-ESBL E. coli or K. pneumoniae). There was no significant difference in relation to age (p=0.757), sex (p=0.548), presence (p=0.696), duration (p=0.050) or control of diabetes (p=0.448) between cases and controls. Regarding risk factors responsible for UTI due to ESBLpositive organisms, long duration (≥5 years) of diabetes was significant (OR=6.87, 95% CI=2.34-20.16, p=0.0004). On multivariate logistic regression, presence (p=0.002) and long duration of diabetes (p=0.002), past history of UTI (p=0.004) and history of hospitalization due to UTI (p=0.005) appeared as significant risk factors for UTI due to ESBL-positive E. coli or K. pneumoniae. Imipenem, amikacin, gentamycin and nitrofurantoin were among the most sensitive antibiotics. Conclusion: Almost two-thirds of the UTI cases were due to ESBL-positive organisms in this study. Imipenem, aminoglycosides and nitrofurantoin were among the most sensitive antibiotics. Long duration of diabetes, past history of UTI and hospitalization due to UTI were significant risk factors for ESBL-positivity.
BMC Research Notes, 2013
Background: Escherichia coli and Klebsiella pneumoniae are the major bacterial pathogens being isolated and reported from mid stream urine (MSU) specimens, globally. These uropathogens are mostly implicated as the major extended spectrum beta-lactamase (ESBL) producers, severely limiting the therapeutic management in cases of urinary tract infections. Limited studies had been reported from Nepal investigating the ESBL producers among uropathogens. This study was designed to assess the prevalence of ESBL producing E.coli and K. pneumoniae in urinary isolates at a centrally located major tertiary care hospital in Kathmandu valley, Nepal. Methods: Between September 2011 and May 2012, during the nine months period, 6308 MSU specimens were collected aseptically from the same number of clinically suspected patients of urinary tract infections. The samples were cultured on MacConkey agar and blood agar. The isolates with significant bacteriuria (10 5 CFU / ml) were identified based on standard laboratory procedures. Antimicrobial susceptibility tests were carried out using various antimicrobial discs alongwith ceftriaxone on E.coli and K. pneumoniae isolates by Kirby Bauer disc diffusion method as per the recommendations of CLSI. On initial screening with ceftriaxone (30 μg) disc showing resistance was then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) using ceftazidime (30 ug) and ceftazidime + clavulanic acid (30 μg + 10ug) disc as per guidelines of CLSI (2011). Results: Out of a total of 6308 MSU specimens investigated for significant bacteriuria, E.coli isolates were 444 (7.04%) and K.pneuminiae were 145 (2.3%) making a total of 589 (9.34%). Initial screening with ceftriaxone disc revealed 155 isolates of E.coli and 70 isolates of K.pneumoniae to be resistant. Further testing by PCDDT method showed 60/444 (=13.51%) of E. coli and 24/145 (=16.55%) of K. pneumoniae isolates to be confirmed ESBL producers. These ESBLproducer uropathogens showed high degree of resistance to ceftriaxone (100.0%), amoxycillin, fluoroquinolones and co-trimoxazole. Conclusion: An emerging and moderately high prevalence of ESBL-producing E. coli and K. pneumoniae was observed and confirmed in the urinary isolates investigated. It is essential to have a regular and routine monitoring of ESBL producing clinical isolates in laboratory practice.
2016
BACKGROUND Urinary tract infection (UTI) is mainly due to invasion of the urethra, bladder or kidneys by pathogens. The emergence of extended spectrum β-lactamases (ESBL) is responsible for frequently observed empirical therapy failures. OBJECTIVES To study the clinical and laboratory characteristics of UTIs caused by ESBL producing Escherichia coli (E. coli) and Klebsiella pneumonia (K. pneumonia). METHODS A cross-sectional clinical and laboratory study was performed at King Khalid Hospital, Hafr Al Batin, Saudi Arabia between March 2014 to October 2015. A total of 908 urine samples from suspected UTI patients was collected. Samples were isolated on Cysteine Electrolyte-Deficient (CLED) agar. Positive cultures were identified and tested for antimicrobial susceptibility by MicroScan(®) WalkAway-96 SI System, and then ESBL was confirmed by double disc synergy test (DDST) and phenotypic confirmatory disc diffusion test (PCDDT). RESULTS A total of 680 samples (288 males and 392 females...
Flora, 2021
Introduction: Extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae infections in the pediatric age group are mostly nosocomial infections. This study aimed to investigate the clinical pattern of extended-spectrum β-lactamase positive urinary tract infection and its seasonal distribution. Materials and Methods: We retrospectively reviewed the medical records of pediatric patients with extended-spectrum β-lactamases-positive UTI, who were followed-up in our clinic between June 2015 and June 2020. Results: One hundred-and-ten patients with ESBL-positive UTI and 231 with non-ESBL UTI were enrolled in this study. The rate of male sex in the ESBL group was significantly lower than that in the non-ESBL group (10.9% vs 27.2%, p= 0.001). The patients with ESBL were older than those in the non-ESBL group (81.3 ± 49.0 months vs 56.0 ± 47.2 months, p= 0.001). E. coli was the most isolated bacteria in both groups (68% and 70.5%, respectively). The rate of Klebsiella ...
Bali Medical Journal, 2021
Introduction: Extended-spectrum β-lactamase (ESBL) is a mutated β-lactamase enzyme that can hydrolyze beta-lactam antibiotics. The aim of this study was to determine the incidence rate, characteristics of patients, antibiotic use and outcome of urinary tract infections (UTIs) due to ESBL-producing Escherichia coli and Klebsiella pneumoniae at Dr Zainoel Abidin General Hospital Aceh. Method: The samples of this study were all Escherichia coli and Klebsiella pneumoniae isolated from urine culture of UTI cases. Patient characteristics and antibiotic use data were extracted from medical records. UTIs outcome was assessed as clinical improvement or death within a maximum of 30 days of treatment. Result: The results of this study obtained 63 patients with UTIs caused by E. coli and K. pneumonia of which 52.4% of them were ESBL producers. The incidence of UTIs due to E. coli was higher than that of K. pneumoniae, 63.5% and 36.5% respectively. E. coli ESBL producers were more in number than non-ESBL, conversely K. pneumoniae were mostly non-ESBL. The characteristics of patients with UTIs caused by E. coli and K. pneumoniae were predominant women 52.4%, and most cases were at 56-64 years old. Antibiotic therapy that given before and after culture results to UTI patients were generally ceftriaxone. UTIs outcome due to ESBL producing Escherichia coli and Klebsiella pneumoniae showed that 26/33 (78.8%) patients experienced improvement, however, 7/33 (21.2%) patients died. Conclusion: The irrational use of ceftriaxone in patients with UTI caused by ESBL producing E. coli and K. pneumoniae has led to a poor outcome for the patient.
2020
Background: Resistance of Gram-negative bacteria to antibiotics had increased at an alarming pace over the last two decades. Empirical antibiotic treatment of UTI practice created opportunity for frequent use of antibiotics that resulted in emergence of resistant strains. Extended spectrum beta-lactamase producing Enterobacteriaceae are emerging worldwide and are usually multi-drug resistant; thus, limiting treatment options for these organisms. Hence, it is mandatory to scrutinize the extent of the problem in the study area. Objective: We investigated the prevalence and correlates of extended spectrum beta-lactamase producing Enterobacteriaceae and their antibacterial resistance pro le among children with urinary tract infection (UTI) at Hawassa University Comprehensive Specialized Hospital. Method: A hospital-based cross sectional study was conducted from February 1-July 30/ 2018. A semi-structured questionnaire was used to collect data from 284 children suspected of UTI. Bacterial species were isolated using standard bacteriological techniques. Antibiotic susceptibility testing was done using Kirby-Bauer disk diffusion method and ESBL production was detected by double disc synergy test. Data entry, cleaning and statistical analysis was done using SPSS version 20. Results: Overall, Enterobacteriaceae accounted for 75% (72/96) of UTI infections. The most frequent Enterobacteriaceae were E. coli , 44.4% (32/72) and K. pneumoniae , 27.8% (20/72). Overall, ESBL-producers within Enterobacteriaceae accounted for 41.7% (30/72) and magnitude of multi-drug resistance level was 86.1% (62/72). ESBL producing K. pneumoniae and E. coli accounted for 70% (14/20) and 37.5% (12/32), respectively of all the respective isolates. Previous UTI within the past 12 month (AOR= 0.08, 95% CI (0.01-0.57) and medium family wealth index (AOR = 0.03, 95% CI (0.00-0.27) were associated with infection of ESBL-producing Enterobacteriaceae. Conclusion: ESBL producing Enterobacteriaceae were prevalent among UTI cases; where E. coli and K. pneumoniae were the major isolated resistant strains that contributed mainly to the problem. Majority of Enterobacteriaceae isolated were resistant to commonly prescribed drugs.
Investigative and Clinical Urology, 2019
The aim of this study was to determine the prevalence and risk factors for community-acquired urinary tract infections (CA-UTIs) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella species. Materials and Methods: The patients diagnosed with CA-UTIs caused by E. coli or Klebsiella spp. were included in the study. All of the patients were compared to demographic characteristics, underlying diseases, urinary tract pathology, history of hospitalization, use of antibiotics according to ESBL positivity. Results: A total of 322 urine isolates were studied. Sixty-six patients (37.1%) of a total of 178 patients were ESBL positive E. coli and Klebsiella spp. Being over the age of sixty (odds ratio [OR], 1.90; p=0.03), history of renal stone (OR, 3.00; p=0.03), urinary tract anatomical of physiological disorder (OR, 2.17; p=0.01), urologic intervention (OR, 3.43; p<0.001), history of urinary tract surgery (OR, 3.10; p=0.01), history of urinary catheterization (OR, 3.43; p<0.001), and hospitalization for last 1 year (OR, 3.70; p=0.01) and antibiotic usage in the last 3 months (OR, 1.90; p=0.04) were found as significant risk factors for the producing of ESBL. However, gender and underlying disease were not related for ESBL production. Conclusions: In present study, high rate of ESBL positivity was detected in CA-UTIs. The increasing of infections caused by ESBL positive E. coli and Klebsiella spp. are bringing together a lot of the problem, such as antibiotic resistance and reducing treatment options for outpatients. Identification of underlying risk factors would be important for the development of preventive strategies.
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2017
There has been a sustained and dramatic increase in community-acquired urinary tract infections (CA-UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria over recent years. Despite this, no studies have been performed in low- or middle-income countries. The main objective of this case-control study was to describe ESBL CA-UTI and its risk factors. Outpatients with CA-UTI seen at the Hospital Cayetano Heredia during 2015 were identified. Patients were contacted by telephone. After consent had been obtained, a questionnaire concerning previously identified risk factors was applied. Univariate and multivariate analyses were conducted using Stata version 13. The overall frequency of ESBL-producing Escherichia coli was 40.85%. Sixty-seven cases and 105 controls were included in this study. The following main risk factors were identified on multivariate analysis: previous antibiotic use (odds ratio (OR) 3.09), previous hospitalization (OR 2.92), and previous surgery (O...
Research Square (Research Square), 2023
Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) are common pathogens of UTI in children and their prevalence is increasing worldwide. The aim of this study was to determine risk factors for ESBL-positive UTI and susceptibility to antibiotic treatments. Methods A retrospective cohort study conducted at Rambam Health Care Campus, a tertiary hospital in northern Israel. The study included patients younger than < 18 years old and ESBL positive UTI between January 2017 and December 2019. Patient demographics, previous antibiotic treatment, previous UTI episode, genitourinary tract abnormalities, identi ed organisms in urine cultures, and sensitivity to antibiotics were recorded. The current recommendation of empiric treatment of community acquired UTI may lead to inappropriate treatment. What Is New Known ESBL carriers and recent antibiotic treatment are risk factors for UTI caused by ESBL pathogens. Lack of oral empiric antibiotic treatment and prophylactic treatment for UTI caused by ESBL pathogens. Once-daily amikacin is useful as empiric treatment in anticipation of culture susceptibility and facilitates outpatient treatment. Supplementary Files This is a list of supplementary les associated with this preprint. Click to download. supplementary gure1.tif Supplementary gure2.tif