Michael Osthoff1, Sarah L McGuinness2, Aaron Z Wagen2, Damon P Eisen3. 1. Victorian Infectious Diseases Service at the Peter Doherty Institute for Infection and Immunology, Royal Melbourne Hospital, Victoria, Australia; Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. 2. Victorian Infectious Diseases Service at the Peter Doherty Institute for Infection and Immunology, Royal Melbourne Hospital, Victoria, Australia. 3. Victorian Infectious Diseases Service at the Peter Doherty Institute for Infection and Immunology, Royal Melbourne Hospital, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia. Electronic address: damon.eisen@mh.org.au.
Abstract
OBJECTIVES: Extended-spectrum beta-lactamase-expressing Gram-negative bacilli (ESBL-GNB) now commonly cause community-acquired infections, including urinary tract infections (UTI), and represent a challenge for practitioners in choosing empirical antibiotics. The aim of this study was to describe the epidemiology and clinical characteristics of UTIs/bacteriuria due to ESBL-GNB in Australia. METHODS: At a single-site tertiary referral hospital, 100 cases with UTIs/bacteriuria due to ESBL-GNB were matched to 100 cases where UTIs/bacteriuria were caused by organisms matching the ESBL bacterial species that had routine susceptibility to antibiotics. Potential risk factors for ESBL-GNB UTI/bacteriuria and differences in clinical outcomes were identified. RESULTS: Length of admission prior to positive sample (odds ratio (OR) 1.3, p = 0.03, per week), exposure to antibiotics (OR 5.7, p < 0.001), return from overseas travel (OR 6.5, p = 0.002), and nursing home residency (OR 4.2, p = 0.03) were identified as risk factors associated with ESBL-GNB UTI/bacteriuria in the multivariate analysis. In addition, ESBL-GNB-infected cases subsequently had a longer inpatient stay (median 6 vs. 2 days, p = 0.002) and were admitted to the intensive care unit more frequently (28/100 vs. 8/100, p < 0.001). CONCLUSIONS: Our results emphasize the need for culture of a mid-stream urine specimen prior to commencing antibacterials, especially in patients with the risk factors identified herein associated with ESBL-GNB UTI/bacteriuria.
OBJECTIVES: Extended-spectrum beta-lactamase-expressing Gram-negative bacilli (ESBL-GNB) now commonly cause community-acquired infections, including urinary tract infections (UTI), and represent a challenge for practitioners in choosing empirical antibiotics. The aim of this study was to describe the epidemiology and clinical characteristics of UTIs/bacteriuria due to ESBL-GNB in Australia. METHODS: At a single-site tertiary referral hospital, 100 cases with UTIs/bacteriuria due to ESBL-GNB were matched to 100 cases where UTIs/bacteriuria were caused by organisms matching the ESBL bacterial species that had routine susceptibility to antibiotics. Potential risk factors for ESBL-GNB UTI/bacteriuria and differences in clinical outcomes were identified. RESULTS: Length of admission prior to positive sample (odds ratio (OR) 1.3, p = 0.03, per week), exposure to antibiotics (OR 5.7, p < 0.001), return from overseas travel (OR 6.5, p = 0.002), and nursing home residency (OR 4.2, p = 0.03) were identified as risk factors associated with ESBL-GNB UTI/bacteriuria in the multivariate analysis. In addition, ESBL-GNB-infected cases subsequently had a longer inpatient stay (median 6 vs. 2 days, p = 0.002) and were admitted to the intensive care unit more frequently (28/100 vs. 8/100, p < 0.001). CONCLUSIONS: Our results emphasize the need for culture of a mid-stream urine specimen prior to commencing antibacterials, especially in patients with the risk factors identified herein associated with ESBL-GNB UTI/bacteriuria.
Authors: Vimalanand S Prabhu; Joseph S Solomkin; Goran Medic; Jason Foo; Rebekah H Borse; Teresa Kauf; Benjamin Miller; Shuvayu S Sen; Anirban Basu Journal: Antimicrob Resist Infect Control Date: 2017-10-27 Impact factor: 4.887
Authors: Anna Letícia Miranda; Ana Lúcia Lyrio de Oliveira; Daiana Terra Nacer; Cynthia Adalgisa Mesojedovas Aguiar Journal: Rev Lat Am Enfermagem Date: 2016-09-09