A Clinical Prediction Tool for Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Urinary Tract Infection

Abstract

Background To explore the risk factors of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) infection through urine samples of hospitalized patients and establish a predictive model to improve treatment outcomes.MethodsThis retrospective study included all patients with an Enterobacteriaceae-positive urine sample at the first affiliated hospital of Jinan university from January 2018 to December 2019. Antimicrobial susceptibility patterns of ESBL-PE were analyzed, and multivariate analysis of related factors was performed. From these, a nomogram was established to predict the possibility of ESBL-PE infection. Simultaneously, susceptibility testing of a broad array of carbapenem antibiotics was performed on ESBL-PE cultures to explore possible alternative treatment options.ResultsOf the total 874 patients with urinary tract infections (UTIs), 272 (31.1%) were ESBL-PE positive. In the predictive analysis, five variables were identified as independent risk factors for ESBL-PE infection: male gender (OR=1.607, 95% CI 1.066-2.416), older age (OR=4.100, 95% CI 1.678-12.343), a hospital stay in preceding 3 months (OR=1.872, 95% CI 1.141-3.067), invasive urological procedure (OR=1.810, 95% CI 1.197-2.729), and antibiotic use within the previous 3 months (OR 0.546, 95% CI 0.314-0.948). In multivariate analysis, the data set was divided into a training set of 611 patients and a validation set of 263 patients The model developed to predict ESBL-PE infection was effective, with the AuROC of 0.650 (95% CI 0.577-0.725). Among the antibiotics tested, several showed very high effectiveness against ESBL-PE: amikacin (85.7%), carbapenems (83.8%), tigecycline (97.1%) and polymyxin (98.2%). ConclusionsThe nomogram is useful for estimating a bacteremic patient’s likelihood of infection with ESBL-PE. It could improve clinical decision making and enable more efficient empirical treatment. Empirical treatment may be informed by the results of the antibiotic susceptibility testing.

Evaluation of the antibacterial activity of Weissella confusa K3 cell-free supernatant against extended-spectrum βeta lactamase (ESBL) producing uropathogenic Escherichia coli U60

“…Consistently, Pandit et al (2020) reported that E. coli is essential, and the majorities (64.9 %) of them are MDR, and among them (40.3 %) are ESBL-producing bacteria. Furthermore, it was reported that among cases with UTI, 30 % are ESBL ( Liu et al, 2022 ). CLS I (2012) noted that ESBL was examined in three categories, ESBL screening method, phenotypic confirmation using a double-disc synergy test, and genotypic detection.…”