Bayesian Approach to Urinary ESBL-Producing Escherichia coli

Abstract

This is a retrospective study about the prevalence of ESBL-producing Escherichia coli (EEC) in urinary specimens from patients from the Comunitat Valenciana from January 2007 to December 2008. Data were retrieved from RedMIVA, and Bayesian generalized linear mixed models were considered to study the prevalence of EEC with regard to demographical and microbiological factors.The total number of infections considered was 164,502, the amount of urinary isolates was 70,827 belonging to 49,304 different patients, and 5,161 (7.3%) of the urinary isolates were EEC. Three out of four E. coli were isolated in women (76.8%), men showed higher rates of EEC (9.7% in men vs. 6.5% in women). EEC patients were, in average, 10.8 years older, and hospitalization was more frequent (9.9% vs. 6.9%).Resistance to non-β-lactams antimicrobials was higher in EEC. The rates of ciprofloxacin and co-trimoxazol resistance in EEC were 75.5% and 52.0%, respectively, whereas it ranged between 1.4-12.4% for the rest of antimicrobials.Prior EEC infection and hospitalization were the most relevant risk factors and increased the expected EEC probability approximately 400% and 50% respectively. Other infections played an important and positive role too, Enterobacteriaceae, P. aeruginosa and other bacteria being the most relevant elements. Female gender was a protective factor and reduced the risk by approximately 25% while age was an additive risk factor.Finally, an open-access web-based software was constructed to compute the probability that an E. coli in a urinary infection be an EEC from a specific combination of risk factors. This pharmacovigilance tool should prove useful to monitor and control antimicrobial resistance spread.

Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance

“…Hence, unadjusted empirical antibiotic therapy could fail to adequately cover UTIs in these patient groups or delay the establishment of an appropriate antibiotic therapy, resulting in increased morbidity and mortality. However, in contrast to evidence provided by other works and systematic reviews, recent antibiotic therapy or hospital admission were not associated with a significant increase in antibiotic resistance in the regression model 17 , 18 . Dependence, comorbidity, obesity, female sex and bacteraemia, on the contrary, were proven to be related to the length of the hospital stay.…”

“…Similar to other Spanish cohorts, the all-cause mortality rate in our cohort was 11% 24 , whilst Eliakim et al reported a mortality rate of almost 9% in their multicentre retrospective cohort study 13 . However, the mortality rate widely differs among series, ranges between 3 and up to 33% in some works and may depend on the characteristics of the included patients 13 – 18 , 25 – 27 . In our cohort, the fragile state of the older population manifested as severe dependence was significantly associated to longer hospital stay as previously reported 28 .…”

Multidrug resistant Enterobacteriaceae and extended spectrum β-lactamase producing Escherichia coli: a cross-sectional study in National Kidney Center, Nepal

“…E. coli , that can produce ESBLs, has arisen and disseminated worldwide as an important cause of both nosocomial and community infections and nowadays represents a major threat. Early identification of potential ESBL carriers is the first step to withhold the dispersal of these microorganisms and to avoid possible complications [ 8 ]. Since, ESBL production is usually plasmid mediated, it is possible for one specimen to contain both ESBL producing and non ESBL producing cells of the same species.…”