Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Urology Ward: Epidemiology, Risk Factors and Antimicrobial Susceptibility Patterns

Abstract

Introduction: Our aim was to describe the incidence and risk factors associated with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and their resistance rate in a urological ward. Material and Methods: We carried out a prospective observational study from November 2011 to December 2014, reviewing healthcare-associated infections (HAIs) in our department. We evaluated the infections caused by ESBL-producing Enterobacteriaceae. Results: The incidence of HAIs in our urology ward was 6.8%. Enterobacteriaceae including Escherichia coli (24.9%), Klebsiella spp. (12.1%), Enterobacter spp. (5.9%), Morganella spp. (1.5%), Proteus spp. (1.5%), and Citrobacter spp. (1.5%) represented 47.4% of the isolated pathogens. The percentage of ESBL-producing Enterobacteriaceae was 26.4. Risk factors associated with a higher incidence of ESBL-producing bacteria were prior urinary tract infection (UTI; p < 0.001), hypertension (p = 0.042), immunosuppression (p = 0.004), and urinary stone (p = 0.027). The multivariable analysis confirmed prior UTI, immunosuppression and urinary stone as risk factors. ESBL-producing strains showed resistance rates of 85.3% for fluoroquinolones and 11.8% for carbapenems. Moreover, 16.7% of ESBL-Klebsiella were resistant to carbapenems. Conclusions: ESBL-producing enterobacteria are associated with higher cross resistance to antibiotics such as quinolones. Higher resistance rates are reported in ESBL-producing Klebsiella. Among patients admitted in a urology ward, risk factors for ESBL-producing strains were previous UTI, immunosuppression, and urinary stone.

Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a Urology ward

“…Isolating of ESBL-producing bacteria is a key point in prevention of HAIs as frequently cross-resistance is found. Risk factors described for ESBL-producing bacteria are older age, male sex, diabetes mellitus, urinary catheter and prior urinary infections [2930]. Therefore, rationalization of antibiotic usage and select empirical antibiotics adequately is essential to achieve better outcomes.…”

Global epidemiology of urinary tract infections

“…Unfortunately, the exact incidence and prevalence are not well known because of the lack of surveillance and prevalence studies. A recent institutional report from Spain published in 2015 has identified ESBL to be responsible for 26.4% HAUTIs in a urology department [34]. Recommended treatments are acyl-aminopenicillins/ beta-lactamase inhibitor (BLI), novel cephalosporins/beta-lactamase inhibitor for commonly found ESBLs or carbapenems.…”

Resistance and virulence potential of uropathogenic Escherichia coli strains isolated from patients hospitalized in urology departments: a French prospective multicentre study

“…In recent decades, multidrug-resistant UPEC has led to major difficulties treating infected patients. Although many recent studies have investigated UPEC virulence, few data are available on antibiotic resistance and the virulence features of these strains directly isolated from UTIs in patients hospitalized in urology departments (Merle et al, 2002;Wada et al, 2009;Medina-Polo et al, 2015). Thus, we conducted a prospective multicentre study in French urology units to better characterize UPEC in terms of resistance and virulence.…”