Risk factors of urinary tract infection caused by extended spectrum β-lactamase-producing Escherichia coli in emergency department

Lee, Hyeonseok; Han, Seung Baik; Kim, Ji Hye; Kang, Soo Young; Durey, Areum

doi:10.1016/j.ajem.2018.01.046

Cited by 25 publications

(29 citation statements)

References 29 publications

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“…Őstholm-Balkhed et al, 2013 48 Prasad et al, 2016 49 Goodman et al, 2019 36 Hagel et al, 2019 42 Kuenzli et al, 2014 44 Lee et al, 2018 46 1 Subtotal (95% CI) Heterogeneity: τ 2 = 0.04; χ 2 = 8.68, df = 6 (P = .19); I 2 = 31% Test for overall effect: z = 4.74 (P<.001)…”

Section: Discussionmentioning

confidence: 99%

“…We divided the 15 hospital-based studies into 2 groups: 4 studies 9,36,37,43 evaluated colonization at admission (sc reening w ithin 48 hours of admission), and 11 studies 15,[38][39][40][41][42]46,47,50,52,53 I 2 = 33%); 4 community-based studies 10,51,54,57 showed similar results but with a slightly smaller association (OR = 1.41; 95% CI, 1.07-1.87; I 2 = 21%). However, meta-analysis of 4 travelbased studies 8,44,48,56 yielded an OR with a very broad CI (OR = 1.11; 95% CI, 0.82-1.50; I 2 = 0%) (eFigure 4 in the Supplement).…”

Section: By Settingmentioning

confidence: 99%

“…Hagel et al, 2019 42 Kuenzli et al, 2014 44 Lee et al, 2018 46 Rodríguez-Baño et al, 2008 51 Vading et al, 2016 56 Őstholm-Balkhed et al, 2013 48 Subtotal (95% CI) Heterogeneity: τ 2 = 0.00; χ 2 = 4.83, df = 5 (P = .44); I 2 = 0 Test for overall effect: z = 0.91 (P = .36) Total (95% CI) Heterogeneity: τ 2 = 0.03; χ 2 = 20.39, df = 13 (P = .09); I 2 = 36% Test for overall effect: z Ben-Ami et al, 2006 37 Hamprecht et al, 2016 43 Huizinga et al, 2017 9 Latour et al, 2019 45 Reuland et al, 2016 10 Søgaard et al, 2017 54 Wielders et al, 2017 57 Subtotal (95% CI) Heterogeneity: τ 2 = 0.04; χ 2 = 15.42, df = 7 (P = .03); I 2 = 55% Test for overall effect: z Okamoto et al, 2017 15 Prasad et al, 2016 49 Seekatz et al, 2018 52…”

Section: Unadjustedmentioning

confidence: 99%

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Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms

et al. 2020

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IMPORTANCE Acid suppressants inhibit gastric acid secretion and disrupt the intestinal microbiome. Whether acid suppression increases the risk of colonization with multidrug-resistant microorganisms (MDROs) is unclear. OBJECTIVES To systematically examine the association of use of acid suppressants with the risk of colonization with MDROs and to perform a meta-analysis of current evidence. DATA SOURCES PubMed, Embase, the Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials were searched from database inception through July 8, 2019. STUDY SELECTION Study selection was performed independently by 2 authors (R.P.J.W. and C.M.J.E.V.-G.) on the basis of predefined selection criteria; conflicts were resolved by consensus or by an adjudicator (K.v.D.). Human observational studies (case control, cohort, and cross-sectional) and clinical trial designs were selected if they quantified the risk of MDRO colonization in users of acid suppressants in comparison with nonusers. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations were followed. Data were extracted independently by the same 2 authors, and adjudication was conducted when necessary. Risk of bias was assessed according to a modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were estimated using random-effects models; heterogeneity was evaluated using the I 2 method. MAIN OUTCOMES AND MEASURES The primary outcome measure was intestinal colonization with MDROs of the Enterobacterales order (producing extended-spectrum β-lactamases, carbapenemases, or plasmid-mediated AmpC β-lactamases), vancomycin-resistant enterococci, methicillin-resistant or vancomycin-resistant Staphylococcus aureus, or multidrug-resistant Pseudomonas or Acinetobacter species. RESULTS A total of 26 observational studies including 29 382 patients (11 439 [38.9%] acid suppressant users) met the selection criteria. Primary meta-analysis of 12 studies including 22 305 patients that provided adjusted ORs showed that acid suppression increased the odds of intestinal carriage of MDROs of the Enterobacterales order and of vancomycin-resistant enterococci by roughly 75% (OR = 1.74; 95% CI, 1.40-2.16; I 2 = 68%). The odds were concordant with the secondary pooled analysis of all 26 studies (OR = 1.70; 95% CI, 1.44-1.99; I 2 = 54%). Heterogeneity was partially explained by variations in study setting and the type of acid suppression. CONCLUSIONS AND RELEVANCE Acid suppression is associated with increased odds of MDRO colonization. Notwithstanding the limitations of observational studies, the association is plausible and is strengthened by controlling for confounders. In view of the global increase in antimicrobial resistance, stewardship to reduce unnecessary use of acid suppressants may help to prevent MDRO colonization.

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Section: Discussionmentioning

confidence: 99%

Section: By Settingmentioning

confidence: 99%

Section: Unadjustedmentioning

confidence: 99%

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Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms

et al. 2020

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“…found that diabetes and cerebrovascular disease were more frequent than other comorbid conditions in 150 patients with positive urine cultures. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

Which patient should start empirical antibiotic treatment in urinary tract infection in emergency departments?

et al. 2020

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OBJECTIVES: This study aims to determine the factors that would lead the doctors in EDs to a more the accurate diagnosis of urinary tract infection (UTI) and the correct initiation of empirical antibiotherapy in the emergency room and reduce the use of unnecessary antibiotherapy. METHODS: This study is a prospective observational study from a single-center, investigating patients with an age of 18 years and older who presented to the emergency department (ED) with the symptoms of UTI between January and May 2018. The guiding parameters to establish a UTI diagnosis and start an empirical antibiotherapy were investigated between the negative (Group 1) and positive (>10 3 colonies) (Group 2) groups, as a result of urine culture in terms of urine culture. RESULTS: Our study included a total of 108 patients (59 women and 49 men). The average age was 47.11 ± 14.97. Age and gender were similar among the groups and not a discriminating factor in the diagnosis of UTI. High Charlson Comorbidity Index score, history of chronic kidney failure and cerebrovascular disease, leukocyte esterase, nitrite positivity, and leukocyte cluster presence were higher in Group 2. We suggest that these parameters might be predictive values to detect bacterial growth in urine culture. Empirical antibiotherapy was started in 48.4% of the patients in Group 1 and 95.7% of the patients in Group 2. CONCLUSIONS: In EDs, admission complaints of the patients and physical examination findings do not always result in the diagnosis of UTI. Our study showed that UTI diagnosis could be made more accurately using leukocyte esterase, nitrite positivity, the presence of leukocyte clusters, and the Charlson Comorbidity Index score. We also suggest that regional antibiotic resistance should be considered before starting empirical antibiotherapy.

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“…Case patients were classified as hospital-acquired, healthcare-associated, or community-acquired [ 7 ]. Infections were considered to be hospital-acquired if the patients were transferred from another hospital after > 48h hospitalization.…”

Section: Methodsmentioning

confidence: 99%

Clinical Predictors of Pseudomonas aeruginosa Bacteremia in Emergency Department

Choi

Paik

Kim

et al. 2018

Emergency Medicine International

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Objectives Pseudomonas aeruginosa shows higher mortality rate compared to other bacterial infections and is susceptible to a limited number of antimicrobial agents. Considering inadequate empirical treatment of Pseudomonas bacteremia has been associated with increased mortality, it is important for emergency physicians to identify infections by P. aeruginosa. Methods This was a single-center retrospective case-control study to investigate the clinical predictors of patients diagnosed as Pseudomonas bacteremia in the emergency department (ED) from June 2012 to December 2016. Patients with blood culture positive for Escherichia coli in the same period were chosen as the control group, and type of infection was matched for each patient. Results A total of 54 cases with Pseudomonas bacteremia and 108 controls with E. coli bacteremia were included. In the case group, 76% was community-acquired infection, 44% received inappropriate empirical treatment in the ED, and in-hospital mortality was 30%. Multiple logistic regression showed that respiratory tract infection was an independent risk factor for Pseudomonas bacteremia (OR 6.56, 95% CI 1.78-23.06; p = 0.004), whereas underlying diabetes mellitus (OR 0.22, 95% CI 0.07-0.61; p = 0.004) and presentation as urinary tract infection (OR 0.06, 95% CI 0.02-0.18; p < 0.001) were negative clinical predictors. Conclusions We suggest that antipseudomonal antibiotics should be considered beyond simple coverage of Gram-negative bacteria in the ED, especially if the patient is likely to have pneumonia. Having diabetes or presenting with urinary tract infection could be clinical factors unfavorable to use of antipseudomonal antibiotics.

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Risk factors of urinary tract infection caused by extended spectrum β-lactamase-producing Escherichia coli in emergency department

Cited by 25 publications

References 29 publications

Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms

Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms

Which patient should start empirical antibiotic treatment in urinary tract infection in emergency departments?

Clinical Predictors of Pseudomonas aeruginosa Bacteremia in Emergency Department

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