Infection Control & Hospital Epidemiology
Results Study population
In total, 2,009 unique subjects grew an EB species on a urine culture from an outpatient visit, ED visit, or within 72 hours of hospital admission during the study period. After applying exclusion criteria, 887 subjects were eligible. Of these 887 potential subjects, 574 (65%) consented to participate in the study. Of these, 151 had an ESC-R EB on urine culture that was consistent with true UTI (rather than colonization) and were thus the final “exposed” group. Finally, 151 patients with community-onset UTI due to an ESC-susceptible EB were then matchedtothe exposedpatientsand comprisedthe final “unexposed” group. Among the entire study cohort of 302 patients, the median
age was 56 years (interquartile range [IQR], 37–68), and 62 (21%) were men. The most common pathogens isolated were Escherichia coli (76%), Klebsiella spp (13%), and Enterobacter spp (9%). Baseline characteristics of the cohort that were
1433
candidates for the multivariable models are shown in Table 1; additional baseline characteristics are described in Supplemental Table 1.
Association of ESC-R EB UTI with clinical failure
Within the entire cohort, 86 patients (29%) experienced clinical failure. In the unadjusted analysis, ESC-R EB UTI was associated with an increased odds of clinical failure (odds ratio [OR], 4.82; 95% confidence interval [CI], 2.52–9.22; P<.01). In the final multivariable model (Table 2), ESC-R EB UTI remained a sig- nificant independent risk factor for clinical failure (adjusted OR [aOR], 7.07; 95% CI, 3.16–15.82; P<.01). Other independent risk factors for clinical failure included infection with a Citrobacter spp and need for hemodialysis. Odds of clinical failure was decreased with baseline respiratory disease. With the modified clinical failure outcome, we again found a
borderline significant association between ESC-R EB UTI and clinical failure on multivariable analysis (aOR, 2.65; 95% CI,
Table 1. Baseline Characteristics of the Study Cohort Stratified by Exposure Status Variablea
Demographics Age, y, median (IQR) Culture taken in ED
Culture taken within 72 h of inpatient admission
Comorbidities/Exposures Surgery in prior 6 mo
Baseline respiratory diseasec Diabetes mellitus
Need for hemodialysis Prior renal transplantation
Antibiotic exposures prior to index UTId Any antibiotic
Extended-spectrum cephalosporin TMP-SMX
Severity of infection Pyelonephritis at diagnosis BSI at diagnosis
Causative organism Escherichia coli Klebsiella spp Citrobacter spp
ESC-S EB (Unexposed)b (N=151), No. (%)
49 (27–64) 29 (19) 3 (2)
21 (14) 17 (11) 14 (9) 1 (1) 6 (4)
84 (56) 4 (3)
19 (13)
18 (12) 3 (2)
116 (77) 18 (12) 3 (2)
ESC-R EB (Exposed) (N=151), No. (%)
60 (46–70) 54 (36) 8 (5)
36 (24) 29 (19) 31 (21) 5 (3)
13 (8)
94 (62) 19 (13) 36 (24)
44 (29) 6 (4)
112 (74) 20 (13) 1 (1)
P Value
<.01 <.01 .23
.04 .06 .01 .22 .11
.24
<.01 .02
<.01 .51
.59 .72 .63
Note. EB, Enterobacteriaceae; BSI, bloodstream infection; CI, confidence interval; ESC-R, extended-spectrum cephalosporin-resistant; ESC-S, extended-spectrum cephalosporin-susceptible;
ED, emergency department; IQR, interquartile range; OR, odds ratio; TMP-SMX, trimethoprim-sulfamethoxazole; UTI, urinary tract infection; COPD, chronic obstructive pulmonary disease. aOnly those variables that were candidates for the final multivariable models of clinical failure and IIAT are shown here. See Supplemental Table 1 for the complete list of variables
considered. bData are presented as numbers (percentages) except where noted. cCOPD or chronic bronchitis. dReceipt in the 6 months prior to EB UTI presentation (not mutually exclusive).
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124
