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Abstract

Vol.66 No.6 November 2018

Risk factors for urinary tract infection caused by extended-spectrum β -lactamase-producing Escherichia coli in inpatients

Maiko Hashimoto1), Riho Sesumi1,2), Akira Mimura1,3), Eriko Kasuga4), Go Matsumoto4), Takayuki Honda4), Tomoyuki Hamamoto2), Satoshi Yamaori1) and Shigeru Ohmori1)

1)Department of Pharmacy, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Japan
2)Center for Education & Research on Clinical Pharmacy, Showa Pharmaceutical University
3)Center for Clinical Research, Shinshu University Hospital
4)Department of Laboratory Medicine, Shinshu University Hospital

Abstract

Since the prevalence of extended-spectrum β -lactamase (ESBL)-producing bacteria has recently grown worldwide, antibiotic agents for the treatment of urinary tract infection increasingly need to be selected considering infection by ESBL-producing bacteria. Although risk factors for isolation of ESBL-producing Escherichia coli have been extensively investigated, there are only a limited number of case-control studies focused on inpatients requiring for antibiotic treatment. In this study, we examined risk factors for urinary tract infection caused by ESBL-producing E. coli in hospitalized patients. Clinical data from 299 inpatients with urinary tract infection (bacteriuria of ≥ 105 CFU/mL) at Shinshu University Hospital were collected retrospectively. Among the patients examined, 37 cases were positive for ESBL-producing E. coli. A multivariate logistic regression analysis indicated three independent risk factors: male gender (odds ratio 2.579, p=0.029), antibiotic use in the past 3 months (odds ratio 7.245, p=0.010) and antifungal use in the past 3 months (odds ratio 5.296, p=0.012). Furthermore, the multivariate analyses of antibiotic and antifungal classes associated with the isolation of ESBL-producing E. coli were conducted. As a result, the use of cephem antibiotics (odds ratio 2.902, p=0.011), sulfamethoxazole-trimethoprim (odds ratio 6.807, p=0.002) and triazole antifungals (odds ratio 4.826, p=0.029) in the past 3 months was identified as risk factors. These results would prompt us to treat inpatients having these risk factors with precise antibiotic agent (s) considering possible infection by ESBL-producing E. coli.

Key word

extended-spectrum β-lactamase, Escherichia coli, urinary tract infection, risk factor

Received

February 1, 2018

Accepted

July 5, 2018

Jpn. J. Chemother. 66 (6): 749-757, 2018