Characteristics of Hospitalized Adults With Recurrent Urinary Tract Infection Due to Extended Spectrum Beta-Lactamase Producing Escherichia coli in a Tertiary Center in Saudi Arabia

Badriah H Alanazi; Najla Alrasheed; Jamila A Alonazi; Mohammed Alqahtani; Amjad Alseraya; Rajkumar Rajendram; Majed Alsheikh; Abdullah Bawazir; Fayzah Dugashim; Bayan Albdah

doi:10.7759/cureus.33054

Characteristics of Hospitalized Adults With Recurrent Urinary Tract Infection Due to Extended Spectrum Beta-Lactamase Producing Escherichia coli in a Tertiary Center in Saudi Arabia

Cureus. 2022 Dec 28;14(12):e33054. doi: 10.7759/cureus.33054. eCollection 2022 Dec.

Authors

Affiliations

¹ Department of Medicine, King Abdulaziz Medical City, Riyadh, SAU.
² Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, SAU.
³ College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.
⁴ Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, SAU.
⁵ Section of Biostatistics, Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, SAU.

Abstract

Background: The increase in extended-spectrum β-lactamase (ESBL) producing microbes in recent years represents a major challenge.

Aim: To study the risk factors for urinary tract infections (UTIs) caused by ESBL-producing Escherichia coli in patients requiring hospitalization for treatment.

Materials and method: Electronic health records were used to identify 616 inpatients over the age of 18 who had UTI symptoms and/or signs and an ESBL-producing E. coli strain cultured on urine culture between January 1 and December 31, 2018. The electronic health care records of these patients were searched to identify those patients with previous UTIs due to an ESBL-producing E. coli grown on urine culture. Patients with cancer or those taking prophylactic antibiotics or immunosuppression were excluded.

Result: Risk factors for the acquisition of ESBL-producing E. coli included male sex (P = 0.0032), age over 66 years (P < 0.0001), renal stones (P = 0.0021), urology intervention within six months of presentation (P = 0.0360), pressure sores (P = 0.0002), feeding tubes (P = 0.0076), and urinary catheter (P = 0.0023). Comorbidities (e.g., diabetes mellitus and duration of antibiotic therapy were not associated with an increased risk of recurrence of ESBL-producing E. coli UTI (P = 0.4680, P = 0.3826, respectively).

Conclusion: Antimicrobial stewardship programs may have reduced the development of antimicrobial resistance in E. coli. However, the recognition of risk factors for UTI caused by ESBL-producing E. coli may facilitate the early detection of high-risk cases and guide treatment decisions. This can improve patient outcomes while decreasing the length of the hospital stay.

Keywords: esbl; esbl e.coli; esbl uti; risk factor; uti.