İlknur KALELİ, Türkan TÜZÜN, Selda SAYIN KUTLU, Murat KUTLU

Risk factors for community-onset urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli

Background/aim: Community-onset urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producingEscherichia coli have increased in many parts of the world. This study aimed to determine the prevalence and risk factors for communityonset UTI caused by ESBL-producing E. coli.Materials and methods: This prospective cohort study was conducted between January 2012 and March 2014 in cases of communityonset UTI caused by E. coli. Patients with UTI due to ESBL-producing E. coli and patients with UTI due to non-ESBL-producing E. coliwere compared to identify risk factors for ESBL-producing E. coli in the community.Results: A total of 305 patients (116 males [46.4%]; mean age: 57.76 ± 18.06 years) were included in the study. Among these patients, 154(50.5%) were infected with ESBL-producing E. coli. In multivariate analysis, the healthcare-associated UTI (odds ratio [OR]: 1.80; 95%confidence interval [CI]: 1.02–3.18; P = 0.041), upper urinary tract infection (OR: 3.05; 95% CI: 1.76–5.29; P < 0.0001), use of antibioticsin the preceding 6 months (OR: 2.28; 95% CI: 1.21–4.30; P = 0.011), and having two or more risk factors (OR: 4.03; 95% CI: 1.73–9.35;P = 0.001) were the significant factors associated with increased risk of community-onset UTIs due to ESBL-producing E. coli.Conclusion: The increasing prevalence of ESBL-producing E. coli makes it difficult to decide the empirical therapy in UTIs, especially inpatients with two or more of the risk factors. A better understanding of the epidemiology and risk factors associated with communityonset UTIs due to ESBL-producing E. coli may have significant implications in decision-making for empirical antimicrobial treatment.

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