TY - JOUR
T1 - Risk factors for extended-spectrum β-lactamase-producing Escherichia coli urinary tract infection in the community in Denmark
T2 - a case–control study
AU - Søgaard, M.
AU - Heide-Jørgensen, U.
AU - Vandenbroucke, J. P.
AU - Schønheyder, H. C.
AU - Vandenbroucke-Grauls, C. M.J.E.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Objective To verify the role of proton pump inhibitors (PPI) and nitrofurantoin, which have appeared as novel risk factors for carriage of extended-spectrum β-lactamase (ESBL) -producing Escherichia coli, as risk factors for ESBL E. coli urinary tract infection (UTI). We included known risk factors to ascertain whether our findings are comparable with those of previous studies. Methods Population-based case–control study including 339 cases with community-onset ESBL E. coli UTI in 2007–2012, 3390 non-ESBL E. coli UTI controls and 3390 population controls. We investigated potential risk factors by estimating ORs and 95% CIs adjusting for sex, age and co-morbidity. Results Comparing cases with non-ESBL E. coli UTI, PPI use yielded an OR of 1.6 (95% CI 1.2–2.0) and antibiotic exposure gave an OR of 1.4 (95% CI 1.1–1.8); these were driven by nitrofurantoin (OR 1.8; 95% CI 1.3–2.6) and macrolides (OR 1.7; 95% CI 1.2–2.3). Other risk factors included previous hospitalization with one or two and more than two hospitalizations versus none yielding ORs of 1.9 (95% CI 1.4–2.5) and 4.6 (95% CI 3.2–6.8), recent surgery (OR 2.0; 95% CI 1.5–2.8), renal disease (OR 2.2; 95% CI 1.4–3.4), chronic pulmonary disease (OR 1.4; 95% CI 1.0–2.0) and cancer (OR 1.5; 95% CI 1.1–2.1). Comparing cases with population controls, we found that most risk factors were also risk factors for non-ESBL UTI. Conclusions ESBL E. coli UTI were associated with previous hospitalization and surgery. Nitrofurantoin and macrolides augmented the risk. PPIs had a moderate effect but may be important facilitators of ESBL carriage due to their widespread use.
AB - Objective To verify the role of proton pump inhibitors (PPI) and nitrofurantoin, which have appeared as novel risk factors for carriage of extended-spectrum β-lactamase (ESBL) -producing Escherichia coli, as risk factors for ESBL E. coli urinary tract infection (UTI). We included known risk factors to ascertain whether our findings are comparable with those of previous studies. Methods Population-based case–control study including 339 cases with community-onset ESBL E. coli UTI in 2007–2012, 3390 non-ESBL E. coli UTI controls and 3390 population controls. We investigated potential risk factors by estimating ORs and 95% CIs adjusting for sex, age and co-morbidity. Results Comparing cases with non-ESBL E. coli UTI, PPI use yielded an OR of 1.6 (95% CI 1.2–2.0) and antibiotic exposure gave an OR of 1.4 (95% CI 1.1–1.8); these were driven by nitrofurantoin (OR 1.8; 95% CI 1.3–2.6) and macrolides (OR 1.7; 95% CI 1.2–2.3). Other risk factors included previous hospitalization with one or two and more than two hospitalizations versus none yielding ORs of 1.9 (95% CI 1.4–2.5) and 4.6 (95% CI 3.2–6.8), recent surgery (OR 2.0; 95% CI 1.5–2.8), renal disease (OR 2.2; 95% CI 1.4–3.4), chronic pulmonary disease (OR 1.4; 95% CI 1.0–2.0) and cancer (OR 1.5; 95% CI 1.1–2.1). Comparing cases with population controls, we found that most risk factors were also risk factors for non-ESBL UTI. Conclusions ESBL E. coli UTI were associated with previous hospitalization and surgery. Nitrofurantoin and macrolides augmented the risk. PPIs had a moderate effect but may be important facilitators of ESBL carriage due to their widespread use.
KW - Community-onset
KW - Extended-spectrum β-lactamase
KW - Hospitalization
KW - Risk factors
KW - Urinary tract infection
UR - http://www.scopus.com/inward/record.url?scp=85020482663&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.cmi.2017.03.026
DO - https://doi.org/10.1016/j.cmi.2017.03.026
M3 - Article
C2 - 28377310
SN - 1198-743X
VL - 23
SP - 952
EP - 960
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 12
ER -