Clinical characterization of urinary tract infections caused by extended-spectrum betalactamase producing enterobacteria; Caracterización clínica de infecciones de tracto urinario producidas por enterobacterias productoras de betalactamasas de espectro extendido

Abstract

Introduction: Urinary tract infections are among the most prevalent infections in clinical practice. They are a global health problem and may present with or without symptoms. The bacterial agents most commonly isolated are Escherichia coli, Klebsiella spp. and Proteus spp. Objective: Characterize urinary tract infections caused by extended-spectrum betalactamase producing enterobacteria in hospitalized patients from Lima in the period 2016-2018. Methods: A descriptive study was conducted at two health institutions from Lima, Peru, in the period 2016-2018, based on isolation of ESBL pathogens associated to urinary tract infections. Attention was paid to sociodemographic variables, associated conditions, agents isolated, treatment and clinical response. Results: A sample was selected of 117 patients; mean age was 58.18 ± 11.8 years; 65.0% were women and 89.74% came from the urban area of Lima. The most common associated conditions were diabetes (39.3%) and moderate or serious kidney disease (12.8%), with a mean Charlson index of 2.70 ± 1.21. The most common isolated agents were Escherichia coli (92.3%), Klebsiella spp. (6.0%) and Proteus spp. (1.7%). The empirical treatments used were ampicillin/sulbactam (18.9%), ciprofloxacin (49.6%) and nitrofurantoin (16.7%). 49.2% of the patients received targeted treatment, 22.8% ertapenem and 13.9% piperacillin/tazobactam. Conclusions: People with diabetes and kidney disease are vulnerable to urinary tract infections. The causative agent most commonly isolated was ESBL Escherichia coli. The initial treatments indicated after clinical identification of urinary infection were ciprofloxacin and cephalosporins. When microbiological results were obtained, antibiotic therapy was changed to carbapenems and penicillins. Reassessment of the antibiotics used in patients with associated conditions is important for the success of the treatment. © 2021 Elsevier B.V., All rights reserved.