Introduction: Our aim was to describe the incidence and risk factors associated with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and their resistance rate in a urological ward. Material and Methods: We carried out a prospective observational study from November 2011 to December 2014, reviewing healthcare-associated infections (HAIs) in our department. We evaluated the infections caused by ESBL-producing Enterobacteriaceae. Results: The incidence of HAIs in our urology ward was 6.8%. Enterobacteriaceae including Escherichia coli (24.9%), Klebsiella spp. (12.1%), Enterobacter spp. (5.9%), Morganella spp. (1.5%), Proteus spp. (1.5%), and Citrobacter spp. (1.5%) represented 47.4% of the isolated pathogens. The percentage of ESBL-producing Enterobacteriaceae was 26.4. Risk factors associated with a higher incidence of ESBL-producing bacteria were prior urinary tract infection (UTI; p < 0.001), hypertension (p = 0.042), immunosuppression (p = 0.004), and urinary stone (p = 0.027). The multivariable analysis confirmed prior UTI, immunosuppression and urinary stone as risk factors. ESBL-producing strains showed resistance rates of 85.3% for fluoroquinolones and 11.8% for carbapenems. Moreover, 16.7% of ESBL-Klebsiella were resistant to carbapenems. Conclusions: ESBL-producing enterobacteria are associated with higher cross resistance to antibiotics such as quinolones. Higher resistance rates are reported in ESBL-producing Klebsiella. Among patients admitted in a urology ward, risk factors for ESBL-producing strains were previous UTI, immunosuppression, and urinary stone.

Keywords:
Genitourinary tract infection, Infection, Prevalence, Risk factor, Extended-spectrum beta-lactamases, Healthcare-associated infection
1.
Pitout JD: Enterobacteriaceae that produce extended-spectrum β-lactamases and AmpC β-lactamases in the community: the tip of the iceberg? Curr Pharm Des 2013;19:257-263.
2.
Horan TC, Andrus M, Dudeck MA: CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-332.
3.
Wagenlehner FM, Naber KG: Treatment of bacterial urinary tract infections: presence and future. Eur Urol 2006;49:235-244.
4.
Park SY, Kang CI, Joo EJ, Ha YE, Wi YM, Chung DR, Peck KR, Lee NY, Song JH: Risk factors for multidrug resistance in nosocomial bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Microb Drug Resist 2012;18:518-524.
5.
Peña C, Gudiol C, Calatayud L, Tubau F, Domínguez MA, Pujol M, Ariza J, Gudiol F: Infections due to Escherichia coli producing extended-spectrum beta-lactamase among hospitalised patients: factors influencing mortality. J Hosp Infect 2008;68:116-122.
6.
Falagas ME, Karageorgopoulos DE: Extended-spectrum beta-lactamase-producing organisms. J Hosp Infect 2009;73:345-354.
7.
Briongos-Figuero LS, Gómez-Traveso T, Bachiller-Luque P, Domínguez-Gil González M, Gómez-Nieto A, Palacios-Martín T, González-Sagrado M, Dueñas-Laita A, Pérez-Castrillón JL: Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract 2012;66:891-896.
8.
Rodríguez-Avial C, Rodríguez-Avial I, Hernández E, Picazo JJ: [Increasing prevalence of fosfomycin resistance in extended-spectrum-beta-lactamase-producing Escherichia coli urinary isolates (2005-2009-2011)]. Rev Esp Quimioter 2013;26:43-46.
9.
Bonkat G, Müller G, Braissant O, Frei R, Tschudin-Suter S, Rieken M, Wyler S, Gasser TC, Bachmann A, Widmer AF: Increasing prevalence of ciprofloxacin resistance in extended-spectrum-β-lactamase-producing Escherichia coli urinary isolates. World J Urol 2013;31:1427-1432.
10.
Azap OK, Arslan H, Serefhanoğlu K, Colakoğlu S, Erdoğan H, Timurkaynak F, Senger SS: Risk factors for extended-spectrum beta-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections. Clin Microbiol Infect 2010;16:147-151.
11.
Rubio-Perez I, Martin-Perez E, Garcia DD, Calvo ML, Barrera EL: Extended-spectrum beta-lactamase-producing bacteria in a tertiary care hospital in Madrid: epidemiology, risk factors and antimicrobial susceptibility patterns. Emerg Health Threats J 2012;5:11589.
12.
Cullen IM, Manecksha RP, McCullagh E, Ahmad S, O'kelly F, Flynn RJ, McDermott T, Murphy P, Grainger R, Fennell JP, Thornhill JA: The changing pattern of antimicrobial resistance within 42,033 Escherichia coli isolates from nosocomial, community and urology patient-specific urinary tract infections, Dublin, 1999-2009. BJU Int 2012;109:1198-1206.
13.
García-Tello A, Gimbernat H, Redondo C, Arana DM, Cacho J, Angulo JC: Extended-spectrum beta-lactamases in urinary tract infections caused by Enterobacteria: understanding and guidelines for action. Actas Urol Esp 2014;38:678-684.
14.
Tsui K, Wong SS, Lin LC, Tsai CR, Chen LC, Huang CH: Laboratory identification, risk factors, and clinical outcomes of patients with bacteremia due to Escherichia coli and Klebsiella pneumoniae producing extended-spectrum and AmpC type β-lactamases. J Microbiol Immunol Infect 2012;45:193-199.
15.
Kuster SP, Hasse B, Huebner V, Bansal V, Zbinden R, Ruef C, Ledergerber B, Weber R: Risks factors for infections with extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae at a tertiary care university hospital in Switzerland. Infection 2010;38:33-40.
16.
Ena J, Arjona F, Martínez-Peinado C, López-Perezagua Mdel M, Amador C: Epidemiology of urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Urology 2006;68:1169-1174.
17.
Ortega M, Marco F, Soriano A, Almela M, Martínez JA, Muñoz A, Mensa J: Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob Chemother 2009;63:568-574.
18.
Lee SY, Kotapati S, Kuti JL, Nightingale CH, Nicolau DP: Impact of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species on clinical outcomes and hospital costs: a matched cohort study. Infect Control Hosp Epidemiol 2006;27:1226-1232.
19.
Meier S, Weber R, Zbinden R, Ruef C, Hasse B: Extended-spectrum β-lactamase-producing gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy. Infection 2011;39:333-340.
20.
Liu HY, Lin HC, Lin YC, Yu SH, Wu WH, Lee YJ: Antimicrobial susceptibilities of urinary extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae to fosfomycin and nitrofurantoin in a teaching hospital in Taiwan. J Microbiol Immunol Infect 2011;44:364-368.
21.
Tamayo J, Orden B, Cacho J, Cuadros J, Gomez-Garces JL, Alos JI: Activity of ertapenem and other antimicrobials against ESBL-producing enterobacteria isolated from urine in patients from Madrid. Rev Esp Quimioter 2007;20:334-338.
22.
Arslan H, Azap OK, Ergönül O, Timurkaynak F; Urinary Tract Infection Study Group: Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 2005;56:914-918.
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2015
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