AUTHOR=Alkan Sena , Balkan Ilker Inanc , Surme Serkan , Bayramlar Osman Faruk , Kaya Sibel Yildiz , Karaali Ridvan , Mete Bilgul , Aygun Gokhan , Tabak Fehmi , Saltoglu Nese
TITLE=Urinary tract infections in older adults: associated factors for extended-spectrum beta-lactamase production
JOURNAL=Frontiers in Microbiology
VOLUME=15
YEAR=2024
URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2024.1384392
DOI=10.3389/fmicb.2024.1384392
ISSN=1664-302X
ABSTRACT=ObjectiveUrinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae are among the leading causes of morbidity and mortality in older adults. Identifying associated factors for ESBL production may contribute to more appropriate empirical treatment.
Materials and methodsThis was a prospective observational study. Hospitalized patients of age > 65 with community-onset or hospital-acquired upper UTI due to E. coli or Klebsiella pneumoniae were included. A multivariate analysis was performed.
ResultsA total of 97 patients were included. ESBL prevalence among UTIs with E. coli or Klebsiella pneumoniae was 69.1% (n = 67). CRP values at the time of UTI diagnosis were found to be significantly higher in the ESBL-producing group (p = 0.004). The multivariate analysis revealed that male gender (OR: 2.72, CI: 1.02–7.25), prior recurrent UTI (OR: 3.14, CI: 1.21–8.14), and the development of secondary bacteremia (OR: 4.95, CI: 1.03–23.89) were major associated factors for UTI in older adults due to ESBL-producing E. coli and Klebsiella pneumoniae.
ConclusionSevere UTI in older men with a history of recurrent UTI may be a warning to the clinician for ESBL production in the setting of high ESBL prevalence. Carbapenems may be prioritized in the empirical treatment of patients with known risk factors for ESBL.