Case-control study of recurrent Extended-Spectrum Beta Lactamase Enterobacteriaceae Urinary Tract Infections (ESBL UTIs): the management challenges

Recurrent UTIs are associated with increased hospitalisation and antibiotic use. We investigated patients with recurrent ESBL versus non-ESBL UTIs to identify risk factors and potential treatments.

A30 month retrospective case-control study was performed in patients with recurrent EBSL versus non-ESBL UTI. Definition :1) > three in a year (>two weeks apart) or 2) > two in six months (>one week apart) with the same profile. 3) ESBL UTIs were Enterobacteriaceae resistant to cefalexin AND ceftazadime/ceftriaxone.

281/1449 “recurrent UTI” patients were ESBLs. Patients were more likely to be older, male, with associated bacteraemia, colonisation with carbapenemase-producing Enterobacteriaceae (CPE) and higher resistance rates to non beta-lactam antibiotics. 75% of renal patients were transplant cases, 81% of urology patients had a tube insertion.

Recurrent ESBL UTIRecurrent non-ESBL UTIp value

Number (%)Number (%)(Chi-squared test)

Patients 281 1168

Organism Klebsiella spp (%)42 (14.9) 10 (0.8) <0.001

E coli (%)199 (70.8)811 (69.4)0.665

Demographics Age (mean, SD)64.1, 19 58.7, 22 <0.001

Male 137 (48.8)328 (28) <0.001

Associations Gram negative bacteraemia 35 (12.4) 37 (3.1) 0.001

Colonisation with CPE 21 (7.5) 31 (2.7) <0.001

Speciality Renal 84 (30.0) 196 (16.8)<0.001

Urology 47 (16.7) 104 (8.9) <0.001

Resistance Trimethoprim 219 (77.9)354 (30.3)<0.001

Ciprofloxacin 214 (76.2)160 (13.7)<0.001

Gentamicin135 (48). 64 (5.5) <0.001

ESBL infection is associated with worse outcomes and significant premorbid conditions. The oral crossover resistance prevented long term prophylaxis.

Options are needed to reduce colonisation burden of resistant organisms such as faecal microbiota transplantation.