Volume 22, Number 9—September 2016
CME ACTIVITY - Research
Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase–Producing Escherichia coli Infections in Patients with Pyelonephritis, United States1
David A. Talan
, Sukhjit S. Takhar, Anusha Krishnadasan, Fredrick M. Abrahamian, William R. Mower, Gregory J. Moran, and EMERGEncy ID Net Study Group
, Sukhjit S. Takhar, Anusha Krishnadasan, Fredrick M. Abrahamian, William R. Mower, Gregory J. Moran, and EMERGEncy ID Net Study Group
Table 5
Factors associated with ESBL production among 453 US emergency department patients with pyelonephritis caused by Escherichia coli, July 2013–December 2014*
| Factor | ESBL-producing E. coli rate |
Relative risk (95% CI) | |
|---|---|---|---|
| Factor present, no./total (%) | Factor absent, no./total (%) | ||
| Age >65 y | 4/22 (18.2) | 25/431 (5.8) | 3.1 (0.96–8.1) |
| Complicated infection |
22/181 (12.2) |
7/272 (2.6) |
4.7 (2.0–12.0) |
| Prior antimicrobial drugs | |||
| Within past 60 d | 16/94 (17.0) | 13/359 (3.6) | 4.7 (2.2–10.0) |
| Within past 2 d |
4/27 (14.8) |
25/426 (5.9) |
2.5 (0.8–6.7) |
| IV antimicrobial drugs taken within past 30 d | 4/26 (15.4) | 25/425 (5.9) | 2.6 (0.8–6.9) |
| LTC within past 90 d | 1/3 (33.3) | 28/450 (6.2) | 5.4 (0.3–14.9) |
| Hospital admittance within past 90 d | 5/42 (11.9) | 24/411 (5.8) | 2.0 (0.7–5.2) |
| Travel outside United States within past 90 d |
4/17 (23.5)† |
25/436 (5.7) |
4.1 (1.3–10.1) |
| UTI caused by fluoroquinolone-resistant E. coli | |||
| Within past year | 5/9 (55.6) | 24/444 (5.4) | 10.3 (3.8–17.5) |
| Within past 90 d |
5/8 (62.5) |
24/445 (5.4) |
11.6 (4.4–18.3) |
| UTI caused by ceftriaxone-resistant E. coli | |||
| Within past year | 5/6 (83.3) | 24/447 (5.4) | 15.5 (6.2 −19.2) |
| Within past 90 d |
5/5 (100.0) |
24/448 (5.4) |
18.7 (8.0–18.7) |
| Fluoroquinolone resistance | 24/53 (45.3) | 5/400 (1.3) | 36.2 (14.2–104.7) |
*Denominators differ because factors have a different distribution among the patient population. ESBL, extended spectrum β-lactamase; IV, intravenous; LTC, residence in a long-term care facility; UTI, urinary tract infection.
†Of these 4 patients who traveled to other regions, 3 traveled to Mexico or Central America and 1 traveled to Asia.
1Preliminary results of this research were presented at the 2014 IDWeek Meeting, Philadelphia, PA, USA, October 8–12, 2014.
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