Risk factors for extended-spectrum β-lactamase-producing Escherichia coli urinary tract infection in the community in Denmark: a case–control study

摘要

Abstract Objective To verify the role of proton pump inhibitors (PPI) and nitrofurantoin, which have appeared as novel risk factors for carriage of extended-spectrum β-lactamase (ESBL) -producing Escherichia coli , as risk factors for ESBL E.?coli urinary tract infection (UTI). We included known risk factors to ascertain whether our findings are comparable with those of previous studies. Methods Population-based case–control study including 339 cases with community-onset ESBL E.?coli UTI in 2007–2012, 3390 non-ESBL E.?coli UTI controls and 3390 population controls. We investigated potential risk factors by estimating ORs and 95% CIs adjusting for sex, age and co-morbidity. Results Comparing cases with non-ESBL E.?coli UTI, PPI use yielded an OR of 1.6 (95% CI 1.2–2.0) and antibiotic exposure gave an OR of 1.4 (95% CI 1.1–1.8); these were driven by nitrofurantoin (OR 1.8; 95% CI 1.3–2.6) and macrolides (OR 1.7; 95% CI 1.2–2.3). Other risk factors included previous hospitalization with one or two and more than two hospitalizations versus none yielding ORs of 1.9 (95% CI 1.4–2.5) and 4.6 (95% CI 3.2–6.8), recent surgery (OR 2.0; 95% CI 1.5–2.8), renal disease (OR 2.2; 95% CI 1.4–3.4), chronic pulmonary disease (OR 1.4; 95% CI 1.0–2.0) and cancer (OR 1.5; 95% CI 1.1–2.1). Comparing cases with population controls, we found that most risk factors were also risk factors for non-ESBL UTI . Conclusions ESBL E.?coli UTI were associated with previous hospitalization and surgery. Nitrofurantoin and macrolides augmented the risk. PPIs had a moderate effect but may be important facilitators of ESBL carriage due to their widespread use.