Temporal trends and risk factors for extended-spectrum beta-lactamase-producing Escherichia coli in adults with catheter-associated urinary tract infections

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli cause up to 10% of catheter-associated urinary tract infections (CAUTI). We report changes in ESBL prevalence among CAUTIs in an adult acute care hospital from 2006-2012 and describe factors associated ESBL-production among E. coli CAUTI. FINDINGS: Data on patients ≥18 years discharged from a 647-bed tertiary/quaternary care hospital (2006-2012), a 221-bed community hospital (2007-2012), and a 914-bed tertiary/quaternary care hospital (2008) were obtained retrospectively from an electronic database (N = 415,430 discharges). Infections were identified using a previously validated electronic algorithm. Information on medical conditions and treatments were collected from electronic health records and discharge billing codes. A case-control design was used to determine factors associated with having a CAUTI caused by an ESBL-producing E. coli versus a non-ESBL-producing E. coli. Changes in yearly proportion of ESBL E. coli CAUTI at the 647-bed tertiary/quaternary care hospital were evaluated. ESBL increased from 4% in 2006 to 14% in 2012, peaking at 18% in 2009. Prior antibiotic treatment and urinary tract disease significantly increased odds of ESBL. CONCLUSIONS: This study provides evidence that treatment with beta-lactam and non-beta-lactam antibiotics is a risk factor for acquiring ESBL-producing E. coli CAUTI, and the prevalence of this organism may be increasing in acute care hospitals.