Factors Associated with Acute Community-Acquired Pyelonephritis Caused by Extended-Spectrum ß-Lactamase-Producing Escherichia coli.

This study aimed to identify the factors associated with the presence of extended-spectrum ß-lactamase-(ESBL) in patients with acute community-acquired pyelonephritis (APN) caused by Escherechia coli (E. coli), with a view of optimising empirical antibiotic therapy in this context. We performed a retrospective analysis of patients with community-acquired APN and confirmed E. coli infection, collecting data related to demographic characteristics, comorbidities, and treatment. The associations of these factors with the presence of ESBL were quantified by fitting multivariate logistic models. Goodness-of-fit and predictive performance were measured using the ROC curve. We included 367 patients of which 51 presented with ESBL, of whom 90.1% had uncomplicated APN, 56.1% were women aged ≤55 years, 33.5% had at least one mild comorbidity, and 12% had recently taken antibiotics. The prevalence of ESBL-producing E. coli was 13%. In the multivariate analysis, the factors independently associated with ESBL were male sex (OR 2.296; 95% CI 1.043-5.055), smoking (OR 4.846, 95% CI 2.376-9.882), hypertension (OR 3.342, 95% CI 1.423-7.852), urinary incontinence (OR 2.291, 95% CI 0.689-7.618) and recurrent urinary tract infections (OR 4.673, 95% CI 2.271-9.614). The area under the ROC curve was 0.802 (IC 95% 0.7307-0.8736), meaning our model can correctly classify an individual with ESBL-producing E. coli infection in 80.2% of cases.

[Risk factors for the development and persistence of asymptomatic bacteriuria in patients with type 2 diabetes]. / Factores relacionados con el desarrollo y la persistencia de la bacteriuria asintomática en los pacientes con diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: To study the risk factors for the development and persistence of asymptomatic bacteriuria (AB) in type 2 diabetes mellitus (DM) patients from our health zone. PATIENTS AND METHOD: Observational and laboratory prospective cohort study. INCLUSION CRITERIA: women and men with type 2 DM from the 2 health centers of Petrer (Alicante). DATA: questionnaire including particular and epidemiological data. Laboratory values: biochemistry, glycosylated hemoglobin A1C, microalbuminuria, urinary sediment and urine culture. RESULTS: A total of 457 patients with type 2 DM were included; 63.2% women and 36.8% men. The prevalence of AB at baseline was 19.9% (25.6% in women vs 10.1% in men). 78.02% had persistence of AB after the twelve months of follow-up; 21.7% developed symptomatic urinary tract infection (UTI) and 35.2% were treated with antimicrobial agents for any reason different from UTI during the follow-up period. The persistence of AB at the end of the study was 15.5%. Female sex (p = 0.04), leukocyturia (p = 0.008), urinary incontinence (p = 0.04) and elevated C reactive protein concentration (p = 0.009) remained significant risk factors for the presence and the persistence of AB when the multivariate logistical regression analysis was done. The presence of UTI within one year before the study started (p= 0.024) and previous antibiotic treatments (p = 0.04) were also independent significant factors associated with persistent AB. 84.5% of diabetic patients with persistent AB had the same infective organism in the urine culture as those found during the initial AB. CONCLUSIONS: In patients with type 2 diabetes, female sex, urinary incontinence, leukocyturia, and elevated C reactive protein concentration were associated with development of AB. The same occurred with obesity in women and prostatic syndrome in men. The persistence of AB with the same species of isolated microorganisms as those found in AB at study entry is frequent, but it remains to be known if eradication of pathogens is more difficult in diabetic patients or, alternatively, if AB episodes are transient.

Factores relacionados con el desarrollo y la persistencia de la bacteriuria asintomática en los pacientes con diabetes mellitus tipo 2 / Risk factors for the development and persistence of assymptomatic bacteriuria in patients with type 2 diabetes

Fundamento y objetivo: Identificar los factores que predisponen o se asocian con el desarrollo y la persistencia de bacteriuria asintomática (BA) en pacientes con diabetes mellitus (DM) tipo 2. Pacientes y método: Estudio observacional analítico prospectivo de cohortes. Se incluyó a pacientes con DM tipo 2 de los centros de salud de Petrer (Alicante). A todos los pacientes se les aplicó un cuestionario con los datos de filiación, epidemiológicos, bioquímica, hemoglobina glucosilada, microalbuminuria, sedimento urinario y urocultivos. Resultados: Se ha analizado a 457 pacientes con DM tipo 2, de los que un 36,8% eran varones y un 63,2% mujeres. La prevalencia de BA inicial fue del 19,9% (un 25,6% en mujeres comparado con un 10,1% en varones). El 78,02% mantuvo la BA persistentemente al año, a pesar de que el 21,7% desarrolló infección del tracto urinario (ITU) sintomática y recibió tratamiento antibiótico y un 35,2% recibió antimicrobianos por causas distintas de ITU. La prevalencia de BA persistente en el total de la muestra estudiada fue del 15,5%. El sexo femenino (p = 0,04), la presencia de sedimento patológico (p = 0,008), incontinencia urinaria (p = 0,04) y valores elevados de proteína C reactiva (p = 0,009) se asociaron de forma independiente con la presencia de BA y con la BA persistente en el total de la muestra, además de la ITU en el año anterior al inicio del estudio (p = 0,024) y los tratamientos antimicrobianos previos (p = 0,04) en el caso de la BA persistente. En el 84,5% de los pacientes se aisló la misma especie de microorganismo que en el cultivo inicial. Conclusiones: En los pacientes con DM tipo 2, el sexo femenino, la incontinencia urinaria, el sedimento patológico y los valores elevados de proteína C reactiva se asociaron con BA, además de la obesidad en las mujeres y del síndrome prostático en los varones. La persistencia de BA por la misma especie de microorganismo es frecuente. Se desconoce si este hecho representa la persistencia del mismo patógeno no erradicado o nuevas reinfecciones

Background and objective: To study the risk factors for the development and persistence of asymptomatic bacteriuria (AB) in type 2 diabetes mellitus (DM) patients from our health zone. Patients and method: Observational and laboratory prospective cohort study. Inclusion criteria: women and men with type 2 DM from the 2 health centers of Petrer (Alicante). Data: questionnaire including particular and epidemiological data. Laboratory values: biochemistry, glycosylated hemoglobin A1C, microalbuminuria, urinary sediment and urine culture. Results: A total of 457 patients with type 2 DM were included; 63.2% women and 36.8% men. The prevalence of AB at baseline was 19.9% (25.6% in women vs 10.1% in men). 78.02% had persistence of AB after the twelve months of follow-up; 21.7% developed symptomatic urinary tract infection (UTI) and 35.2% were treated with antimicrobial agents for any reason different from UTI during the follow-up period. The persistence of AB at the end of the study was 15.5%. Female sex (p = 0.04), leukocyturia (p = 0.008), urinary incontinence (p = 0.04) and elevated C reactive protein concentration (p = 0.009) remained significant risk factors for the presence and the persistence of AB when the multivariate logistical regression analysis was done. The presence of UTI within one year before the study started (p= 0,024) and previous antibiotic treatments (p = 0,04) were also independent significant factors associated with persistent AB. 84.5% of diabetic patients with persistent AB had the same infective organism in the urine culture as those found during the initial AB. Conclusions: In patients with type 2 diabetes, female sex, urinary incontinence, leukocyturia, and elevated C reactive protein concentration were associated with development of AB. The same occurred with obesity in women and prostatic syndrome in men. The persistence of AB with the same species of isolated microorganisms as those found in AB at study entry is frequent, but it remains to be known if eradication of pathogens is more difficult in diabetic patients or, alternatively, if AB episodes are transient

Necrotic cellulitis by Serratia plymuthica.

This case report describes an uncommon cellulitis caused by Serratia plymuthica in a patient treated with steroids. The evolution was favorable after surgical exploration with debridement and antibiotic treatment. This is the first case of necrotic cellulitis caused by S. plymuthica described in the literature.