Risk Factors of Extended-Spectrum Beta-Lactamases-Producing Escherichia coli Community Acquired Urinary Tract Infections: A Systematic Review

Figures & data

Figure 1 Study flowchart according to the PRISMA recommendations.

Table 1 Characteristics and Quality of the Included Studies

Authors/Ref Country/Year	Study Type	Patients	Quality (Score)
Søgaard M et al^Citation38 Denmark, 2017	Dual case-control study	Patients from general medicine departments n=7,170 UTI due to ESBL-producing E. coli n=339 Controls: UTI due to non-ESBL-producing E. coli n=3,390	9/9
Hertz FB et al^Citation27 Denmark, 2015	Triple case-control study	Patients from general medicine departments with UTI due to E. coli n=449 ESBL-producing E. coli n=98 Controls: multi-sensitive n=177	9/9
Søraas A et al^Citation35 Norway 2013	Case-control study	All patients with community-acquired UTI due to enterobacteria from 4 hospitals n=290 E. coli subgroup n=272 ESBL-producing E. coli n=95 non-ESBL-producing E. coli n=177	8/9
Artero A et al^Citation31 Spain, 2017	Case-control study	Patients >65 years, hospitalized for community-acquired acute pyelonephritis or urinary sepsis due to E. coli n=310 ESBL-producing E. coli n=85 non-ESBL-producing E. coli n=225	8/9
Calbo E et al^Citation36 Spain, 2006	Case-control study	Outpatients or emergency patients with UTI due to E. coli n=74 ESBL-producing E. coli n=19 Non-ESBL-producing E. coli n=55	8/9
Azap OK et al^Citation37 Turkey, 2009	Case-control study	Outpatients with UTI aged between 18 and 65 years n=510 E. coli subgroup n=464 ESBL-producing E. coli n=51 Non-ESBL-producing E. coli n=413	8/9
Ozdogan FN et al^Citation33 Turkey, 2015	Case-control study	Outpatients with UTI due to E. coli aged >18 years n=200 ESBL-producing E. coli n=100 Non-ESBL-producing E. coli n=100	7/9
Toumi A et al^Citation34 Tunisia, 2015	Case-control study	Patients aged >14 years hospitalized in infectious disease departments for community-acquired acute pyelonephritis due to E. coli n=484 ESBL-producing E. coli n=24 Non-ESBL-producing E. coli n=442	7/9
Castillo-Tokumori F et al^Citation39 Peru, 2017	Case-control study	Outpatients with UTI due to E. coli aged >18 years n=172 ESBL-producing E. coli n=67 Non-ESBL-producing E. coli n=105	7/9
Blanco Victor M et al^Citation24 Colombia, 2015	Case-control study	Emergency patients with UTI due to E. coli with no age restriction n=431 ESBL-producing E. coli n=54 Non-ESBL-producing E. coli n=377	7/9
Savatmorigkorngul S et al^Citation29 Thailand, 2016	Cross-sectional study	Emergency patients with UTI due to E. coli aged >15 years n=408 ESBL-producing E. coli n=159 Non-ESBL-producing E. coli n=249	8/10
Park SH et al^Citation30 South Korea, 2015	Case-control study	Patients hospitalized for community-acquired acute pyelonephritis due to E. coli aged >15 years n=300 ESBL-producing E. coli n=75 Non-ESBL-producing E. coli n=225	8/9
Kang CI et al^Citation28 South Korea, 2012	Case-control study	Outpatients or emergency patients with infection due to E. coli aged >15 years n=140 Subgroup with UTI alone: ESBL-producing E. coli n=73 Non-ESBL-producing E. coli n=67	6/9
Nisha KV et al^Citation25 India, 2017	Case-control study	Outpatient children with UTI due to E. coli aged 3 months to 18 years n=523 ESBL-producing E. coli n=196 Non-ESBL-producing E. coli n=327	8/9
Pérez Heras I et al.^Citation26 Spain, 2017	Cross-sectional study	Emergency pediatric patients with UTI due to E. coli aged <14 years n=229 ESBL-producing E. coli n=21 Non-ESBL-producing E. coli n=208	4/10
Fan NC et al.^Citation32 Taiwan, 2014	Case-control study	Inpatient children with community-acquired UTI due to E. coli aged <15 years n=312 ESBL-producing E. coli n=104 Non-ESBL-producing E. coli n=208	5/9

Table 2 Identified ESBL-E coli Community-Acquired Urinary Tract Infection Risk Factors

Risk Factors (Reference)	Adjusted OR	CI	Sample Size
Care related factors
Prior use of antibiotics
In the last 30 days^Citation27	1.8	[1.0–3.1]	n=449
[^Citation39]	3.1	[1.4–6.7]	n=172
In the last 3 months^Citation34	4.0	[1.6–10.0]	n=484
In the previous year^Citation30	4.6	[1.9–11.0]	n=300
Time NS^Citation28	5.6	[2.1–14.8]	n=140
Prior use of broad spectrum antibiotic
Any, 31–365 days before index date^Citation38	0.9	[0.5–1.7]	n=7,170
Penicillin, 31–365 days before index date^Citation38	1.0	[0.7–1.5]	n=7,170
Prior use of beta-lactams
In the last 90 days^Citation35	4.5	[1.8–11.0]	n=290
[^Citation37]	4.6	[2.0–10.7]	n=510
Prior use of penicillin
Any, time NS^Citation29	2.7	[1.2–6.3]	n=408
Prior use of cephalosporine
Cefuroxime, time NS^Citation36	21.4	[5.4–85.2]	n=74
2GC, time NS^Citation33	3.9	[1.8–8.5]	n=200
Cephalosporin, time NS^Citation29	2.2	[1.1–4.5]	n=408
3GC, time NS^Citation33	2.2	[1.01–5.0]	n=200
Prior use of Macrolide
Any, 31–365 days before index date^Citation38	1.5	[1.1–2.2]	n=7,170
Prior use of nitrofurantoin
31–365 days before index date^Citation38	1.54	[1.1–2.3]	n=7,170
Prior use of fluoroquinolones
Any, in the last 30 days^Citation27	2.1	[0.6–7.3]	n=449
Any, in the last 90 days^Citation35	19.0	[3.3–111.4]	n=290
Any, time NS^Citation33	2.6	[1.3–5.1]	n=200
[^Citation28]	9.9	[2.2–44.6]	n=140
Prior hospitalization
Any, in the last 30 days^Citation27	3.9	[1.2–12.7]	n=449
Any, in the last 3–12 months^Citation39	2.9	[1.3–6.6]	n=172
1–2 hospitalizations, in the previous year^Citation38	1.7	[1.3–2.3]	n=7,170
> 3 hospitalizations, in the previous year^Citation38	3.9	[2.6–5.8]	n=7,170
Prior surgery, in the last 3–12 months^Citation39	2.8	[1.9–8.0]	n=172
History of UTIs
Any, in the previous year^Citation38	1.3	[1.01–1.6]	n=7,170
≥3 episodes of UTI, in the previous year^Citation37	3.8	[1.8–8.1]	n=510
History of UTI due to E. coli, time NS^Citation29	3.4	[1.8–6.7]	n=408
Renal or urological disorder
History of recurrent acute pyelonephritis^Citation30	1.7	[0.7–3.9]	n=300
Recurrent acute pyelonephritis + history of diabetes^Citation30	4.2	[1.3–16.9]	n=300
Renal disease^Citation38	1.6	[1.0–2.5]	n=7,170
Urological abnormality^Citation34	3.5	[1.0–11.5]	n=484
Prior urinary catheterization^Citation29	3.3	[1.7–6.6]	n=408
History of prostatic disease^Citation37	9.6	[2.1–44.8]	n=510
Diabetes
[^Citation35]	3.7	[1.1–12.7]	n=290
[^Citation34]	3.0	[1.1–8.0]	n=484
[^Citation30]	1.7	[0.8–3.4]	n=300
Prior medication
Prior immunosuppressive therapy^Citation38	1.5	[1.1–2.1]	n=7,170
Chronic treatment with corticosteroids^Citation39	24.3	[2.4–246.9]	n=172
Demographic characteristics
Male sex
[^Citation38]	1.6	[1.2–2.1]	n=7,170
Age >55 years
[^Citation30]	2.0	[1.02–3.5]	n=300
Citizenship
Northern Europe vs other countries^Citation38	0.4	[0.2–0.7]	n=7,170
Environmental factors
Travelling abroad (Asia, Middle East, Africa)
In the previous 6 weeks^Citation35	16.4	[3.4–78.8]	n=290
Same regions between 6 weeks and 2 years before^Citation35	2.2	[1.1–4.3]	n=290
Swimming in freshwater
[^Citation35]	2.1	[1.02–4.2]	n=290
Number of fish meals per week
[^Citation35]	0.6	[0.5–0.9]	n=290

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