Spatial clusters of extended-spectrum beta-lactamase-producing Escherichia coli causing community-onset bacteriuria due to repeat infections: cluster analysis from a large urban medical center, San Francisco, 2014-2020.

Autor:	Raphael E; University of California, San Francisco., Inamdar PP; University of California, San Francisco., Belmont C; University of California, San Francisco., Shariff-Marco S; University of California, San Francisco., Huang A; University of California, San Francisco., Chambers H; University of California, San Francisco.
Jazyk:	angličtina
Zdroj:	Research square [Res Sq] 2023 May 22. Date of Electronic Publication: 2023 May 22.
DOI:	10.21203/rs.3.rs-2949551/v1
Abstrakt:	Background: Urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL- E. coli ) may occur as outbreaks due to common-source exposures. Yet, it is currently unknown if they cluster geographically as would be expected as part of an outbreak. Methods: We collected electronic health record data on all patients living in San Francisco with culture-documented community-onset E. coli bacteriuria in a safety-net public healthcare system from January 2014 to March 2020 (diagnosed < 48 hours after hospital admission or in outpatient clinical settings without a hospitalization in the past 90 days). We assessed the presence of spatial clusters of (1) ESBL- E. coli bacteriuria episodes, and (2) individuals with any ESBL- E. coli bacteriuria episode, with Global and Local Moran's I. We evaluated differences in prevalence of bacteriuria recurrence by ESBL-production by Poisson regression. Results: Out of 4,304 unique individuals, we identified spatial clusters of ESBL- E. coli bacteriuria episodes (n = 461) compared to non-ESBL- E. coli bacteriuria episodes (n = 5477; Global Moran's p < 0.001). Spatial clusters of individuals with any bacteriuria caused by ESBL- E. coli were not identified (p = 0.43). Bacteriuria recurrence was more likely to occur with ESBL- E. coli (odds ratio [OR] 2.78, 95% confidence interval [95% CI] 2.10, 3.66, p < 0.001), particularly after an initial ESBL- E. coli bacteriuria episode (OR 2.27, 95% CI 1.82, 2.83, p < 0.001). Conclusion: We found spatial clusters of ESBL- E. coli bacteriuria episodes. However, this was partly explained by clustering within individuals more than between individuals, as having an ESBL- E. coli bacteriuria was associated with recurrence with ESBL- E. coli . Competing Interests: Competing interests. The authors declare that they have no competing interests.
Databáze:	MEDLINE
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