Urinary Tract Infections Caused by ESBL-producing Enterobacteria
Urinary Tract Infections Caused by ESBL-producing Enterobacteria
The aim of this study was to compare the etiologic agents, the antimicrobial resistance
 rates, and the risk factors associated with a HA-UTI and CA-UTI among complicated and
 uncomplicated UTI patients in a tertiary-care hospital in Mexico. This study was performed
 according to the principles expressed in the Declaration of Helsinki with the approval of the
 Local Ethics Committee of the School of Medicine of the Universidad Autónoma de Nuevo León
 (UR14-004). All patients with a UTI and a positive urine culture (> 100,000 UFC/mL) from
 March to October 2015 were included. The study was carried out at the Hospital Universitario
 "Dr. José Eleuterio González" hospital, a tertiary-care teaching hospital in Monterrey,
 Mexico. Identification and susceptibility antibiotic assays were performed to all isolates
 from positive urine culture.
The aim of this study was to compare the etiologic agents, the antimicrobial resistance
 rates, and the risk factors associated with a HA-UTI and CA-UTI among complicated and
 uncomplicated UTI patients in a tertiary-care hospital in Mexico.

 This study was performed according to the principles expressed in the Declaration of Helsinki
 with the approval of the Local Ethics Committee of the School of Medicine of the Universidad
 Autónoma de Nuevo León (UR14-004).

 All patients with a UTI and a positive urine culture (> 100,000 UFC/mL) from March to October
 2015 were included. The study was carried out at the Hospital Universitario "Dr. José
 Eleuterio González" hospital, a tertiary-care teaching hospital in Monterrey, Mexico. This
 hospital has 500 beds, serves a population of approximately 5 million people, and has an
 average of 250,000 medical consultations and 22,000 hospitalizations annually.

 A UTI was defined as the presence of symptoms related to the urinary tract, pyuria (≥10
 leucocytes per high-power field) and a positive urine culture (≥105 CFU/mL) of one
 uropathogen according to the guidelines of the Infectious Diseases Society of America (IDSA)
 and the European Association of Urology (EAU). Patients with urine cultures with
 significative counts of two or more bacterial species were excluded.

 Patients' charts were reviewed for clinical and demographic characteristics. The
 classification of UTIs as either complicated or uncomplicated, and hospital-acquired or
 community-acquired, was based on the IDSA and EAU criteria. Cases which could not be
 classified due to insufficient clinical information were excluded.

 Urine cultures were performed according to standard protocols. Species identification of all
 isolates was performed using MALDI-TOF mass spectrometry (Microflex, Bruker Daltonics,
 Billerica, MA). The drug resistance profile of all E. coli isolates was determined using the
 broth microdilution method for gentamicin, amoxicillin-clavulanic acid, aztreonam,
 ceftriaxone, ertapenem, ciprofloxacin, levofloxacin, nitrofurantoin,
 trimethoprim/sulfamethoxazole, and colistin; except fosfomycin, in which the agar dilution
 method was used. The results were interpreted according to the Clinical and Laboratory
 Standards Institute (CLSI) criteria.

 Multidrug resistance (MDR) was defined as non-susceptibility to at least one agent in three
 or more antimicrobial categories. All isolates with resistance to at least one
 third-generation cephalosporin were evaluated for production of ESBL in E. coli using the
 double-disc test according to the CLSI.

 Categorical variables were expressed as frequencies and percentages. Numerical variables were
 expressed as a mean and standard deviation. Clinical and demographic characteristics were
 analyzed using the χ2 test for categorical variables and the t-test (or Mann-Whitney test in
 the absence of normal distribution) for continuous variables. Statistical significance was
 set at p <0.05. Statistical analysis was performed with the SPSS software version 20.0 (IBM
 Corp, Armonk, NY).
Inclusion Criteria:

 -  All patients (> 18 years old) with a UTI and a positive urine culture (> 100,000
 UFC/mL) from March to October 2015 were included

 Exclusion Criteria:

 -