ESBL-producing Escherichia coli bacteraemic urinary tract infections: Clinical and economic burden and antimicrobial stewardship opportunities in a retrospective cohort study
Background: The study aimed to assess the clinical and economic impact of extended-spectrum β-lactamase (ESBL)–producing Escherichia coli bacteraemic UTIs (Ec-BUTI) and to evaluate the possibility of developing antimicrobial stewardship interventions. Methods: Retrospective single-centre cohort stud...
| Autores: | , , , , , , , |
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| Formato: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2026 |
| País: | España |
| Recursos: | Universidad de Sevilla (US) |
| Repositorio: | idUS. Depósito de Investigación de la Universidad de Sevilla |
| OAI Identifier: | oai:dnet:idus________::508a7a20521cea1fcf746442fa5fb0e9 |
| Acesso em linha: | https://hdl.handle.net/11441/186707 https://doi.org/10.1016/j.ijantimicag.2026.107787 |
| Access Level: | acceso abierto |
| Palavra-chave: | Extended-spectrum beta-lactamase producing (ESBL) Escherichia coli UTI Bloodstream infection Antimicrobial stewardship Hospital cost |
| Resumo: | Background: The study aimed to assess the clinical and economic impact of extended-spectrum β-lactamase (ESBL)–producing Escherichia coli bacteraemic UTIs (Ec-BUTI) and to evaluate the possibility of developing antimicrobial stewardship interventions. Methods: Retrospective single-centre cohort study included all consecutive episodes of Ec-BUTI requiring hospitalisation from September 2020 to February 2023. Primary outcome: clinical failure. Secondary outcome: hospital resource consumption, length of stay, 30-d recurrence and mortality and 90-d readmissions. Antimicrobial stewardship interventions were evaluated. A propensity score matching analysis was performed. Results: Three hundred ten E. coli-BUTI episodes were included; 86 caused by ESBL-producing strains. The ESBL group had greater comorbidity burden than the non-ESBL group (median Charlson index 4 [IQR 2–6] vs. 2 [IQR 1–4]; P < 0.001) and more frequent inappropriate empirical therapy (40.7% vs. 3.6%; P < 0.001). Overall, an intravenous-to-oral switch was made within the first week in 172 (55.5%) episodes. In the ESBL group, an oral switch was made in 17 patients (19.7%), while no oral option was available in 48 (55.8%) based on susceptibility results. After adjustment, ESBL was not significantly associated with clinical failure (aOR 1.85, 95% CI 0.33–10.48), recurrence (aOR 1.98, 95% CI 0.70–5.62) or mortality (aHR 2.12, 95% CI 0.43–10.38). However, ESBL-producing Ec-BUTI was associated with longer stays (P = 0.014), higher pharmacy costs (P < 0.001) and independently increased overall hospitalisation costs by a median of €1493 (P = 0.022). Conclusions: ESBL-producing Ec-BUTI was associated with greater healthcare resource consumption and costs, though not with worse clinical outcomes. These findings highlight the economic impact of antimicrobial resistance and support antimicrobial stewardship. |
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