Journal reference: Freeman JT, McBride SJ, Heffernan H, et al. Community-onset genitourinary tract infection due to CTX-M-15-producing Escherichia coli among travelers to the Indian subcontinent in New Zealand. Clinical Infectious Diseases 2008; 47:689–92 ^[1]

Link: http://dx.doi.org/10.1086/590941

Evidence cookie says...

Travel to the Indian subcontinent is associated with the acquisition of multi-resistant E. coli causing genitourinary tract infections in the community. Microbiological testing of urine should be performed for clinical diagnoses of UTIs in this patient group if not already performed routinely. If ESBL-producing E. coli is isolated, the patient may need immediate treatment at hospital.

More details:

Article details

Study design:

Study aim:

to determine whether community onset urinary tract infections (UTI) caused by extended spectrum beta lactamase (ESBL) producing E. coli isolates was associated with overseas travel to the Indian subcontinent.

Methods summary:

Review of case records of ESBL producing E. coli isolated in microbiology laboratory over a three-year period.

Results summary:

• 1.1% of E. coli isolated from urinary specimens were ESBL positive (66/5936)
• Of those with community onset symptomatic UTI, 48.1% (13/27) had a history of overseas travel.
• 10 of these patients had travelled or immigrated from the Indian subcontinent. 9 of 10 of these had travelled within the last six months.
• 8 of 10 patients required intravenous therapy with carbapenems or aminoglycosides.

Study conclusion:

Community onset of UTI caused by ESBL producing E. coli is associated with travel to Indian subcontinent. These isolates have limited therapeutic options, and may require hospital admission and intravenous therapy.

Participants:

Patients with urinary tract isolates submitted to the microbiology laboratory in Auckland hospital, New Zealand.

• limited demographic data

Methodological weaknesses

• Population selected may reflect high incidence of travel to Indian subcontinent, and recent immigrants from this area.
• Retrospective study, subject to selection biases.
• The numbers included in the study are small.

Methodological strengths

• Typing of isolates confirmed presence of CTX-M gene that is widespread in India
• Study period included routine ESBL screening by laboratory.

Biases and conflicts of interests

Nil declared and nil seem obvious.

Clinical relevance to primary health care

Urinary tract infections are the most common bacterial infections seen in Australian general practice. They are considered easily treated with oral antibiotics.

Extended spectrum beta lactamase producing organisms are effectively resistant to all oral antibiotics and will require treatment in a hospital setting.  This study demonstrated an association between travel to the Indian subcontinent and subsequent community acquired UTIs caused by ESBL E. coli in New Zealand.  The evidence is limited due to the nature of this study but has face validity given the known prevalence of ESBL E. coli in India.

General practitioners who are not routinely collecting urine for microbiology for clinical diagnoses of community urinary tract infections should consider the history of international travel placing the patient at risk of having a resistant organism; and thus perform it for this patient group.

Isolation of ESBL producing organisms may require hospital level management.

References

1. Freeman JT, McBride SJ, Heffernan H, et al. Community-onset genitourinary tract infection due to CTX-M-15-producing Escherichia coli among travelers to the Indian subcontinent in New Zealand. Clinical Infectious Diseases 2008; 47:689–92

Editor: Michael Tam