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Abstract：
Objective: To analyze the clinical and economic impact of community-onset urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae requiring hospitalization. Methods: A retrospective cohort study that included all adults with a UTI caused by K. pneumoniae that were admitted to a tertiary care hospital in Barcelona, Spain, between 2011 and 2015. Demographic, clinical, and economic data were analyzed. Results: One hundred and seventy-three episodes of UTIs caused by K. pneumoniae were studied; 112 were non-ESBL-producing and 61 were ESBL-producing. Multivariate analysis identified ESBL production, acute confusional state associated with UTI, shock, and the time taken to obtain adequate treatment as risk factors for clinical failure during the first seven days. An economic analysis showed differences between ESBL-producing and non-ESBL-producing K. pneumoniae for the total cost of hospitalization per episode (mean EUR 6718 vs EUR 3688, respectively). Multivariate analysis of the higher costs of UTI episodes found statistically significant differences for ESBL production and the time taken to obtain adequate treatment. Conclusion: UTIs caused by ESBL-producing K. pneumoniae requiring hospitalization and the time taken to obtain adequate antimicrobial therapy are associated with worse clinical and economic outcomes.
摘要：
目的:分析需要住院治疗的产超广谱β-内酰胺酶(ESBL)肺炎克雷伯菌引起的社区型尿路感染(UTI)的临床和经济影响。方法：一项回顾性队列研究，包括巴塞罗那三级医院收治的肺炎克雷伯菌引起的所有UTI成人，西班牙,2011年至2015年。人口统计,临床,并对经济数据进行了分析。结果：研究了由肺炎克雷伯菌引起的UTI发作的一百七十三例；112例不产生ESBL，61例产生ESBL。多变量分析确定了ESBL生产，与UTI相关的急性混淆状态，震惊,以及获得适当治疗所需的时间作为前7天临床失败的危险因素。经济分析显示，产ESBL和非产ESBL肺炎克雷伯菌在每次发作的住院总费用方面存在差异（分别为6718欧元和3688欧元）。对UTI发作的较高成本的多变量分析发现，ESBL产生和获得适当治疗所需时间的统计学差异显着。结论：由产生ESBL的肺炎克雷伯菌引起的UTI需要住院治疗和获得足够的抗菌治疗所需的时间与较差的临床和经济结果相关。
