Risk Factor Analysis of Urinary Tract Infection by Cefotaxime-Resistant Escherichia coli and Klebsiella pneumoniae: A Simple and Effective Analysis Using the National Health Insurance Data Sharing Service

Abstract

Background: This study aims to analyze the risk factors for urinary tract infection (UTI) by cefotaxime-resistant Escherichia coli or Klebsiella pneumoniae, using data from the National Health Insurance Data Sharing Service. Methods: A retrospective case-control study was conducted to analyze the risk factors during 11 years (2010–2020). Study groups were selected based on the laboratory data of the hospital, which comprised 3,638 and 877 cases of cefotaxime-resistant E. coli and K. pneumoniae , respectively. Controls comprised 8,994 and 1,573 cases of cefotaxime-nonresistant (intermediate or susceptible) E. coli and K. pneumoniae, respectively. Clinical and socioeconomical features were obtained from the National Health Insurance service data. Results: In a multivariate analysis of risk factors for UTI by cefotaxime-resistant E. coli, the odds ratio (OR) of the male sex was 1.335 (95% confidence interval, 1.204–1.480), age 0–9 years was 1.794 (1.468–2.191), chronic renal disease was 1.227 (1.062–1.417), and hemodialysis was 1.685 (1.255–2.262). Moreover, the ORs of L-tube, central venous pressure catheter, and Foley catheter use were 1.204 (1.047–1.385), 1.332 (1.156–1.534), and 1.473 (1.316–1.649), respectively; the OR of previous antimicrobial use was 1.103 (1.009–1.206) and that of healthcare facility use was 1.782 (1.576–2.014). In a multivariate analysis of risk factors for UTI by cefotaxime-resistant K. pneumoniae, OR of the male sex was 1.460 (1.199–1.778), liver disease was 1.295 (1.037–1.617), and hemodialysis was 2.046 (1.263–3.315). The ORs of L-tube and Foley catheter use were 2.329 (1.861–2.915) and 1.793 (1.431–2.246), respectively, and the OR of the healthcare facility use was 1.545 (1.161–2.056). Conclusion: In this study, the risk factors for UTI caused by cefotaxime-resistant E. coli or K. pneumoniae were analyzed based on the data of a specific healthcare facility linked to the National Health Insurance system. We suggest that it is a simple and effective way to elucidate risk factors of infections caused by major antimicrobial-resistant pathogens.