Distinct individual and community-level drivers of extended-spectrum beta-lactamase-producing Enterobacterales urinary tract infections.

Abstract

Objective: Compare characteristics of community-associated (CA) versus healthcare-associated (HCA) extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) urinary tract infection (UTI) cases and assess associations between ESBL-E UTI prevalence and census-tract social vulnerability.

Design: Retrospective cohort study.

Setting: Monroe County, NY, January 2020-December 2023.

Patients: Population surveillance of first urinary ESBL-E isolate among county residents.

Methods: ESBL-E, defined as resistance to ≥1 third-generation cephalosporin, was identified from inpatient and outpatient urinary specimens. Demographic, clinical, and healthcare exposure data were abstracted; cases were classified as CA or HCA using standardized definitions. Addresses were geocoded to census tracts and linked to CDC Social Vulnerability Index (SVI) scores. Characteristics were compared using χ² and Wilcoxon tests. Generalized linear models assessed associations between SVI themes and ESBL-E prevalence by epidemiologic classification.

Results: Of 3,100 ESBL-E UTI cases, 1,621 (52.3%) were CA and 1,468 (47.4%) HCA. CA cases were younger (median 56 vs 71.5 years), more often female (89.5% vs 68.4%), and less medically complex than HCA cases. HCA prevalence increased with SVI score, while CA prevalence remained stable across SVI levels. The HCA association was mainly driven by SVI Theme 2 (household composition/disability; P = .0011).

Conclusions: CA and HCA ESBL-E UTIs exhibit distinct epidemiology. No association was observed between SVI and CA ESBL-E UTI prevalence. HCA prevalence increased with social vulnerability, largely driven by SVI Theme 2, potentially reflecting healthcare exposure and medical complexity. Factors driving CA ESBL-E differ, and ESBL-E reduction efforts should consider broader structural and community factors beyond those captured by the SVI.