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Community-acquired urinary tract infection (CA-UTI) is the most common infection caused by extended-spectrum  β- lactamase (ESBL)-producing  Enterobacteriaceae,  but the clinical epidemiology of these infections in low prevalence countries is largely unknown. A population based case-control study was conducted to assess risk factors for CA-UTI caused by ESBL-producing  E. coli  or  K. pneumoniae . The study was carried out in a source population in Eastern Norway, a country with a low prevalence of infections caused by ESBL-producing  Enterobacteriaceae . The study population comprised 100 cases and 190 controls with CA-UTI caused by ESBL-producing and non-ESBL-producing  E. coli  or  K. pneumoniae,  respectively. The following independent risk factors of ESBL-positive UTIs were identified: Travel to Asia, The Middle East or Africa either during the past six weeks (Odds ratio (OR) = 21; 95% confidence interval (CI): 4.5–97) or during the past 6 weeks to 24 months (OR = 2.3; 95% CI: 1.1–4.4), recent use of fluoroquinolones (OR = 16; 95% CI: 3.2–80) and  β- lactams (except mecillinam) (OR = 5.0; 95% CI: 2.1–12), diabetes mellitus (OR = 3.2; 95% CI: 1.0–11) and recreational freshwater swimming the past year (OR = 2.1; 95% CI: 1.0–4.0). Factors associated with decreased risk were increasing number of fish meals per week (OR = 0.68 per fish meal; 95% CI: 0.51–0.90) and age (OR = 0.89 per 5 year increase; 95% CI: 0.82–0.97). In conclusion, we have identified risk factors that elucidate mechanisms and routes for dissemination of ESBL-producing  Enterobacteriaceae  in a low prevalence country, which can be used to guide appropriate treatment of CA-UTI and targeted infection control measures.

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Risk Factors for Community-Acquired Urinary Tract Infections Caused by ESBL-Producing Enterobacteriaceae –A Case–Control Study in a Low Prevalence Country