{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:38:33Z","timestamp":1785404313275,"version":"3.56.0"},"reference-count":28,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2732494X25102672_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The incidence of community-onset (CO) symptomatic urinary tract infection (SUTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales is increasing worldwide. Our study aims were to explore the independent predictors for CO-ESBL SUTI and to compare the effectiveness of several oral therapeutics, which are used for this indication in community health settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102672_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Retrospective matched case-case-control and case-case studies, among insurers of Maccabi health maintenance organization, Shfella district, Israel (10\u201311\/2019). Patients with CO-ESBL (\n                      <jats:italic>Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis<\/jats:italic>\n                      ) SUTI were matched to patients with CO-non-ESBL SUTI and to uninfected controls (1:1:1). Matched analyses (logistic regressions) were used to model predictors for CO-ESBL SUTI. A composite parameter for worse SUTI outcomes was compared among patients who were managed with a single, supposedly effective (ie, in vitro), oral agent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102672_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study consisted of 1,455 patients (ie, three matched groups of 485 patients). The independent predictors for CO-ESBL SUTI were certain recent exposures: (1) hospitalization (3 months), (2) past carriage of multidrug-resistant organisms (2 years), (3) exposure to any antimicrobial (3 months), and (4) prior SUTI (6 months). Among 331 patients with CO-ESBL SUTI, resistance rates were lowest for fosfomycin (4.9%), while outcomes were worst for patients managed with oral amoxicillin-clavulanate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102672_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>CO-ESBL SUTI independent predictors in this community region were recent hospitalization, known MDRO carriage, exposure to antimicrobials and prior SUTI. Amoxicillin-clavulanate should be avoided, even for ESBL susceptible isolates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ash.2025.10267","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T04:44:09Z","timestamp":1767847449000},"source":"Crossref","is-referenced-by-count":0,"title":["Community-onset symptomatic urinary tract infections (SUTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales: independent predictors and comparative effectiveness of oral agents"],"prefix":"10.1017","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9289-4392","authenticated-orcid":false,"given":"Shani","family":"Zilberman-Itskovich","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"},{"id":[{"id":"https:\/\/ror.org\/04mhzgx49","id-type":"ROR","asserted-by":"publisher"}],"name":"Tel Aviv University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1482-1195","authenticated-orcid":false,"given":"Majdi","family":"Masarwi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0607-4459","authenticated-orcid":false,"given":"Eyal","family":"Levy","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04mhzgx49","id-type":"ROR","asserted-by":"publisher"}],"name":"Tel Aviv University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8221-7400","authenticated-orcid":false,"given":"Moti","family":"Iflah","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04mhzgx49","id-type":"ROR","asserted-by":"publisher"}],"name":"Tel Aviv University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inbar","family":"Levi Steinweg","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04mhzgx49","id-type":"ROR","asserted-by":"publisher"}],"name":"Tel Aviv University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Yapryntsev","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shani","family":"Mednyk","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2847-4625","authenticated-orcid":false,"given":"Roni","family":"Gur-Lavy","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Alfahel","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keren","family":"Amity","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avi","family":"Itzhaki","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6745-4939","authenticated-orcid":false,"given":"Dror","family":"Marchaim","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02722hp10","id-type":"ROR","asserted-by":"publisher"}],"name":"Shamir (Assaf Harofeh) Medical Center"},{"id":[{"id":"https:\/\/ror.org\/04mhzgx49","id-type":"ROR","asserted-by":"publisher"}],"name":"Tel Aviv University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"S2732494X25102672_ref1","unstructured":"1. 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