Outcomes of ESBL status among UTI admissions: a retrospective analysis of the Nationwide Inpatient Sample from 2016 to 2022

Abstract Background Extended-spectrum beta-lactamase (ESBL) producing organisms are an increasing cause of urinary tract infections (UTIs) and pose significant challenges to inpatient management due to antimicrobial resistance and limited treatment options. Prior studies focus on prevalence and resistance patterns, but nationally representative inpatient outcome data are lacking. This study assesses the association of ESBL status on clinical outcomes among hospitalized adults with UTIs in the United States. Methods A retrospective cohort study was conducted using the Nationwide Inpatient Sample (NIS) from 2016 to 2022. Adult patients aged ≥ 18 years hospitalized with a primary diagnosis of UTI were included. ESBL status was identified using ICD-10-CM code Z16.12, with non-ESBL UTIs serving as the comparison group. The primary outcome was in-hospital mortality, while secondary outcomes included hospital length of stay (LOS) and total inflation-adjusted hospital costs. Propensity score stratification and multivariable regression adjusted for demographic, clinical, and hospital confounders. Results Among 1,844,239 UTI hospitalizations from 2016 to 2022, 63,190 (3.4%) involved ESBL-producing organisms. ESBL status was not associated with increased in-hospital mortality compared with non-ESBL UTIs. However, ESBL infections were associated with longer hospital stays (mean difference 1.0 days; 95% CI 0.93 to 1.10; p < 0.001) and higher total hospital charges (mean difference $9,179; 95% CI $8,101 to $10,257; p < 0.001). Conclusions In this nationally representative analysis, ESBL-producing UTIs were associated with increased healthcare utilization but not higher in-hospital mortality. These findings highlight the clinical and economic burden of ESBL infections and the importance of targeted prevention and optimized inpatient management strategies.