Epidemiology of Complicated Urinary Tract Infections due to Enterobacterales Among Adult Patients Presenting in Emergency Departments Across the United States

Lodise, Thomas; Chopra, Teena; Nathanson, Brian H.; Sulham, Kate; Rodriguez, Mauricio

doi:10.1093/ofid/ofac315

Cited by 9 publications

(4 citation statements)

References 30 publications

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“…We opted to examine each nonsusceptibility phenotype vs the percentage of patients resistant to 0, 1, 2, 3, or ≥4 antibiotic classes. Like other studies [ 4 , 6 , 66 , 67 ], cross-nonsusceptibility rates (eg, TMP-SMX–nonsusceptible cUTIs that were also nonsusceptible to fluoroquinolone, nitrofurantoin, or 3-GC) were commonplace ( Supplementary Table 3 ), and a similar set of risk factors was identified for each nonsusceptibility phenotype. These findings limit the ability to generate clinically meaningful risk scores to estimate the probability of having a cUTI that was nonsusceptible to 1 specific antibiotic but susceptible to other agents.…”

Section: Discussionmentioning

confidence: 60%

Clinical Risk Scores to Predict Nonsusceptibility to Trimethoprim-Sulfamethoxazole, Fluoroquinolone, Nitrofurantoin, and Third-Generation Cephalosporin Among Adult Outpatient Episodes of Complicated Urinary Tract Infection

Lodise

Chen

Wei

et al. 2023

Open Forum Infectious Diseases

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Background Clinical risk scores were developed to estimate the risk of adult outpatients having a complicated urinary tract infection (cUTI) that was non-susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolone, nitrofurantoin, or third-generation cephalosporins (3-GC) based on variables available on clinical presentation. Methods A retrospective cohort study (12/1/2017-12/31/2020) was performed among adult Kaiser Permanente Southern California members with an outpatient cUTI. Separate risk scores were developed for TMP-SMX, fluoroquinolone, nitrofurantoin, and 3-GC. The models were translated into risk scores to quantify the likelihood of non-susceptibility based on the presence of final model covariates in a given cUTI outpatient. Results A total of 30,450 cUTIs (26,326 patients) met the study criteria. Non-susceptibility to TMP-SMX, fluoroquinolones, nitrofurantoin, and 3-GC were 37%, 20%, 27%, and 24%, respectively. Receipt of prior antibiotics was the most important predictor across all models. The risk of non-susceptibility in the TMP-SMX model exceeded 20% in the absence of any risk factors, suggesting that empiric use of TMP-SMX may not be advisable. For fluoroquinolone, nitrofurantoin, or 3-GC, clinical risk scores of 10, 7, and 11, respectively, predicted a ≥20% estimated probability of non-susceptibility in the models that included cumulative number of prior antibiotics at model entry. This finding suggests caution should be used when considering these agents empirically in patients who have several risk factors present in a given model(s) at presentation. Conclusions We developed high-performing parsimonious risk scores to facilitate empiric treatment selection for adult cUTI outpatients in the critical period between infection presentation and availability of susceptibility results.

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Section: Discussionmentioning

confidence: 60%

Clinical Risk Scores to Predict Nonsusceptibility to Trimethoprim-Sulfamethoxazole, Fluoroquinolone, Nitrofurantoin, and Third-Generation Cephalosporin Among Adult Outpatient Episodes of Complicated Urinary Tract Infection

Lodise

Chen

Wei

et al. 2023

Open Forum Infectious Diseases

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“…Several recent studies have been published describing the in vitro susceptibilities of common urinary pathogens. 6 , 11 , 18 Aronin et al . 11 assessed the susceptibility of 546 716 E. coli urine isolates from patients hospitalized in the USA over a 10 year period (2011–20).…”

Section: Discussionmentioning

confidence: 99%

“…The percentage of isolates testing not susceptible to trimethoprim/sulfamethoxazole, fluoroquinolones and nitrofurantoin were 25.4%, 21.1% and 3.8%, respectively, and 6.4% were positive for ESBL production. Lodise et al 6 evaluated the in vitro activity of common antimicrobials versus bacterial isolates obtained from patients presenting to emergency departments in the USA from 2013 to 2018 with a diagnosis of complicated UTI, stratified by whether the patient was admitted to hospital or in the emergency room (ER) only. Among 106 038 E. coli isolates, resistance rates to fluoroquinolones were 16.4% for ER patients and 35.6% for admitted patients, resistance rates to trimethoprim/sulfamethoxazole were 27.8% for ER patients and 33.2% for admitted patients, and resistance rates to nitrofurantoin were 3.4% for ER patients and 5.6% for admitted patients.…”

Section: Discussionmentioning

confidence: 99%

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Antimicrobial resistance patterns of bacterial pathogens recovered from the urine of patients at Canadian hospitals from 2009 to 2020

Walkty

Karlowsky

Lagacé-Wiens

et al. 2022

JAC-Antimicrobial Resistance

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Objectives To investigate in vitro susceptibility patterns of bacterial pathogens recovered from the urine of outpatients (isolates from outpatient clinics or emergency departments) and hospital inpatients across Canada from 2009 to 2020 as part of the CANWARD study Methods Canadian hospital microbiology laboratories submitted bacterial pathogens cultured from urine to the CANWARD study coordinating laboratory on an annual basis (January 2009 to December 2020). Antimicrobial susceptibility testing was performed by CLSI broth microdilution, with MICs interpreted by current CLSI breakpoints. Results In total, 4644 urinary pathogens were included in this study. Escherichia coli was recovered most frequently (53.3% of all isolates), followed by Enterococcus faecalis, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa and Staphylococcus aureus. Together, these six species accounted for 84.2% of study isolates. Nitrofurantoin demonstrated excellent in vitro activity versus E. coli, with 97.6% of outpatient and 96.1% of inpatient isolates remaining susceptible. In contrast, E. coli susceptibility rates were lower for ciprofloxacin (outpatient 79.5%, inpatient 65.9%) and trimethoprim/sulfamethoxazole (outpatient 75.2%, inpatient 73.5%). The percentage of E. coli isolates that were phenotypically positive for ESBL production significantly increased from 4.2% (2009–11) to 11.3% (2018–20). A similar although less pronounced temporal trend was observed with ESBL-producing K. pneumoniae. Conclusions E. coli was the pathogen most frequently recovered from the urine of Canadian patients, and the proportion of isolates that were ESBL producers increased over time. Susceptibility data presented here suggest that ciprofloxacin and trimethoprim/sulfamethoxazole may be suboptimal for the empirical treatment of complicated urinary infections.

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Population based cohort to examine association between geospatial antibiotic factors and urinary tract infection outcomes

Nero¹,

Weber²,

Reveles³

et al. 2023

American Journal of Infection Control

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Epidemiology of Complicated Urinary Tract Infections due to Enterobacterales Among Adult Patients Presenting in Emergency Departments Across the United States

Cited by 9 publications

References 30 publications

Clinical Risk Scores to Predict Nonsusceptibility to Trimethoprim-Sulfamethoxazole, Fluoroquinolone, Nitrofurantoin, and Third-Generation Cephalosporin Among Adult Outpatient Episodes of Complicated Urinary Tract Infection

Clinical Risk Scores to Predict Nonsusceptibility to Trimethoprim-Sulfamethoxazole, Fluoroquinolone, Nitrofurantoin, and Third-Generation Cephalosporin Among Adult Outpatient Episodes of Complicated Urinary Tract Infection

Antimicrobial resistance patterns of bacterial pathogens recovered from the urine of patients at Canadian hospitals from 2009 to 2020

Population based cohort to examine association between geospatial antibiotic factors and urinary tract infection outcomes

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