Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains

Abstract

Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients’ medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863–0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018–1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289–0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234–0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.

Urinary Tract Infections in Elderly Patients: A 10-Year Study on Their Epidemiology and Antibiotic Resistance Based on the WHO Access, Watch, Reserve (AWaRe) Classification

“…Since the early 2000s, the prevalence of Enterobacterales resistant to III. generation cephalosporins (most frequently due to the production of ESBLs) in UTIs has shown an increasing an trend worldwide, which has led to the substantial use of carbapenem antibiotics to manage these infections [ 40 , 41 ]. However, carbapenem-resistance (CR) in urinary pathogens is emerging threat, which severely limits the therapeutic arsenal of clinicians to provide safe antimicrobial therapy, often forcing them to use older drugs with a disadvantageous side effect profile (e.g., colistin) or newer, significantly more expensive antibiotics (e.g., meropenem/vaborbactam, if appropriate) with limited availability and clinical experience [ 42 , 43 , 44 ].…”

Point prevalence survey of antibiotic utilization in secondary care hospital in the United Arab Emirates

“… 7 , 8 Several studies have identified a growing resistance pattern to antibiotics due to the increased use of existing antibiotics 9 , 10 and the slow pace of new antibiotic discovery. 11 This has resulted in an international public health crisis of antimicrobial resistance, 10 , 12 which represents a great threat to the humankind. 13 , 14 In some countries, including the European Union, the disseminated risk of antibiotic resistance introduced devastating tragedy and has reached alarming levels 15 , 16 with a paradigm shift in prescribing patterns to broader spectrum agents of antibiotics in the last several decades.…”