Determining a urinary-specific antibiogram and risk factors of trimethoprim/sulfamethoxazole, ciprofloxacin and multidrug resistance among Enterobacterales in primary care
© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND: Risk factors for ciprofloxacin or MDR in primary care urine specimens are not well defined.
OBJECTIVES: We created a primary care-specific antibiogram for Escherichia coli isolates from cases with complicated and uncomplicated urinary tract infection (UTI) and evaluated risk factors for ciprofloxacin, trimethoprim/sulfamethoxazole and MDR among Enterobacterales.
METHODS: We conducted a cross-sectional study to determine resistance and risk factors by collecting urine cultures from all patients (≥18 years) presenting with provider-suspected UTI at two primary care, safety-net clinics in Houston, TX, USA between November 2018 and March 2020.
RESULTS: Among 1262 cultures, 308 cultures grew 339 uropathogens. Patients with Enterobacterales (n = 199) were mostly female (93.5%) with a mean age of 48.5 years. E. coli was the predominant uropathogen isolated (n = 187/339; 55%) and had elevated trimethoprim/sulfamethoxazole (43.6%) and ciprofloxacin (29.5%) resistance, low nitrofurantoin (1.8%) resistance, and no fosfomycin resistance. Among E. coli, 10.6% were ESBL positive and 24.9% had MDR. Birth outside the U.S.A., prior (2 year) trimethoprim/sulfamethoxazole resistance, and diabetes mellitus were associated with trimethoprim/sulfamethoxazole resistance. Prior (60 day) fluoroquinolone use, prior ciprofloxacin resistance and both diabetes mellitus and hypertension were strongly associated with ciprofloxacin resistance. Prior fluoroquinolone use and a history of resistance to any studied antibiotic were associated with MDR, while pregnancy was protective.
CONCLUSIONS: We found elevated resistance to UTI-relevant antimicrobials and novel factors associated with resistance; these data can be incorporated into clinical decision tools to improve organism and drug concordance.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:79 |
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| Enthalten in: |
The Journal of antimicrobial chemotherapy - 79(2024), 3 vom: 01. März, Seite 559-563 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Valentine-King, Marissa [VerfasserIn] |
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| Links: |
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| Themen: |
5E8K9I0O4U |
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| Anmerkungen: |
Date Completed 04.03.2024 Date Revised 04.03.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/jac/dkae004 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM367083973 |
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| 100 | 1 | |a Valentine-King, Marissa |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Determining a urinary-specific antibiogram and risk factors of trimethoprim/sulfamethoxazole, ciprofloxacin and multidrug resistance among Enterobacterales in primary care |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 04.03.2024 | ||
| 500 | |a Date Revised 04.03.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Risk factors for ciprofloxacin or MDR in primary care urine specimens are not well defined | ||
| 520 | |a OBJECTIVES: We created a primary care-specific antibiogram for Escherichia coli isolates from cases with complicated and uncomplicated urinary tract infection (UTI) and evaluated risk factors for ciprofloxacin, trimethoprim/sulfamethoxazole and MDR among Enterobacterales | ||
| 520 | |a METHODS: We conducted a cross-sectional study to determine resistance and risk factors by collecting urine cultures from all patients (≥18 years) presenting with provider-suspected UTI at two primary care, safety-net clinics in Houston, TX, USA between November 2018 and March 2020 | ||
| 520 | |a RESULTS: Among 1262 cultures, 308 cultures grew 339 uropathogens. Patients with Enterobacterales (n = 199) were mostly female (93.5%) with a mean age of 48.5 years. E. coli was the predominant uropathogen isolated (n = 187/339; 55%) and had elevated trimethoprim/sulfamethoxazole (43.6%) and ciprofloxacin (29.5%) resistance, low nitrofurantoin (1.8%) resistance, and no fosfomycin resistance. Among E. coli, 10.6% were ESBL positive and 24.9% had MDR. Birth outside the U.S.A., prior (2 year) trimethoprim/sulfamethoxazole resistance, and diabetes mellitus were associated with trimethoprim/sulfamethoxazole resistance. Prior (60 day) fluoroquinolone use, prior ciprofloxacin resistance and both diabetes mellitus and hypertension were strongly associated with ciprofloxacin resistance. Prior fluoroquinolone use and a history of resistance to any studied antibiotic were associated with MDR, while pregnancy was protective | ||
| 520 | |a CONCLUSIONS: We found elevated resistance to UTI-relevant antimicrobials and novel factors associated with resistance; these data can be incorporated into clinical decision tools to improve organism and drug concordance | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Ciprofloxacin |2 NLM | |
| 650 | 7 | |a 5E8K9I0O4U |2 NLM | |
| 650 | 7 | |a Trimethoprim, Sulfamethoxazole Drug Combination |2 NLM | |
| 650 | 7 | |a 8064-90-2 |2 NLM | |
| 650 | 7 | |a Fluoroquinolones |2 NLM | |
| 700 | 1 | |a Hansen, Michael A |e verfasserin |4 aut | |
| 700 | 1 | |a Zoorob, Roger |e verfasserin |4 aut | |
| 700 | 1 | |a Schlueter, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a Matas, Jennifer L |e verfasserin |4 aut | |
| 700 | 1 | |a Willis, Samuel E |e verfasserin |4 aut | |
| 700 | 1 | |a Danek, Lisa C K |e verfasserin |4 aut | |
| 700 | 1 | |a Muldrew, Kenneth |e verfasserin |4 aut | |
| 700 | 1 | |a Zare, Mohammad |e verfasserin |4 aut | |
| 700 | 1 | |a Hudson, Forrest |e verfasserin |4 aut | |
| 700 | 1 | |a Atmar, Robert L |e verfasserin |4 aut | |
| 700 | 1 | |a Chou, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Trautner, Barbara W |e verfasserin |4 aut | |
| 700 | 1 | |a Grigoryan, Larissa |e verfasserin |4 aut | |
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