Antimicrobial susceptibility and cross-resistance patterns among common complicated urinary tract infections in US hospitals, 2013-2018.

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Citation: Antimicrobial Agents & Chemotherapy. 2020 May 18PMID: 32423953Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020Local holdings: Available online from MWHC library: 1972 - present (after 4 months), Available in print through MWHC library: July 1996 - 2006ISSN:
  • 0066-4804
Name of journal: Antimicrobial agents and chemotherapyAbstract: Background: In the face of increasing rates of antimicrobial resistance in complicated urinary tract infections (cUTI), clinicians need to understand cross-resistance patterns among commonly encountered pathogens. Methods: We performed a multicenter, retrospective cohort study in the Premier database of approximately 180 hospitals, 2013-2018. Using an ICD-9/10-based algorithm we identified all adult patients hospitalized with cUTI and included those with a positive blood or urine culture. We examined the microbiology and susceptibilities to common cUTI antimicrobials (3rd generation cephalosporin [C3], fluoroquinolones [FQ], trimethoprim-sulfamethoxazole [TMP/SMX], fosfomycin [FFM], and nitrofurantoin [NFT]) singly and in groups of two. Results: Among 28,057 organisms from 23,331 patients, the 3 most common pathogens were E. coli (41.0%, C3R 15.1%), K. pneumoniae (12.1%, C3R 13.2%), and P. aeruginosa (11.0%, C3R 12.0%). E. coli was most frequently resistant to FQ (43.5%) and least to NFT (6.7%). K. pneumoniae was most frequently resistant to NFT (60.8%) and least to FFM (0.1%). P. aeruginosa was most frequently resistant to FQ (34.4%) and least to TMP/SMX (4.2%). Of the C3R E. coli, 87.1% were also FQR, 63.7% TMP/SMX-R, and 13.3% NFTR. C3R K. pneumoniae had a 76.5% chance of being FQR, 78.1% TMP/SMZ-R, and 77.6% NFTR. C3R P. aeruginosa coexisted with FQR in 47.3%, TMP/SMZ-R in 18.9%, and NFTR in 28.7%. Conclusions: Among the most common pathogens isolated from hospitalized patients with cUTI, the rates of single resistance to common treatments and of cross-resistance to these regimens are substantial. Knowing the patterns of cross-resistance may help clinicians tailor empiric therapy more precisely. Copyright (c) 2020 American Society for Microbiology.All authors: Nathanson BH, Shorr AF, Sulham K, Zilberberg MDFiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32423953 Available 32423953

Available online from MWHC library: 1972 - present (after 4 months), Available in print through MWHC library: July 1996 - 2006

Background: In the face of increasing rates of antimicrobial resistance in complicated urinary tract infections (cUTI), clinicians need to understand cross-resistance patterns among commonly encountered pathogens. Methods: We performed a multicenter, retrospective cohort study in the Premier database of approximately 180 hospitals, 2013-2018. Using an ICD-9/10-based algorithm we identified all adult patients hospitalized with cUTI and included those with a positive blood or urine culture. We examined the microbiology and susceptibilities to common cUTI antimicrobials (3rd generation cephalosporin [C3], fluoroquinolones [FQ], trimethoprim-sulfamethoxazole [TMP/SMX], fosfomycin [FFM], and nitrofurantoin [NFT]) singly and in groups of two. Results: Among 28,057 organisms from 23,331 patients, the 3 most common pathogens were E. coli (41.0%, C3R 15.1%), K. pneumoniae (12.1%, C3R 13.2%), and P. aeruginosa (11.0%, C3R 12.0%). E. coli was most frequently resistant to FQ (43.5%) and least to NFT (6.7%). K. pneumoniae was most frequently resistant to NFT (60.8%) and least to FFM (0.1%). P. aeruginosa was most frequently resistant to FQ (34.4%) and least to TMP/SMX (4.2%). Of the C3R E. coli, 87.1% were also FQR, 63.7% TMP/SMX-R, and 13.3% NFTR. C3R K. pneumoniae had a 76.5% chance of being FQR, 78.1% TMP/SMZ-R, and 77.6% NFTR. C3R P. aeruginosa coexisted with FQR in 47.3%, TMP/SMZ-R in 18.9%, and NFTR in 28.7%. Conclusions: Among the most common pathogens isolated from hospitalized patients with cUTI, the rates of single resistance to common treatments and of cross-resistance to these regimens are substantial. Knowing the patterns of cross-resistance may help clinicians tailor empiric therapy more precisely. Copyright (c) 2020 American Society for Microbiology.

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