Abstract
BackgroundUrinary tract infections are common and are increasingly resistant to antibiotic therapy. Northern Australia is a sparsely populated region with limited access to healthcare, a relatively high burden of disease, a substantial regional and remote population, and high rates of antibiotic resistance in skin pathogens.ObjectivesTo explore trends in antibiotic resistance for common uropathogens Escherichia coli and Klebsiella pneumoniae in northern Australia, and how these relate to current treatment guidelines in the community and hospital settings.MethodsWe used data from an antibiotic resistance surveillance system. We calculated the monthly and yearly percentage of isolates that were resistant in each antibiotic class, by bacterium. We analysed resistance proportions geographically and temporally, stratifying by healthcare setting. Using simple linear regression, we investigated longitudinal trends in monthly resistance proportions and correlation between community and hospital isolates.ResultsOur analysis included 177 223 urinary isolates from four pathology providers between 2007 and 2020. Resistance to most studied antibiotics remained <20% (for E. coli and K. pneumoniae, respectively, in 2019: amoxicillin/clavulanate 16%, 5%; cefazolin 17%, 8%; nitrofurantoin 1%, 31%; trimethoprim 36%, 17%; gentamicin 7%, 2%; extended-spectrum cephalosporins 8%, 5%), but many are increasing by 1%–3% (absolute) per year. Patterns of resistance were similar between isolates from community and hospital patients.ConclusionsAntibiotic resistance in uropathogens is increasing in northern Australia, but treatment guidelines generally remain appropriate for empirical therapy of patients with suspected infection (except trimethoprim in some settings). Our findings demonstrate the importance of local surveillance data (HOTspots) to inform clinical decision making and guidelines.
Highlights
Treatment guideline recommendations (Table 1) and available data,[15,16,17] our analysis focused on resistance in five antibiotic classes: b-lactamase inhibitor plus penicillin combinations, first-generation cephalosporins [cefazolin], fluoroquinolones, aminoglycosides and extendedspectrum cephalosporins (ESCs)
More narrow-spectrum agents such as cefalexin remain a better option than fluoroquinolones, which continue to be restricted for use in Australia.[36,37,38]
In northern Australia resistance in uropathogens is slowly increasing, but in most cases, guidelines remain appropriate for empirical therapy
Summary
Urinary tract infections (UTIs) are common infections predominantly caused by Gram-negative Enterobacterales and have a substantial health and economic impact in both the community and hospital setting.[1,2,3,4,5] The prevalence of healthcare-associated UTIs treated in Australian hospitals has been estimated at between1%–2%, increasing the patient length of stay by 3–5 days.[6,7] UTIs caused by Escherichia coli are consistently the most frequently occurring infections in Australian hospitals (7.85 episodes per 1000 patient days) and account for approximately 7% of antibiotic prescriptions (fourth most common indication).[8,9]Antibiotic resistance in UTI-causing organisms is common and of most concern in Australia are extended-spectrum b-lactamasesVC The Author(s) 2021. Urinary tract infections (UTIs) are common infections predominantly caused by Gram-negative Enterobacterales and have a substantial health and economic impact in both the community and hospital setting.[1,2,3,4,5] The prevalence of healthcare-associated UTIs treated in Australian hospitals has been estimated at between. Antibiotic resistance in UTI-causing organisms is common and of most concern in Australia are extended-spectrum b-lactamases. Northern Australia is a sparsely populated region with limited access to healthcare, a relatively high burden of disease, a substantial regional and remote population, and high rates of antibiotic resistance in skin pathogens
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call