Abstract
BackgroundThis retrospective cohort study characterized the impact of prior antibiotic exposure on distribution and nonsusceptibility profiles of Gram-negative pathogens causing hospital-onset urinary tract infections (UTI).MethodsHospital patients with positive urine culture for Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and other Enterobacteriaceae ≥3 days after hospital admission were included. Assessment outcomes included the distribution of bacteria in urine cultures, antibiotic susceptibility patterns, and the effect of prior antibiotic exposure, defined as 0, 1, or ≥2 prior antibiotics, on the distribution and antibiotic susceptibility profiles of the Gram-negative organisms.ResultsThe most commonly isolated pathogens from 5574 unique UTI episodes (2027 with and 3547 without prior antibiotic exposure) were E. coli (49.5%), K. pneumoniae (17.1%), and P. aeruginosa (8.2%). P. aeruginosa was significantly more commonly isolated in patients with ≥2 prior antibiotic exposures (12.6%) compared with no exposure (8.2%; p = 0.036) or 1 prior exposure (7.9%; p = 0.025). Two or more prior antibiotic exposures were associated with slightly higher incidences of fluoroquinolone nonsusceptibility, multidrug resistance, and extended-spectrum β-lactamase phenotype compared with 0 or 1 exposure, suggesting an increased risk for resistant Gram-negative pathogens among hospital patients with urinary tract infections occurring ≥3 days after admission.ConclusionsClinicians should critically assess prior antibiotic exposure when selecting empirical therapy for patients with hospital-onset urinary tract infections caused by Gram-negative pathogens.
Highlights
This retrospective cohort study characterized the impact of prior antibiotic exposure on distribution and nonsusceptibility profiles of Gram-negative pathogens causing hospital-onset urinary tract infections (UTI)
Considering the limitations associated with an antibiogram-only approach to empirical antibiotic selection, this study was designed to characterize the impact of prior antibiotic exposure on the distribution and nonsusceptibility profiles of key Gram-negative pathogens among US inpatients with hospital-onset UTIs
A total of 5574 unique UTI episodes were included in the analysis (n = 2027 prior antibiotic exposure; n = 3547 no prior exposure), from which 6093 pathogens were isolated (n = 2227 from patients with prior antibiotic exposure; n = 3866 from patients with no prior exposure)
Summary
This retrospective cohort study characterized the impact of prior antibiotic exposure on distribution and nonsusceptibility profiles of Gram-negative pathogens causing hospital-onset urinary tract infections (UTI). Increasing antibiotic resistance among Gram-negative pathogens, in the hospital setting, is well documented and constitutes a major public health concern [1, 2]. Gram-negative organisms are implicated in a number of hospital-acquired infections, with urinary tract infections (UTIs) common [1, 3]. Considering the limitations associated with an antibiogram-only approach to empirical antibiotic selection, this study was designed to characterize the impact of prior antibiotic exposure on the distribution and nonsusceptibility profiles of key Gram-negative pathogens among US inpatients with hospital-onset UTIs. We focused on this single modifiable risk factor because it is readily identifiable and accessible in the medical record system for all patients. Other possible patient risk factors were not included in the analysis so that a simple and straightforward guide to empirical antibiotic selection could be created
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