Abstract
A specific antibiogram is necessary for the empiric antibiotic treatment of community-acquired urinary tract infections (UTI) because of the global spread of antimicrobial resistance. This study aimed to develop an antibiogram specific for community-acquired UTI and assess the risk factors associated with community-acquired UTI caused by antimicrobial-resistant organisms. This cross-sectional observational retrospective study included patients with community-acquired UTI caused by Gram-negative rods (GNR) who were admitted to the emergency department at a tertiary care hospital in Ibaraki, Japan, in 2017–2018. A total of 172 patients were enrolled (including 38 nursing home residents). Of the 181 GNR strains considered as causative agents, 135 (75%) were Escherichia coli, and 40 (22%) exhibited third-generation cephalosporin resistance. Extended-spectrum β-lactamase (ESBL)-producing E. coli accounted for 25/40 (63%) of resistant GNR. Overall susceptibility rate of Enterobacterales was 92%, 81%, 100%, 75%, and 89% for cefmetazole, ceftriaxone, meropenem, levofloxacin, and trimethoprim–sulfamethoxazole, respectively. Residence in a nursing home (odds ratio (OR), 2.83; 95% confidence interval (CI), 1.18–6.79) and recent antibiotic use (OR, 4.52; 95% CI, 1.02–19.97) were independent risk factors for UTI with resistant GNR. ESBL-producing E. coli was revealed to have a strong impact on antimicrobial resistance pattern. Therefore, an antibiotic strategy based on a disease-specific antibiogram is required.
Highlights
Urinary tract infection (UTI) is a common infectious disease worldwide [1,2,3]
172 patients who had community-acquired UTI caused by Gram-negative rods (GNR) were included in the analyses
40 resistant GNR strains were isolated from 37 patients, and were classified as the resistant GNR group
Summary
Urinary tract infection (UTI) is a common infectious disease worldwide [1,2,3]. Lower UTIs such as cystitis are usually treated in the outpatient setting. Upper UTIs such as pyelonephritis or kidney abscess are often complicated by sepsis and/or bacteremia [4]; intravenous empiric antibiotic therapy and hospitalization are frequently required. UTIs are caused by several different types of bacteria, so-called uropathogens. While Escherichia coli is the most frequent causative agent, other Enterobacterales, enterococci, and Pseudomonas aeruginosa cause UTIs. Over the past decade, antimicrobial resistance has become a global threat [4,5,6]. The mechanisms of β-lactam resistance in Enterobacterales include extended-spectrum β-lactamases (ESBL), AmpC, Antibiotics 2020, 9, 438; doi:10.3390/antibiotics9080438 www.mdpi.com/journal/antibiotics
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