Abstract
BackgroundBacterial resistance to first line antibiotics used to treat community-onset urinary tract infections (UTIs) continues to emerge. We sought to determine the association between extended-spectrum cephalosporin resistance (ESC-R) and recurrence among Enterobacteriaceae (EB) UTIs.MethodsA retrospective cohort study was performed. All patients presenting to the Emergency Departments (EDs) or outpatient practices in a large health system with EB UTIs between 2010 and 2013 were included. Exposed patients had ESC-R EB UTIs. Unexposed patients had ESC-susceptible EB UTIs and were matched to exposed patients 1:1 on study year. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between ESC-R EB UTI and time to recurrent UTI within 12 months.ResultsA total of 302 patients with an index community-onset EB UTI were included, with 151 exposed and 151 unexposed. Overall, 163 (54%) patients experienced a recurrent UTI with a median time to recurrence of 69 days (interquartile range 25–183). On multivariable analyses, ESC-resistance was associated with an increased hazard of recurrent UTI (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.01–1.91, P = 0.04). Other variables that were independently associated with recurrence included a history of UTI prior to the index UTI and presence of a urinary catheter at the time of the index UTI. Secondarily, we found that when the treatment for the index UTI was adjusted for, there was no longer a significant association between ESC-R status and time to recurrent UTI (aHR 1.26, 95% CI 0.91–1.76, P = 0.17).ConclusionsCommunity-onset UTI due to EB demonstrating ESC-resistance is associated with a significantly increased hazard of recurrent UTI within 12 months compared to ESC-susceptible EB, even after adjusting for baseline factors that predispose patients to UTI recurrence. This association appears to be driven primarily by delayed or inappropriate treatment for the index ESC-R EB UTI.
Highlights
Bacterial resistance to first line antibiotics used to treat community-onset urinary tract infections (UTIs) continues to emerge
Secondary analyses In secondary exploratory analyses, we evaluated whether the association between extended-spectrum cephalosporin resistance (ESC-R) EB index UTI and time to recurrent UTI was impacted by prompt administration of antibiotics for the index UTI
We found that ESC-R EB UTI was associated with an increased hazard of recurrent UTI
Summary
Bacterial resistance to first line antibiotics used to treat community-onset urinary tract infections (UTIs) continues to emerge. We sought to determine the association between extended-spectrum cephalosporin resistance (ESC-R) and recurrence among Enterobacteriaceae (EB) UTIs. Urinary tract infections (UTIs) are the most common bacterial infection among adults in the community [1], and there is significant bacterial resistance to first-line antibiotics used to treat UTIs in ambulatory settings [2]. There have been increasing reports of extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) UTIs in the outpatient setting [3,4,5,6,7]. In post-menopausal women, the risk for recurrence is as high as 80% in the following 12 months, with a mean of three recurrences during this period [8]. Known risk factors for recurrent UTI include female gender, sexual activity, diabetes mellitus, obesity, and anatomic abnormalities of the genitourinary tract [10]
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