Antimicrobial Susceptibility and Cross-Resistance Patterns Among Common Complicated Urinary Tract Infections in U.S. Hospitals, 2013 to 2018

Overview

Journal Antimicrob Agents Chemother

Publisher American Society for Microbiology

Specialty Pharmacology

Date 2020 May 20

PMID 32423953

Citations 19

Authors

Marya D Zilberberg

Brian H Nathanson

Kate Sulham

Andrew F Shorr

Affiliations

Soon will be listed here.

Abstract

In the face of increasing rates of antimicrobial resistance in complicated urinary tract infections (cUTIs), clinicians need to understand cross-resistance patterns among commonly encountered pathogens. We performed a multicenter, retrospective cohort study in the Premier database of approximately 180 hospitals, from 2013 to 2018. Using an ICD-9/10-based algorithm, we identified all adult patients hospitalized with cUTIs 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/SMZ], fosfomycin [FFM], and nitrofurantoin [NFT]) singly and in groups of two. Among 28,057 organisms from 23,331 patients, the 3 most common pathogens were (41.0%; C3, 15.1%), (12.1%; C3, 13.2%), and (11.0%; C3, 12.0%). was most frequently resistant to FQ (43.5%) and least to NFT (6.7%). was most frequently resistant to NFT (60.8%) and least to FFM (0.1%). was most frequently resistant to FQ (34.4%) and least to TMP/SMZ (4.2%). Of the C3 isolates, 87.1% were also FQ, 63.7% were TMP/SMZ, and 13.3% were NFT C3 isolates had a 76.5% chance of being FQ, 78.1% were TMP/SMZ, and 77.6% were NFT C3 coexisted with FQ in 47.3%, TMP/SMZ in 18.9%, and NFT in 28.7%. Among the most common pathogens isolated from hospitalized patients with cUTIs, 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 empirical therapy more precisely.

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