Clinical Setting Comparative Analysis of Uropathogens and Antibiotic Resistance: A Retrospective Study Spanning the Coronavirus Disease 2019 Pandemic

Overview

Journal Open Forum Infect Dis

Specialty Infectious Diseases

Date 2024 Feb 9

PMID 38333882

Authors

Alexandra M Young

Mark M Tanaka

Christopher Yuwono

Michael C Wehrhahn

Li Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Antimicrobial resistance (AMR) in uropathogens has been increasing in Australia. Many nations observed heightened AMR during the coronavirus disease 2019 (COVID-19) pandemic, but it is not known how this may vary across clinical settings and in nations with lower infection rates.

Methods: We investigated the uropathogen composition and corresponding antibiotic resistance of 775 559 Australian isolates from the community, hospitals, and aged care facilities before (2016-2019) and during (2020-2022) the COVID-19 pandemic. A mathematical model was developed to predict the likelihood of resistance to currently recommended antibiotics for treating urinary tract infections (UTIs).

Results: Among uropathogens originating from the community, hospitals, and aged care facilities, accounted for 71.4%, 57.6%, and 65.2%, respectively. During the COVID-19 pandemic period, there was an increase in UTIs caused by across all settings. Uropathogens from aged care and hospitals frequently showed higher resistance to antibiotics compared to those isolated from the community. Interestingly, AMR among uropathogens showed a declining trend during the COVID-19 pandemic. Based on the resistance patterns of the past 3 years, our modeling predicted that 30%, 42.6%, and 38.8% of UTIs in the community, hospitals, and aged care facilities, respectively, would exhibit resistance to trimethoprim treatment as empirical therapy. In contrast, resistance to nitrofurantoin was predicted to be 14.6%, 26%, and 24.1% from these 3 respective settings.

Conclusions: Empirical therapy of UTIs in Australia with trimethoprim requires evaluation due to high rates of resistance observed across clinical settings.

Citing Articles

Shifting Trends of Antimicrobial Resistance Patterns Among Uropathogenic Bacteria Before and During the COVID-19 Pandemic.

AlHemsi H, Altamimi I, Altamimi A, Alhemsi H, Alabdulkarim I, Zawawi A Cureus. 2024; 16(11):e73267.

PMID: 39650875 PMC: 11625378. DOI: 10.7759/cureus.73267.

References

Lopez-Jacome L, Fernandez-Rodriguez D, Franco-Cendejas R, Camacho-Ortiz A, Morfin-Otero M, Rodriguez-Noriega E . Increment Antimicrobial Resistance During the COVID-19 Pandemic: Results from the Invifar Network. Microb Drug Resist. 2021; 28(3):338-345. DOI: 10.1089/mdr.2021.0231. View

Lemay-St-Denis C, Diwan S, Pelletier J . The Bacterial Genomic Context of Highly Trimethoprim-Resistant DfrB Dihydrofolate Reductases Highlights an Emerging Threat to Public Health. Antibiotics (Basel). 2021; 10(4). PMC: 8103504. DOI: 10.3390/antibiotics10040433. View

Cuningham W, Perera S, Coulter S, Nimmo G, Yarwood T, Tong S . Antibiotic resistance in uropathogens across northern Australia 2007-20 and impact on treatment guidelines. JAC Antimicrob Resist. 2021; 3(3):dlab127. PMC: 8364662. DOI: 10.1093/jacamr/dlab127. View

Fasugba O, Mitchell B, Mnatzaganian G, Das A, Collignon P, Gardner A . Five-Year Antimicrobial Resistance Patterns of Urinary Escherichia coli at an Australian Tertiary Hospital: Time Series Analyses of Prevalence Data. PLoS One. 2016; 11(10):e0164306. PMC: 5053592. DOI: 10.1371/journal.pone.0164306. View

Langford B, Soucy J, Leung V, So M, Kwan A, Portnoff J . Antibiotic resistance associated with the COVID-19 pandemic: a systematic review and meta-analysis. Clin Microbiol Infect. 2022; 29(3):302-309. PMC: 9733301. DOI: 10.1016/j.cmi.2022.12.006. View

Tham N, Fazio T, Johnson D, Skandarajah A, Hayes I . Hospital Acquired Infections in Surgical Patients: Impact of COVID-19-Related Infection Prevention Measures. World J Surg. 2022; 46(6):1249-1258. PMC: 8985564. DOI: 10.1007/s00268-022-06539-4. View

Gupta K, Hooton T, Naber K, Wullt B, Colgan R, Miller L . International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011; 52(5):e103-20. DOI: 10.1093/cid/ciq257. View

Peng Z, Hayen A, Hall J, Liu B . Microbiology testing and antibiotic treatment for urinary tract infections in general practice: a nationwide observational study. Infection. 2020; 49(2):249-255. DOI: 10.1007/s15010-020-01512-6. View

Velasquez-Garcia L, Mejia-Sanjuanelo A, Viasus D, Carratala J . Causative Agents of Ventilator-Associated Pneumonia and Resistance to Antibiotics in COVID-19 Patients: A Systematic Review. Biomedicines. 2022; 10(6). PMC: 9220146. DOI: 10.3390/biomedicines10061226. View

10.

Mares C, Petca R, Petca A, Popescu R, Jinga V . Does the COVID Pandemic Modify the Antibiotic Resistance of Uropathogens in Female Patients? A New Storm?. Antibiotics (Basel). 2022; 11(3). PMC: 8944623. DOI: 10.3390/antibiotics11030376. View

11.

Bahce Y, Acer O, Ozudogru O . Evaluation of bacterial agents isolated from endotracheal aspirate cultures of Covid-19 general intensive care patients and their antibiotic resistance profiles compared to pre-pandemic conditions. Microb Pathog. 2022; 164:105409. PMC: 8760848. DOI: 10.1016/j.micpath.2022.105409. View

12.

Yang X, Chen H, Zheng Y, Qu S, Wang H, Yi F . Disease burden and long-term trends of urinary tract infections: A worldwide report. Front Public Health. 2022; 10:888205. PMC: 9363895. DOI: 10.3389/fpubh.2022.888205. View

13.

Flores-Mireles A, Walker J, Caparon M, Hultgren S . Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015; 13(5):269-84. PMC: 4457377. DOI: 10.1038/nrmicro3432. View

14.

Sturm L, Saake K, Roberts P, Masoudi F, Fakih M . Impact of COVID-19 pandemic on hospital onset bloodstream infections (HOBSI) at a large health system. Am J Infect Control. 2021; 50(3):245-249. PMC: 8714610. DOI: 10.1016/j.ajic.2021.12.018. View

15.

Mulder M, Verbon A, Lous J, Goessens W, Stricker B . Use of other antimicrobial drugs is associated with trimethoprim resistance in patients with urinary tract infections caused by E. coli. Eur J Clin Microbiol Infect Dis. 2019; 38(12):2283-2290. PMC: 6858404. DOI: 10.1007/s10096-019-03672-2. View

16.

Davey A, Tapley A, Mulquiney K, van Driel M, Fielding A, Holliday E . Management of urinary tract infection by early-career general practitioners in Australia. J Eval Clin Pract. 2019; 26(6):1703-1710. DOI: 10.1111/jep.13340. View

17.

van den Dool C, Haenen A, Leenstra T, Wallinga J . The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network. Infect Control Hosp Epidemiol. 2016; 37(7):761-7. PMC: 4926272. DOI: 10.1017/ice.2016.59. View

18.

Gillies M, Burgner D, Ivancic L, Nassar N, Miller J, Sullivan S . Changes in antibiotic prescribing following COVID-19 restrictions: Lessons for post-pandemic antibiotic stewardship. Br J Clin Pharmacol. 2021; 88(3):1143-1151. PMC: 8444718. DOI: 10.1111/bcp.15000. View

19.

Pouwels K, Freeman R, Muller-Pebody B, Rooney G, Henderson K, Robotham J . Association between use of different antibiotics and trimethoprim resistance: going beyond the obvious crude association. J Antimicrob Chemother. 2018; 73(6):1700-1707. DOI: 10.1093/jac/dky031. View

20.

Raz R, Colodner R, Kunin C . Who are you--Staphylococcus saprophyticus?. Clin Infect Dis. 2005; 40(6):896-8. DOI: 10.1086/428353. View