High prevalence of fluoroquinolone-resistant UTI among US emergency department patients diagnosed with urinary tract infection, 2018-2020.

Autor: Faine BA; Department of Emergency Medicine and Pharmacy, University of Iowa Hospitals and Clinics, Hawkins, Iowa, USA., Rech MA; Department of Emergency Medicine, Loyola University Medical Center, Maywood, Illinois, USA., Vakkalanka P; Department of Emergency Medicine, University of Iowa, Coralville, Iowa, USA., Gross A; University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA., Brown C; Assistant Professor of Pharmacy and Emergency Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA., Harding SJ; Infectious Diseases Clinical Pharmacy Specialist, Wesley Medical Center, Wichita, Kansas, USA., Slocum G; Emergency Medicine Clinical Pharmacy Specialist, Assistant Professor, Department of Pharmacy Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA., Zimmerman D; Associate Professor of Pharmacy at Duquesne University School of Pharmacy, Emergency Medicine Pharmacist at University of Pittsburgh Medical Center- Mercy Hospital, Pittsburgh, Pennsylvania, USA., Zepeski A; Emergency Medicine Clinical Pharmacist, University of Iowa, Iowa City, Iowa, USA., Rewitzer S; Methodist Hospital, St. Louis Park, Minnesota, USA., Howington GT; Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Emergency Medicine Clinical Pharmacy Specialist, Lexington, Kentucky, USA., Campbell M; Emergency Medicine Clinical Coordinator, Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio, USA., Dawson J; Emergency Medicine and Critical Care, Denver Health Medical Center, Denver, Colorado, USA., Treu CN; New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA., Nelson L; Emergency Center Pharmacist Lead, Park Nicollet, Methodist Hospital, Saint Louis Park, Minnesota, USA., Jones M; Emergency Medicine Clinical Pharmacy Specialist, UK HealthCare, Fellow, Center for Interprofessional Healthcare Education, University of Kentucky, Lexington, Kentucky, USA., Flack T; Emergency Medicine Clinical Pharmacist, Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA., Porter B; Emergency Medicine Pharmacist Clinician, University of Vermont Medical Center, Burlington, Vermont, USA., Sarangarm P; University of New Mexico Hospital, Albuquerque, New Mexico, USA., Mattson AE; Emergency Medicine Clinical Pharmacist, Instructor of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA., Bailey A; Emergency Medicine University of Kentucky HealthCare, Lexington, Kentucky, USA., Kelly G; Rutgers Ernest Mario College of Pharmacy, Emergency Medicine Clinical Pharmacy Specialist, Robert Wood Johnson University Hospital-New Brunswick, New Brunswick, New Jersey, USA., Talan DA; The David Geffen School of Medicine at UCLA, Chairman Emeritus, Dept. of Emergency Medicine, Faculty, Division of Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, California, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2022 Sep; Vol. 29 (9), pp. 1096-1105. Date of Electronic Publication: 2022 Aug 05.
DOI: 10.1111/acem.14545
Abstrakt: Background: Uropathogen resistance, fluoroquinolone-resistance (FQR), and extended spectrum beta-lactamase (ESBL), has been observed to be emerging worldwide with prevalences above recommended thresholds for routine empirical treatment. The primary aim of our study was to determine the prevalence of FQR from a geographically diverse sample of United States emergency departments (EDs).
Methods: We conducted a multi-center, observational cohort study using a network of 15 geographically diverse US EDs. All patients ≥18 years of age with the primary or secondary diagnosis of urinary tract infection (UTI) in the ED identified using International Classification of Diseases (ICD-10) diagnosis code of cystitis, pyelonephritis, or UTI from 2018 to 2020 were included. We calculated descriptive statistics for uropathogens and susceptibilities. Logistic regression analysis was used to identify antimicrobial resistance risk factors associated with FQR Escherichia coli.
Results: Among 3779 patients who met inclusion criteria, median age was 62.9 years (interquartile range [IQR]: 41-77.6) and 76.3% were female. The most common diagnoses were complicated (41.2%) and uncomplicated cystitis (40.3%). E. coli was the most common pathogen (63.2%), followed by Klebsiella pneumoniae (13.2%) and Enterococcus species (5.8%). Across all sites, overall E. coli FQ-resistance prevalence was 22.1%, ranging from 10.5 to 29.7% by site. The prevalence of ESBL-producing uropathogen was 7.4%, ranging from 3.6% to 11.6% by site. Previous IV or oral antimicrobial use in the past 90-days and history of a multi-drug resistant pathogen were associated with FQ-resistant E. coli (odds ratio [OR] 2.68, 95% confidence interval [CI]: 2.04-3.51, and OR 6.93, 95% CI: 4.95-9.70, respectively). Of the patients who had FQ-resistant E. coli or an ESBL-producing uropathogen isolated, 116 (37.1%) and 61 (36.7%) did not have any documented risk factors for resistance.
Conclusion: FQ-resistant E. coli is widely prevalent across US sites highlighting the need for ongoing monitoring of antimicrobial resistance and, at some locations, modification of empirical treatments.
(© 2022 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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