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Older patient age and prior antimicrobial use strongly predict antimicrobial resistance in Escherichia coli isolates recovered from urinary tract infections among female outpatients

BACKGROUND: Increasing prevalence of antimicrobial resistance (AMR), including multidrug resistance (MDR), among Escherichia coli (E. coli) makes treatment of uncomplicated urinary tract infection (uUTI) difficult. We assessed risk factors for fluoroquinolone (FQ)-not-susceptible (NS) and MDR E. col...

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Autores principales: Mitrani-Gold, Fanny S., Kaye, Keith S., Gupta, Vikas, Mulgirigama, Aruni, Trautner, Barbara W., Scangarella-Oman, Nicole E., Yu, Kalvin C., Ye, Gang, Joshi, Ashish V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174568/
https://www.ncbi.nlm.nih.gov/pubmed/37167277
http://dx.doi.org/10.1371/journal.pone.0285427
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author Mitrani-Gold, Fanny S.
Kaye, Keith S.
Gupta, Vikas
Mulgirigama, Aruni
Trautner, Barbara W.
Scangarella-Oman, Nicole E.
Yu, Kalvin C.
Ye, Gang
Joshi, Ashish V.
author_facet Mitrani-Gold, Fanny S.
Kaye, Keith S.
Gupta, Vikas
Mulgirigama, Aruni
Trautner, Barbara W.
Scangarella-Oman, Nicole E.
Yu, Kalvin C.
Ye, Gang
Joshi, Ashish V.
author_sort Mitrani-Gold, Fanny S.
collection PubMed
description BACKGROUND: Increasing prevalence of antimicrobial resistance (AMR), including multidrug resistance (MDR), among Escherichia coli (E. coli) makes treatment of uncomplicated urinary tract infection (uUTI) difficult. We assessed risk factors for fluoroquinolone (FQ)-not-susceptible (NS) and MDR E. coli among US female outpatients. METHODS: This retrospective cohort study utilized data from female outpatients aged ≥ 12 years with E. coli positive urine culture and oral antimicrobial prescription ± 1 day from index. We assessed patient-level factors within 90 and 91–360 days prior to index as predictors of FQ NS (intermediate/resistant) and MDR (NS to ≥ 1 drug across ≥ 3 classes) E. coli: age, prior oral antimicrobial dispensing, prior AMR phenotypes, prior urine culture, and prior hospitalization. RESULTS: Among 1,858 outpatients with urine-isolated E. coli, 369 (19.9%) had FQ NS and 59 (3.2%) had MDR isolates. After multivariable adjustment, independent risk factors (p < 0.03) for FQ NS E. coli were older age, prior FQ NS isolates, prior dispensing of FQ, and dispensing of any oral antibiotic. Independent risk factors (p < 0.02) for MDR were prior extended-spectrum β-lactamase-producing isolates (ESBL+), prior FQ dispensing, and prior oral antibiotic dispensing. CONCLUSIONS: In women with uUTI due to E. coli, prior dispensing of FQ or any oral antibiotic within 90 days predicted FQ NS and MDR urine E. coli. Prior urine culture with FQ NS isolates and older age were predictive of FQ NS E. coli. Prior ESBL+ was predictive of MDR E. coli. These data could help identify patients at risk for AMR E. coli and inform empiric prescribing.
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spelling pubmed-101745682023-05-12 Older patient age and prior antimicrobial use strongly predict antimicrobial resistance in Escherichia coli isolates recovered from urinary tract infections among female outpatients Mitrani-Gold, Fanny S. Kaye, Keith S. Gupta, Vikas Mulgirigama, Aruni Trautner, Barbara W. Scangarella-Oman, Nicole E. Yu, Kalvin C. Ye, Gang Joshi, Ashish V. PLoS One Research Article BACKGROUND: Increasing prevalence of antimicrobial resistance (AMR), including multidrug resistance (MDR), among Escherichia coli (E. coli) makes treatment of uncomplicated urinary tract infection (uUTI) difficult. We assessed risk factors for fluoroquinolone (FQ)-not-susceptible (NS) and MDR E. coli among US female outpatients. METHODS: This retrospective cohort study utilized data from female outpatients aged ≥ 12 years with E. coli positive urine culture and oral antimicrobial prescription ± 1 day from index. We assessed patient-level factors within 90 and 91–360 days prior to index as predictors of FQ NS (intermediate/resistant) and MDR (NS to ≥ 1 drug across ≥ 3 classes) E. coli: age, prior oral antimicrobial dispensing, prior AMR phenotypes, prior urine culture, and prior hospitalization. RESULTS: Among 1,858 outpatients with urine-isolated E. coli, 369 (19.9%) had FQ NS and 59 (3.2%) had MDR isolates. After multivariable adjustment, independent risk factors (p < 0.03) for FQ NS E. coli were older age, prior FQ NS isolates, prior dispensing of FQ, and dispensing of any oral antibiotic. Independent risk factors (p < 0.02) for MDR were prior extended-spectrum β-lactamase-producing isolates (ESBL+), prior FQ dispensing, and prior oral antibiotic dispensing. CONCLUSIONS: In women with uUTI due to E. coli, prior dispensing of FQ or any oral antibiotic within 90 days predicted FQ NS and MDR urine E. coli. Prior urine culture with FQ NS isolates and older age were predictive of FQ NS E. coli. Prior ESBL+ was predictive of MDR E. coli. These data could help identify patients at risk for AMR E. coli and inform empiric prescribing. Public Library of Science 2023-05-11 /pmc/articles/PMC10174568/ /pubmed/37167277 http://dx.doi.org/10.1371/journal.pone.0285427 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Mitrani-Gold, Fanny S.
Kaye, Keith S.
Gupta, Vikas
Mulgirigama, Aruni
Trautner, Barbara W.
Scangarella-Oman, Nicole E.
Yu, Kalvin C.
Ye, Gang
Joshi, Ashish V.
Older patient age and prior antimicrobial use strongly predict antimicrobial resistance in Escherichia coli isolates recovered from urinary tract infections among female outpatients
title Older patient age and prior antimicrobial use strongly predict antimicrobial resistance in Escherichia coli isolates recovered from urinary tract infections among female outpatients
title_full Older patient age and prior antimicrobial use strongly predict antimicrobial resistance in Escherichia coli isolates recovered from urinary tract infections among female outpatients
title_fullStr Older patient age and prior antimicrobial use strongly predict antimicrobial resistance in Escherichia coli isolates recovered from urinary tract infections among female outpatients
title_full_unstemmed Older patient age and prior antimicrobial use strongly predict antimicrobial resistance in Escherichia coli isolates recovered from urinary tract infections among female outpatients
title_short Older patient age and prior antimicrobial use strongly predict antimicrobial resistance in Escherichia coli isolates recovered from urinary tract infections among female outpatients
title_sort older patient age and prior antimicrobial use strongly predict antimicrobial resistance in escherichia coli isolates recovered from urinary tract infections among female outpatients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174568/
https://www.ncbi.nlm.nih.gov/pubmed/37167277
http://dx.doi.org/10.1371/journal.pone.0285427
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