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The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017

Urinary tract infections (UTIs) caused by Escherichia coli have been historically managed with oral antibiotics including the cephalosporins, fluoroquinolones and trimethoprim-sulfamethoxazole. The use of these agents is being compromised by the increase in extended spectrum β-lactamase (ESBL)-produ...

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Autores principales: Critchley, Ian A., Cotroneo, Nicole, Pucci, Michael J., Mendes, Rodrigo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903708/
https://www.ncbi.nlm.nih.gov/pubmed/31821338
http://dx.doi.org/10.1371/journal.pone.0220265
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author Critchley, Ian A.
Cotroneo, Nicole
Pucci, Michael J.
Mendes, Rodrigo
author_facet Critchley, Ian A.
Cotroneo, Nicole
Pucci, Michael J.
Mendes, Rodrigo
author_sort Critchley, Ian A.
collection PubMed
description Urinary tract infections (UTIs) caused by Escherichia coli have been historically managed with oral antibiotics including the cephalosporins, fluoroquinolones and trimethoprim-sulfamethoxazole. The use of these agents is being compromised by the increase in extended spectrum β-lactamase (ESBL)-producing organisms, mostly caused by the emergence and clonal expansion of E. coli multilocus sequence typing (ST) 131. In addition, ESBL isolates show co-resistance to many of oral agents. Management of UTIs caused by ESBL and fluoroquinolone-resistant organisms is becoming increasingly challenging to treat outside of the hospital setting with clinicians having to resort to intravenous agents. The aim of this study was to assess the prevalence of ESBL phenotypes and genotypes among UTI isolates of E. coli collected in the US during 2017 as well as the impact of co-resistance to oral agents such as the fluoroquinolones and trimethoprim-sulfamethoxazole. The national prevalence of ESBL phenotypes of E. coli was 15.7% and was geographically distributed across all nine Census regions. Levofloxacin and trimethoprim-sulfamethoxazole-resistance rates were ≥ 24% among all isolates and this co-resistance phenotype was considerably higher among isolates showing an ESBL phenotype (≥ 59.2%) and carrying bla(CTX-M-15) (≥ 69.5%). The agents with the highest potency against UTI isolates of E. coli, including ESBL isolates showing cross-resistance across oral agents, were the intravenous carbapenems. The results of this study indicate that new oral options with the spectrum and potency similar to the intravenous carbapenems would address a significant unmet need for the treatment of UTIs in an era of emergence and clonal expansion of ESBL isolates resistant to several classes of antimicrobial agents, including oral options.
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spelling pubmed-69037082019-12-20 The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017 Critchley, Ian A. Cotroneo, Nicole Pucci, Michael J. Mendes, Rodrigo PLoS One Research Article Urinary tract infections (UTIs) caused by Escherichia coli have been historically managed with oral antibiotics including the cephalosporins, fluoroquinolones and trimethoprim-sulfamethoxazole. The use of these agents is being compromised by the increase in extended spectrum β-lactamase (ESBL)-producing organisms, mostly caused by the emergence and clonal expansion of E. coli multilocus sequence typing (ST) 131. In addition, ESBL isolates show co-resistance to many of oral agents. Management of UTIs caused by ESBL and fluoroquinolone-resistant organisms is becoming increasingly challenging to treat outside of the hospital setting with clinicians having to resort to intravenous agents. The aim of this study was to assess the prevalence of ESBL phenotypes and genotypes among UTI isolates of E. coli collected in the US during 2017 as well as the impact of co-resistance to oral agents such as the fluoroquinolones and trimethoprim-sulfamethoxazole. The national prevalence of ESBL phenotypes of E. coli was 15.7% and was geographically distributed across all nine Census regions. Levofloxacin and trimethoprim-sulfamethoxazole-resistance rates were ≥ 24% among all isolates and this co-resistance phenotype was considerably higher among isolates showing an ESBL phenotype (≥ 59.2%) and carrying bla(CTX-M-15) (≥ 69.5%). The agents with the highest potency against UTI isolates of E. coli, including ESBL isolates showing cross-resistance across oral agents, were the intravenous carbapenems. The results of this study indicate that new oral options with the spectrum and potency similar to the intravenous carbapenems would address a significant unmet need for the treatment of UTIs in an era of emergence and clonal expansion of ESBL isolates resistant to several classes of antimicrobial agents, including oral options. Public Library of Science 2019-12-10 /pmc/articles/PMC6903708/ /pubmed/31821338 http://dx.doi.org/10.1371/journal.pone.0220265 Text en © 2019 Critchley et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Critchley, Ian A.
Cotroneo, Nicole
Pucci, Michael J.
Mendes, Rodrigo
The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017
title The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017
title_full The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017
title_fullStr The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017
title_full_unstemmed The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017
title_short The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017
title_sort burden of antimicrobial resistance among urinary tract isolates of escherichia coli in the united states in 2017
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903708/
https://www.ncbi.nlm.nih.gov/pubmed/31821338
http://dx.doi.org/10.1371/journal.pone.0220265
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