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Determining a urinary-specific antibiogram and risk factors of trimethoprim/sulfamethoxazole, ciprofloxacin and multidrug resistance among Enterobacterales in primary care.
Valentine-King, Marissa; Hansen, Michael A; Zoorob, Roger; Schlueter, Matthew; Matas, Jennifer L; Willis, Samuel E; Danek, Lisa C K; Muldrew, Kenneth; Zare, Mohammad; Hudson, Forrest; Atmar, Robert L; Chou, Andrew; Trautner, Barbara W; Grigoryan, Larissa.
Afiliação
  • Valentine-King M; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
  • Hansen MA; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
  • Zoorob R; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
  • Schlueter M; Harris Health System, Houston, TX, USA.
  • Matas JL; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
  • Willis SE; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
  • Danek LCK; Harris Health System, Houston, TX, USA.
  • Muldrew K; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
  • Zare M; Harris Health System, Houston, TX, USA.
  • Hudson F; Harris Health System, Houston, TX, USA.
  • Atmar RL; Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA.
  • Chou A; School of Health Professions, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Trautner BW; Department of Pathology and Laboratory Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
  • Grigoryan L; Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
J Antimicrob Chemother ; 79(3): 559-563, 2024 03 01.
Article em En | MEDLINE | ID: mdl-38217846
ABSTRACT

BACKGROUND:

Risk factors for ciprofloxacin or MDR in primary care urine specimens are not well defined.

OBJECTIVES:

We created a primary care-specific antibiogram for Escherichia coli isolates from cases with complicated and uncomplicated urinary tract infection (UTI) and evaluated risk factors for ciprofloxacin, trimethoprim/sulfamethoxazole and MDR among Enterobacterales.

METHODS:

We conducted a cross-sectional study to determine resistance and risk factors by collecting urine cultures from all patients (≥18 years) presenting with provider-suspected UTI at two primary care, safety-net clinics in Houston, TX, USA between November 2018 and March 2020.

RESULTS:

Among 1262 cultures, 308 cultures grew 339 uropathogens. Patients with Enterobacterales (n = 199) were mostly female (93.5%) with a mean age of 48.5 years. E. coli was the predominant uropathogen isolated (n = 187/339; 55%) and had elevated trimethoprim/sulfamethoxazole (43.6%) and ciprofloxacin (29.5%) resistance, low nitrofurantoin (1.8%) resistance, and no fosfomycin resistance. Among E. coli, 10.6% were ESBL positive and 24.9% had MDR. Birth outside the U.S.A., prior (2 year) trimethoprim/sulfamethoxazole resistance, and diabetes mellitus were associated with trimethoprim/sulfamethoxazole resistance. Prior (60 day) fluoroquinolone use, prior ciprofloxacin resistance and both diabetes mellitus and hypertension were strongly associated with ciprofloxacin resistance. Prior fluoroquinolone use and a history of resistance to any studied antibiotic were associated with MDR, while pregnancy was protective.

CONCLUSIONS:

We found elevated resistance to UTI-relevant antimicrobials and novel factors associated with resistance; these data can be incorporated into clinical decision tools to improve organism and drug concordance.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Gammaproteobacteria / Diabetes Mellitus Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged / Pregnancy Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Gammaproteobacteria / Diabetes Mellitus Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged / Pregnancy Idioma: En Ano de publicação: 2024 Tipo de documento: Article