In the Journals Plus

Drug-resistant UTI relapse tied to incorrect antibiotic therapy

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November 2, 2018

Patients with community-onset urinary tract infections caused by Enterobacteriaceae that are resistant to extended-spectrum cephalosporins are less likely to receive initial appropriate antibiotic therapy than those with non-resistant infections and more likely to experience relapse within 7 days, according to study results published in Infection Control & Hospital Epidemiology.

“We are now seeing high rates of drug-resistant bacteria in the community, and when these drug-resistant bacteria cause urinary tract infections (UTIs), the patient outcomes are worse than usual,” Judith A. Anesi, MD, clinical epidemiologist and infectious disease fellow at Penn Medicine, told Infectious Disease News.

Anesi and colleagues studied 302 patients (median age, 56 years; 21% men) with community-onset Enterobacteriaceae UTIs who presented to EDs or outpatient practices from 2010 to 2013. They matched 151 patients with community-onset extended-spectrum cephalosporin (ESC)-resistant Enterobacteriaceae UTIs with 151 patients who had ESC-susceptible Enterobacteriaceae UTIs. Their analysis determined associations between ESC-resistant Enterobacteriaceae UTI and clinical failure and inappropriate initial antibiotic therapy. They measured clinical failure through 7 days following initial evaluation for UTI.

Eighty-six patients (29%) experienced clinical failure. The researchers reported a significant association between UTI due to an ESC-resistant Enterobacteriaceae and clinical failure (OR = 7.07; 95% CI, 3.16-15.82). Infection with Citrobacter species and need for hemodialysis were also identified as independent risk factors for clinical failure.

Overall, 158 patients (53%) had inappropriate initial antibiotic therapy. Anesi and colleagues reported that UTI due to ESC-resistant Enterobacteriaceae had a significant association with inappropriate initial antibiotic therapy (OR = 4.4; 95% CI, 2.64-7.33).

They concluded that inappropriate initial antibiotic therapy is in part responsible for worse outcomes in patients with ESC-resistant Enterobacteriaceae UTIs and noted the need for further studies to determine which patients are at high risk for drug-resistant UTIs, “so that urine cultures are collected and appropriate antibiotics are prescribed promptly.”

“This study adds to the evidence that drug-resistant bacteria are an increasing issue, even in the community and even in patients who have something seemingly uncomplicated, like a urinary tract infection,” Anesi said in a news release. “These drug-resistant infections are difficult to treat, and our study shows that relapses are common. This is an alarming finding, and interventions to curb antibiotic resistance are urgently needed.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.