August 31, 2018
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Antibiotic-resistant UTIs on the rise

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Drug-resistant bacteria caused nearly 6% of urinary tract infections, according to findings published in Annals of Emergency Medicine.

Urinary tract infections (UTIs) caused by multidrug-resistant bacteria pose a serious threat to public health and the economy,” Bradley W. Frazee, MD, from Alameda Health System Highland Hospital, Oakland, California, and colleagues wrote. “Beta-lactamases are the most important emerging form of resistance among Gram-negative Enterobacteriaceae, including Escherichia coli and Klebsiella species, which cause most UTIs.”

Frazee and colleagues investigated the prevalence of UTIs caused by extended-spectrum beta-lactamase (ESBL)–producing Enterobacteriaceae in the ED of an urban public hospital. The researchers examined urine culture results weekly from August 2016 to July 2017 and identified 1,045 patients with a UTI.

Results showed that 5.9% of UTIs were caused by ESBL-producing isolates, mainly E. coli (79%). Patients with ESBL UTIs had a median age of 50 years and were mostly women (60%). Most ESBL UTIs were antibiotic-resistant, with 71% resistant to levofloxacin, 65% resistant to trimethoprim-sulfamethoxazole, 23% resistant to nitrofurantoin and 3% resistant to amikacin.

More than half (56%) of infections were classified as health care-associated, which was defined as being 65 years or older, being functionally dependent, having a bladder catheter, having a urologic procedure or taking antibiotics in the previous 90 days, in addition to standard risk factors. The rest of the infections were classified as community associated which lacked any health care-associated factors.

In 26 of 56 cases, there was discordance between initial antibiotic choice and isolate susceptibility, according to the researchers.

“The rise of drug-resistant infections is worrisome,” Frazee said in a press release. “What’s new is that in many of these resistant urinary tract infections, it may simply be impossible to identify which patients are at risk. Addressing the causes of antibiotic resistance, and developing novel drugs, is imperative. A society without working antibiotics would be like returning to preindustrial times, when a small injury or infection could easily become life-threatening.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.