Prevalence, regional distribution, and trends of antimicrobial resistance among female outpatients with urine Klebsiella spp. isolates: a multicenter evaluation in the United States between 2011 and 2019.

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Keith S Kaye, Vikas Gupta, Aruni Mulgirigama, Ashish V Joshi, Gang Ye, Nicole E Scangarella-Oman, Kalvin Yu, Fanny S Mitrani-Gold
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引用次数: 0

Abstract

Background: Antimicrobial resistance research in uncomplicated urinary tract infection typically focuses on the main causative pathogen, Escherichia coli; however, little is known about the antimicrobial resistance burden of Klebsiella species, which can also cause uncomplicated urinary tract infections. This retrospective cohort study assessed the prevalence and geographic distribution of antimicrobial resistance among Klebsiella species and antimicrobial resistance trends for K. pneumoniae in the United States (2011-2019).

Methods: K. pneumoniae and K. oxytoca urine isolates (30-day, non-duplicate) among female outpatients (aged ≥ 12 years) with presumed uUTI at 304 centers in the United States were classified by resistance phenotype(s): not susceptible to nitrofurantoin, trimethoprim/sulfamethoxazole, or fluoroquinolone, extended-spectrum β-lactamase-positive/not susceptible; and multidrug-resistant based on ≥ 2 and ≥ 3 resistance phenotypes. Antimicrobial resistance prevalence by census division and age, as well as antimicrobial resistance trends over time for Klebsiella species, were assessed using generalized estimating equations.

Results: 270,552 Klebsiella species isolates were evaluated (250,719 K. pneumoniae; 19,833 K. oxytoca). The most frequent resistance phenotypes in 2019 were nitrofurantoin not susceptible (Klebsiella species: 54.0%; K. pneumoniae: 57.3%; K. oxytoca: 15.1%) and trimethoprim/sulfamethoxazole not susceptible (Klebsiella species: 10.4%; K. pneumoniae: 10.6%; K. oxytoca: 8.6%). Extended-spectrum β-lactamase-positive/not susceptible prevalence was 5.4%, 5.3%, and 6.8%, respectively. K. pneumoniae resistance phenotype prevalence varied (p < 0.0001) geographically and by age, and increased over time (except for the nitrofurantoin not susceptible phenotype, which was stable and > 50% throughout).

Conclusions: There is a high antimicrobial resistance prevalence and increasing antimicrobial resistance trends among K. pneumoniae isolates from female outpatients in the United States with presumed uncomplicated urinary tract infection. Awareness of K. pneumoniae antimicrobial resistance helps to optimize empiric uncomplicated urinary tract infection treatment.

女性门诊患者尿液中克雷伯氏菌属分离物的流行率、地区分布和抗菌药耐药性趋势:2011 年至 2019 年美国多中心评估。
背景:对无并发症尿路感染的抗菌药耐药性研究通常侧重于主要致病菌大肠埃希菌;然而,人们对克雷伯氏菌的抗菌药耐药性负担知之甚少,而克雷伯氏菌也可引起无并发症尿路感染。这项回顾性队列研究评估了美国(2011-2019 年)克雷伯氏菌耐药性的流行情况和地理分布,以及肺炎克雷伯氏菌的耐药性趋势:肺炎克雷伯菌和克雷伯菌方法:根据耐药表型对美国 304 个中心的女性门诊患者(年龄≥ 12 岁)的推测尿路感染尿液分离物(30 天,非重复)进行分类:对硝基呋喃妥因、三甲双氨/磺胺甲噁唑或氟喹诺酮不敏感;广谱 β-内酰胺酶阳性/不敏感;基于≥ 2 和≥ 3 耐药表型的多重耐药。使用广义估计方程评估了按普查分区和年龄划分的抗菌药耐药性流行率,以及克雷伯氏菌的抗菌药耐药性随时间变化的趋势。结果:共评估了 270,552 份克雷伯氏菌分离物(250,719 份肺炎克雷伯氏菌;19,833 份克雷伯氏土球菌)。2019 年最常见的耐药表型是对硝基呋喃妥因不敏感(克雷伯菌:54.0%;肺炎克雷伯菌:57.3%;土发克雷伯菌:15.1%)和对三甲双胍/磺胺甲噁唑不敏感(克雷伯菌:10.4%;肺炎克雷伯菌:10.6%;土发克雷伯菌:8.6%)。广谱β-内酰胺酶阳性/不敏感率分别为 5.4%、5.3% 和 6.8%。肺炎克雷伯菌耐药表型流行率各不相同(p 50%):结论:美国女性门诊患者推测为无并发症的尿路感染所分离的肺炎克氏菌中,抗菌药耐药性流行率较高,且呈上升趋势。对肺炎克氏菌抗菌药耐药性的认识有助于优化非复杂性尿路感染的经验性治疗。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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