Co-resistance Among Escherichia coli and Klebsiella pneumoniae Urine Isolates from Female Outpatients with Presumed UTI: A Retrospective US Cohort Study.

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Infectious Diseases and Therapy Pub Date : 2024-07-01 Epub Date: 2024-06-06 DOI:10.1007/s40121-024-00995-2

Keith S Kaye, Vikas Gupta, Aruni Mulgirigama, Ashish V Joshi, Nicole E Scangarella-Oman, Kalvin Yu, Janet Watts, Fanny S Mitrani-Gold

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Abstract

Introduction: Urinary tract infections (UTIs) caused by antimicrobial-resistant Enterobacterales are a global health threat. There are limited surveillance data available to characterize the prevalence of antimicrobial resistance among outpatients in the United States (US).

Methods: This retrospective cohort (database) study investigated co-resistance among Escherichia coli and Klebsiella pneumoniae urinary isolates from US female outpatients aged ≥ 12 years with presumed uncomplicated UTI (uUTI), ≥ 3 months of data (2011-2019), and antimicrobial susceptibility testing results. Eligible isolates were the first urinary E. coli or K. pneumoniae isolate per patient collected within 30 days; classified as not susceptible (NS) if antimicrobial susceptibility testing results were intermediate or resistant to each antibiotic tested. Four resistance phenotypes were identified: NS to fluoroquinolones (FQ), trimethoprim/sulfamethoxazole (SXT), nitrofurantoin (NTF), and extended-spectrum β-lactamase+/third-generation cephalosporin (ESBL+/3GC NS). Co-resistance phenotypes included all possible combinations of resistance to ≥ 2 drug classes.

Results: Of 1,513,882 E. coli isolates and 250,719 K. pneumoniae isolates, 856,918 and 187,459 isolates with ≥ 1 resistance phenotype were included in the analysis, respectively. The most common resistance phenotypes were SXT NS for the E. coli isolates (44.8%) and NTF NS for the K. pneumoniae isolates (75.5%), while ESBL+/3GC NS comprised 11.2 and 5.9%, respectively. Among ESBL+/3GC NS E. coli isolates, 72.4, 56.7, and 46.6% were co-resistant to FQ, SXT, and FQ + SXT, respectively. For ESBL+/3GC NS K. pneumoniae isolates, 65.7 and 45.7% were co-resistant to SXT and FQ + SXT.

Conclusion: Both species exhibited high rates of co-resistance, emphasizing the need to raise awareness of co-resistance and of the unmet need for effective treatment options for uUTI.

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假定患有尿路感染的女性门诊患者尿液分离物中大肠埃希菌和肺炎克雷伯菌的共同耐药性：一项回顾性美国队列研究。

导言：由耐药性肠杆菌引起的尿路感染（UTI）是一个全球性的健康威胁。目前能用于描述美国门诊病人抗菌药耐药性流行情况的监测数据非常有限：这项回顾性队列（数据库）研究调查了大肠埃希菌和肺炎克雷伯菌在美国女性门诊患者尿液分离物中的共同耐药性，这些分离物的年龄≥12岁，推测为无并发症UTI（UTI），有≥3个月的数据（2011-2019年）和抗菌药物药敏试验结果。符合条件的分离物是每位患者在 30 天内收集到的第一个尿液大肠杆菌或肺炎双球菌分离物；如果抗菌药敏感性检测结果为对每种测试抗生素的中度敏感或耐药，则被归类为不敏感（NS）。确定了四种耐药表型：对氟喹诺酮类（FQ）、三甲双氨/磺胺甲恶唑（SXT）、硝基呋喃妥因（NTF）和广谱β-内酰胺酶+/第三代头孢菌素（ESBL+/3GC NS）的耐药表型为NS。共同耐药表型包括对≥2种药物耐药的所有可能组合：在 1,513,882 株大肠杆菌和 250,719 株肺炎双球菌分离物中，分别有 856,918 株和 187,459 株分离物具有≥ 1 种耐药表型。最常见的耐药表型是大肠杆菌分离物的 SXT NS（44.8%）和肺炎克氏菌分离物的 NTF NS（75.5%），ESBL+/3GC NS 分别占 11.2% 和 5.9%。在 ESBL+/3GC NS 大肠杆菌分离物中，分别有 72.4%、56.7% 和 46.6%对 FQ、SXT 和 FQ + SXT 同时耐药。对于ESBL+/3GC NS肺炎克氏菌分离物，65.7%和45.7%对SXT和FQ + SXT具有共耐药性：结论：两种细菌的共同耐药率都很高，这强调了需要提高对共同耐药的认识，以及对尿毒症有效治疗方案的需求尚未得到满足。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Diseases and Therapy Medicine-Microbiology (medical)

CiteScore

8.60

自引率

1.90%

发文量

136

审稿时长

6 weeks

期刊介绍： Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.