Journal
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
Volume 64, Issue 8, Pages -Publisher
AMER SOC MICROBIOLOGY
DOI: 10.1128/AAC.00346-20
Keywords
antimicrobial resistance; complicated UTI; cross-resistance; hospitalization
Categories
Funding
- Spero Therapeutics, Cambridge, MA, USA
- Spero Therapeutics
- EviMed Research Group, LLC
- Merck
- Melinta
- Tetraphase
- Pfizer
- Astellas
- Shionogi
- The Medicines Company
- Lungpacer
- Theravance
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In the face of increasing rates of antimicrobial resistance in complicated urinary tract infections (cUTIs), clinicians need to understand cross-resistance patterns among commonly encountered pathogens. We performed a multicenter, retrospective cohort study in the Premier database of approximately 180 hospitals, from 2013 to 2018. Using an ICD-9/10-based algorithm, we identified all adult patients hospitalized with cUTIs and included those with a positive blood or urine culture. We examined the microbiology and susceptibilities to common cUTI antimicrobials (3rd-generation cephalosporin [C3], fluoroquinolones [FQ], trimethoprim-sulfamethoxazole (TMP/SMa fosfomycin [FFM], and nitrofurantoin (NFT]) singly and in groups of two. Among 28,057 organisms from 23,331 patients, the 3 most common pathogens were Escherichia coli (41.0%; C3(r), 15.1%), Klebsiella pneumoniae (12.1%; C3(r), 13.2%), and Pseudomonas aeruginosa (11.0%; C3(r), 12.0%). E. coli was most frequently resistant to FQ (43.5%) and least to NFT (6.7%). K. pneumoniae was most frequently resistant to NFT (60.8%) and least to FFM (0.1%). P. aeruginosa was most frequently resistant to FQ (34.4%) and least to TMP/SMZ (4.2%). Of the C3(r) E. coli isolates, 87.1% were also FQ(r), 63.7% were TMP/SMZ(r), and 13.3% were NFTr. C3(r) K. pneumoniae isolates had a 76.5% chance of being FQ(r), 78.1% were TMP/SMZ(r), and 77.6% were NFTr. C3(r) P. aeruginosa coexisted with FQ(r) in 47.3%, TMP/SMZ(r) in 18.9%, and NFTr in 28.7%. Among the most common pathogens isolated from hospitalized patients with cUTIs, the rates of single resistance to common treatments and of cross-resistance to these regimens are substantial. Knowing the patterns of crossresistance may help clinicians tailor empirical therapy more precisely.
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