Prevalence and risk factor analysis of resistant Escherichia coli urinary tract infections in the emergency department

  • Abby M. Bailey
  • Kyle A. Weant
  • Stephanie N. Baker
Keywords: Drug Resistance, Bacterial, Risk Factors, Urinary Tract Infections, Uropathogenic Escherichia coli, Trimethoprim-Sulfamethoxazole Combination, Fluoroquinolones, Emergency Service, Hospital, United States.

Abstract

Background: Escherichia coli (E. coli) is a frequent uropathogen in urinary tract infections (UTI). Widespread resistance to sulfamethoxazole-trimethoprim (SMX-TMP) and increasing resistance to fluoroquinolones amongst these isolates has been recognized. There are limited data demonstrating risk factors for resistance to both SMX-TMP and fluoroquinolones.

Objectives: This study was conducted to assess for the prevalence of community resistance amongst E. coli isolates to SMX-TMP and levofloxacin in ambulatory patients discharged from the emergency department (ED).

Methods: Adults presenting for evaluation and discharged from the ED with a diagnosis of an E. coli UTI were retrospectively reviewed. Utilizing demographic and clinical data the prevalence of E. coli resistance and risk factors associated with SMX-TMP- and fluoroquinolone-resistant infection were determined.

Results: Among the 222 patients, the mean rates of E. coli susceptibility to levofloxacin and SMX-TMP were 82.4% and 72.5%, respectively. Significant risk factors for resistance to SMX-TMP included prior antibiotic use (p=0.04) and prior diagnosis of UTI (p= 0.01). Significant risk factors for resistance to levofloxacin included: male gender, age, presence of hypertension, diabetes, chronic respiratory disease, nursing home resident, previous antibiotic use, previous diagnosis of UTI, existence of renal or genitourinary abnormalities, and prior surgical procedures (p <0.05 for all comparisons). The number of hospital days prior to initial ED evaluation (p<0.001) was determined to be a predictive factor in hospital and ED readmission.

Conclusions: These results suggest that conventional approaches to monitoring for patterns of susceptibility may be inadequate. It is imperative that practitioners develop novel approaches to identifying patients with risk factors for resistance. Identification of risk factors from this evaluation should prompt providers to scrutinize the use of these agents in the setting of patients presenting with an uncomplicated UTI in the ED.

Downloads

Download data is not yet available.

References

1. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. doi: 10.1093/cid/ciq257.

2. Gupta K, Scholes D, Stamm WE. Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA. 1999;281(8):736-738.

3. Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States. Antimicrob Agents Chemother. 2002;46(8):2540-3545.

4. Kahlmeter G; ECO.SENS. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother. 2003;51(1):69-76.

5. Zhanel GG, Hisanaga TL, Laing NM, DeCorby MR, Nichol KA, Palatnik LP, Johnson J, Noreddin A, Harding GK, Nicolle LE, Hoban DJ; NAUTICA Group. Antibiotic resistance in outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). Int J Antimicrob Agents. 2005;26(5):380-388.

6. Lautenbach E, Strom BL, Nachamkin I, Bilker WB, Marr AM, Larosa LA, Fishman NO.Longitudinal trends in fluoroquinolone resistance among Enterobacteriaceae isolates from inpatients and outpatients, 1989-2000: differences in the emergence and epidemiology of resistance across organisms. Clin Infect Dis. 2004;38(5):655-662.

7. Alos JI, Serrano MG, Gomez-Garces JL, Perianes J. Antibiotic resistance of Escherichia coli from community-acquired urinary tract infections in relation to demographic and clinical data. Clin Microbiol Infect. 2005;11(3):199-203.

8. Aguiar JM, Chacon J, Canton R, Baquero F. The emergence of highly fluoroquinolone-resistant Escherichia coli in community-acquired urinary tract infections. J Antimicrob Chemother. 1992;29(3):349-350.

9. Goettsch W, van Pelt W, Nagelkerke N, Hendrix MG, Buiting AG, Petit PL, Sabbe LJ, van Griethuysen AJ, de Neeling AJ. Increasing resistance to fluoroquinolones in escherichia coli from urinary tract infections in the netherlands. J Antimicrob Chemother. 2000;46(2):223-228.

10. Rattanaumpawan P, Tolomeo P, Bilker WB, Fishman NO, Lautenbach E. Risk factors for fluoroquinolone resistance in Gram-negative bacilli causing healthcare-acquired urinary tract infections. J Hosp Infect. 2010;76(4):324-327. doi: 10.1016/j.jhin.2010.05.023.

11. Paterson DL. Impact of antibiotic resistance in gram-negative bacilli on empirical and definitive antibiotic therapy. Clin Infect Dis. 2008;47(Suppl 1):S14-S20. doi: 10.1086/590062.

12. Hooton TM. Fluoroquinolones and resistance in the treatment of uncomplicated urinary tract infection. Int J Antimicrob Agents. 2003;22(Suppl 2):65-72.

13. Microbiology UoKDoC. Clinical Microbiology Summary of Antibiotic Susceptibility Testing - January 1, through December 31, 2010; 2010.

14. Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ; EMERGEncy ID NET Study Group. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis. 2008;47(9):1150-1158. doi: 10.1086/592250.

15. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42 Suppl 2:S82-S89.

16. Steinke DT, Seaton RA, Phillips G, MacDonald TM, Davey PG. Factors associated with trimethoprim-resistant bacteria isolated from urine samples. J Antimicrob Chemother. 1999;43(6):841-843.

17. Steinke DT, Seaton RA, Phillips G, MacDonald TM, Davey PG. Prior trimethoprim use and trimethoprim-resistant urinary tract infection: a nested case-control study with multivariate analysis for other risk factors. J Antimicrob Chemother. 2001;47(6):781-787.

18. Wright SW, Wrenn KD, Haynes ML. Trimethoprim-sulfamethoxazole resistance among urinary coliform isolates. J Gen Intern Med. 1999;14(10):606-609.

19. Jang WH, Yoo DH, Park SW. Prevalence of and Risk Factors for Levofloxacin-Resistant E. coli Isolated from Outpatients with Urinary Tract Infection. Korean J Urol. 2011;52(8):554-559. doi: 10.4111/kju.2011.52.8.554.
How to Cite
1.
Bailey AM, Weant KA, Baker SN. Prevalence and risk factor analysis of resistant Escherichia coli urinary tract infections in the emergency department. Pharm Pract (Granada) [Internet]. 1 [cited 2019Jun.16];11(2):96-101. Available from: https://www.pharmacypractice.org/journal/index.php/pp/article/view/341
Section
Original Research