The Uropathogenic Escherichia coli Subclone Sequence Type 131-H30 Is Responsible for Most Antibiotic Prescription Errors at an Urgent Care Clinic
Abstract Background The pandemic spread of antibiotic resistance increases the likelihood of ineffective empirical therapy. The recently emerged fluoroquinolone-resistant Escherichia coli sequence type (ST) 131-H30R subclone (H30) is a leading cause of multidrug-resistant urinary tract infection (UT...
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| Veröffentlicht in: | Clinical infectious diseases 2019-02, Vol.68 (5), p.781-787 |
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| creator | Tchesnokova, Veronika Riddell, Kim Scholes, Delia Johnson, James R Sokurenko, Evgeni V |
| description | Abstract
Background
The pandemic spread of antibiotic resistance increases the likelihood of ineffective empirical therapy. The recently emerged fluoroquinolone-resistant Escherichia coli sequence type (ST) 131-H30R subclone (H30) is a leading cause of multidrug-resistant urinary tract infection (UTI) and bloodstream infection worldwide.
Methods
We studied the relative impact of H30 on the likelihood that bacteria isolated from urine of urgent care patients would be resistant to the empirically prescribed antibiotic regimen for UTI.
Results
Of 750 urinalysis-positive urine samples from urgent care patients with suspected UTI, 306 (41%) yielded E. coli, from 35 different clonal groups (clonotypes). H30 predominated (14% prevalence overall), especially among older patients (age ≥70 years: 26%) and those with diabetes (43%) or urinary catheterization (60%). Resistance to the empirically selected antibiotic regimen occurred in 16% (40/246) of patients overall, 28% (20/71) of older patients, 30% (8/27) of patients with diabetes, 60% (3/5) of catheterized patients, and 71% (22/30) of those with H30. H30’s contribution to such mismatched antibiotic selection was 55% overall, 70% among older patients, and 100% among patients with diabetes or a urinary catheter. Among patients with ≥2 of these factors (older age, diabetes, or urinary catheter), 24% of all urinalysis-positive urine samples yielded H30, with a 92% likelihood of resistance to the selected empirical therapy.
Conclusions
The multidrug-resistant H30 subclone of E. coli ST131 is responsible for the great majority of mismatched empirical antibiotic prescriptions for suspected UTI at an urgent care clinic among patients ≥70 years old or with diabetes or urinary catheterization.
Pandemic multidrug-resistant clone ST131-H30 was responsible for the majority of mismatched antibiotic prescriptions among urgent care patients with Escherichia coli bacteriuria, especially those ≥70 years old or with diabetes or urinary catheterization. |
| doi_str_mv | 10.1093/cid/ciy523 |
| format | Article |
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Background
The pandemic spread of antibiotic resistance increases the likelihood of ineffective empirical therapy. The recently emerged fluoroquinolone-resistant Escherichia coli sequence type (ST) 131-H30R subclone (H30) is a leading cause of multidrug-resistant urinary tract infection (UTI) and bloodstream infection worldwide.
Methods
We studied the relative impact of H30 on the likelihood that bacteria isolated from urine of urgent care patients would be resistant to the empirically prescribed antibiotic regimen for UTI.
Results
Of 750 urinalysis-positive urine samples from urgent care patients with suspected UTI, 306 (41%) yielded E. coli, from 35 different clonal groups (clonotypes). H30 predominated (14% prevalence overall), especially among older patients (age ≥70 years: 26%) and those with diabetes (43%) or urinary catheterization (60%). Resistance to the empirically selected antibiotic regimen occurred in 16% (40/246) of patients overall, 28% (20/71) of older patients, 30% (8/27) of patients with diabetes, 60% (3/5) of catheterized patients, and 71% (22/30) of those with H30. H30’s contribution to such mismatched antibiotic selection was 55% overall, 70% among older patients, and 100% among patients with diabetes or a urinary catheter. Among patients with ≥2 of these factors (older age, diabetes, or urinary catheter), 24% of all urinalysis-positive urine samples yielded H30, with a 92% likelihood of resistance to the selected empirical therapy.
Conclusions
The multidrug-resistant H30 subclone of E. coli ST131 is responsible for the great majority of mismatched empirical antibiotic prescriptions for suspected UTI at an urgent care clinic among patients ≥70 years old or with diabetes or urinary catheterization.
Pandemic multidrug-resistant clone ST131-H30 was responsible for the majority of mismatched antibiotic prescriptions among urgent care patients with Escherichia coli bacteriuria, especially those ≥70 years old or with diabetes or urinary catheterization.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciy523</identifier><identifier>PMID: 29961840</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Aged ; and Commentaries ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - pharmacology ; Drug Prescriptions ; Drug Resistance, Multiple, Bacterial ; Editor's Choice ; Escherichia coli Infections - microbiology ; Female ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Urinary Tract Infections - microbiology ; Uropathogenic Escherichia coli - drug effects</subject><ispartof>Clinical infectious diseases, 2019-02, Vol.68 (5), p.781-787</ispartof><rights>Published by Oxford University Press for the Infectious Diseases Society of America 2018. 2018</rights><rights>Published by Oxford University Press for the Infectious Diseases Society of America 2018.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,782,786,887,1586,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29961840$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tchesnokova, Veronika</creatorcontrib><creatorcontrib>Riddell, Kim</creatorcontrib><creatorcontrib>Scholes, Delia</creatorcontrib><creatorcontrib>Johnson, James R</creatorcontrib><creatorcontrib>Sokurenko, Evgeni V</creatorcontrib><title>The Uropathogenic Escherichia coli Subclone Sequence Type 131-H30 Is Responsible for Most Antibiotic Prescription Errors at an Urgent Care Clinic</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
The pandemic spread of antibiotic resistance increases the likelihood of ineffective empirical therapy. The recently emerged fluoroquinolone-resistant Escherichia coli sequence type (ST) 131-H30R subclone (H30) is a leading cause of multidrug-resistant urinary tract infection (UTI) and bloodstream infection worldwide.
Methods
We studied the relative impact of H30 on the likelihood that bacteria isolated from urine of urgent care patients would be resistant to the empirically prescribed antibiotic regimen for UTI.
Results
Of 750 urinalysis-positive urine samples from urgent care patients with suspected UTI, 306 (41%) yielded E. coli, from 35 different clonal groups (clonotypes). H30 predominated (14% prevalence overall), especially among older patients (age ≥70 years: 26%) and those with diabetes (43%) or urinary catheterization (60%). Resistance to the empirically selected antibiotic regimen occurred in 16% (40/246) of patients overall, 28% (20/71) of older patients, 30% (8/27) of patients with diabetes, 60% (3/5) of catheterized patients, and 71% (22/30) of those with H30. H30’s contribution to such mismatched antibiotic selection was 55% overall, 70% among older patients, and 100% among patients with diabetes or a urinary catheter. Among patients with ≥2 of these factors (older age, diabetes, or urinary catheter), 24% of all urinalysis-positive urine samples yielded H30, with a 92% likelihood of resistance to the selected empirical therapy.
Conclusions
The multidrug-resistant H30 subclone of E. coli ST131 is responsible for the great majority of mismatched empirical antibiotic prescriptions for suspected UTI at an urgent care clinic among patients ≥70 years old or with diabetes or urinary catheterization.
Pandemic multidrug-resistant clone ST131-H30 was responsible for the majority of mismatched antibiotic prescriptions among urgent care patients with Escherichia coli bacteriuria, especially those ≥70 years old or with diabetes or urinary catheterization.</description><subject>Aged</subject><subject>and Commentaries</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Drug Prescriptions</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Editor's Choice</subject><subject>Escherichia coli Infections - microbiology</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Prevalence</subject><subject>Retrospective Studies</subject><subject>Urinary Tract Infections - microbiology</subject><subject>Uropathogenic Escherichia coli - drug effects</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkd1q3DAQhUVpaH7amz5AmZtCb9zox7Llm0JYtk0goaXZXAtZO45VvJIryYF9jL5xFTYNzcUwA3M43zCHkPeMfma0E-fWbUvtJRevyAmToq0a2bHXZaZSVbUS6picpvSLUsYUlW_IMe-6hqmanpA_mxHhLobZ5DHco3cW1smOGJ0dnQEbJge3S2-n4BFu8feC3iJs9jMCE6y6FBSuEvzENAefXD8hDCHCTUgZLnx2vQu5WP6ImGx0c3bBwzrGEBOYDMYXdIFmWJmIsJpc4b8lR4OZEr576mfk7ut6s7qsrr9_u1pdXFdBCJ6rXqGgWLO6Z23X8YYNokXbm4HShis2SEbtYFHymvUDl0paaWtuB2PUFo1EcUa-HHznpd_h1pYzopn0HN3OxL0OxumXG-9GfR8edCPahnZ1Mfj0ZBBD-UvKeueSxWkyHsOSNKdFyWkrRZF--J_1DPmXQxF8PAjCMj9vGdWP-eqSrz7kK_4C8N-ZHg</recordid><startdate>20190215</startdate><enddate>20190215</enddate><creator>Tchesnokova, Veronika</creator><creator>Riddell, Kim</creator><creator>Scholes, Delia</creator><creator>Johnson, James R</creator><creator>Sokurenko, Evgeni V</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190215</creationdate><title>The Uropathogenic Escherichia coli Subclone Sequence Type 131-H30 Is Responsible for Most Antibiotic Prescription Errors at an Urgent Care Clinic</title><author>Tchesnokova, Veronika ; Riddell, Kim ; Scholes, Delia ; Johnson, James R ; Sokurenko, Evgeni V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-o332t-b8e30e414b1799261f37ecbaf006281f510cfce5241bf2585c5c42cfaa8dea5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>and Commentaries</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Drug Prescriptions</topic><topic>Drug Resistance, Multiple, Bacterial</topic><topic>Editor's Choice</topic><topic>Escherichia coli Infections - microbiology</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Prevalence</topic><topic>Retrospective Studies</topic><topic>Urinary Tract Infections - microbiology</topic><topic>Uropathogenic Escherichia coli - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tchesnokova, Veronika</creatorcontrib><creatorcontrib>Riddell, Kim</creatorcontrib><creatorcontrib>Scholes, Delia</creatorcontrib><creatorcontrib>Johnson, James R</creatorcontrib><creatorcontrib>Sokurenko, Evgeni V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tchesnokova, Veronika</au><au>Riddell, Kim</au><au>Scholes, Delia</au><au>Johnson, James R</au><au>Sokurenko, Evgeni V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Uropathogenic Escherichia coli Subclone Sequence Type 131-H30 Is Responsible for Most Antibiotic Prescription Errors at an Urgent Care Clinic</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2019-02-15</date><risdate>2019</risdate><volume>68</volume><issue>5</issue><spage>781</spage><epage>787</epage><pages>781-787</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
The pandemic spread of antibiotic resistance increases the likelihood of ineffective empirical therapy. The recently emerged fluoroquinolone-resistant Escherichia coli sequence type (ST) 131-H30R subclone (H30) is a leading cause of multidrug-resistant urinary tract infection (UTI) and bloodstream infection worldwide.
Methods
We studied the relative impact of H30 on the likelihood that bacteria isolated from urine of urgent care patients would be resistant to the empirically prescribed antibiotic regimen for UTI.
Results
Of 750 urinalysis-positive urine samples from urgent care patients with suspected UTI, 306 (41%) yielded E. coli, from 35 different clonal groups (clonotypes). H30 predominated (14% prevalence overall), especially among older patients (age ≥70 years: 26%) and those with diabetes (43%) or urinary catheterization (60%). Resistance to the empirically selected antibiotic regimen occurred in 16% (40/246) of patients overall, 28% (20/71) of older patients, 30% (8/27) of patients with diabetes, 60% (3/5) of catheterized patients, and 71% (22/30) of those with H30. H30’s contribution to such mismatched antibiotic selection was 55% overall, 70% among older patients, and 100% among patients with diabetes or a urinary catheter. Among patients with ≥2 of these factors (older age, diabetes, or urinary catheter), 24% of all urinalysis-positive urine samples yielded H30, with a 92% likelihood of resistance to the selected empirical therapy.
Conclusions
The multidrug-resistant H30 subclone of E. coli ST131 is responsible for the great majority of mismatched empirical antibiotic prescriptions for suspected UTI at an urgent care clinic among patients ≥70 years old or with diabetes or urinary catheterization.
Pandemic multidrug-resistant clone ST131-H30 was responsible for the majority of mismatched antibiotic prescriptions among urgent care patients with Escherichia coli bacteriuria, especially those ≥70 years old or with diabetes or urinary catheterization.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>29961840</pmid><doi>10.1093/cid/ciy523</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Aged and Commentaries Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - pharmacology Drug Prescriptions Drug Resistance, Multiple, Bacterial Editor's Choice Escherichia coli Infections - microbiology Female Humans Logistic Models Male Multivariate Analysis Prevalence Retrospective Studies Urinary Tract Infections - microbiology Uropathogenic Escherichia coli - drug effects |
| title | The Uropathogenic Escherichia coli Subclone Sequence Type 131-H30 Is Responsible for Most Antibiotic Prescription Errors at an Urgent Care Clinic |
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