Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011 to 2019: Rising ESBL Strains and Impact on Patient Management
Uncomplicated urinary tract infection (uUTI) is predominantly caused by Escherichia coli, which has increasing antimicrobial resistance (AMR) at the United States (US)-community level. As uUTI is often treated empirically, assessing AMR is challenging, and there are limited contemporary data charact...
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| Veröffentlicht in: | Clinical infectious diseases 2021-12, Vol.73 (11), p.1992-1999 |
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| container_title | Clinical infectious diseases |
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| creator | Kaye, Keith S Gupta, Vikas Mulgirigama, Aruni Joshi, Ashish V Scangarella-Oman, Nicole E Yu, Kalvin Ye, Gang Mitrani-Gold, Fanny S |
| description | Uncomplicated urinary tract infection (uUTI) is predominantly caused by Escherichia coli, which has increasing antimicrobial resistance (AMR) at the United States (US)-community level. As uUTI is often treated empirically, assessing AMR is challenging, and there are limited contemporary data characterizing period prevalence in the US.
This was a retrospective study of AMR using Becton, Dickinson and Company Insights Research Database (Franklin Lakes, New Jersey, US) data collected 2011-2019. Thirty-day, nonduplicate Escherichia coli urine isolates from US female outpatients (aged ≥12 years) were included. Isolates were evaluated for nonsusceptibility (intermediate/resistant) to trimethoprim-sulfamethoxazole, fluoroquinolones, or nitrofurantoin, and assessed for extended-spectrum β-lactamase production (ESBL+) and for ≥2 or ≥3 drug-resistance phenotypes. Generalized estimating equations were used to model AMR trends over time and by US census region.
Among 1 513 882 E. coli isolates, the overall prevalence of isolates nonsusceptible to trimethoprim-sulfamethoxazole, fluoroquinolones, and nitrofurantoin was 25.4%, 21.1%, and 3.8%, respectively. Among the isolates, 6.4% were ESBL+, 14.4% had ≥2 drug-resistance phenotypes, and 3.8% had ≥3. Modeling demonstrated a relative average yearly increase of 7.7% (95% confidence interval [CI], 7.2-8.2%) for ESBL+ isolates and 2.7% (95% CI, 2.2-3.2%) for ≥3 drug-phenotypes (both P |
| doi_str_mv | 10.1093/cid/ciab560 |
| format | Article |
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This was a retrospective study of AMR using Becton, Dickinson and Company Insights Research Database (Franklin Lakes, New Jersey, US) data collected 2011-2019. Thirty-day, nonduplicate Escherichia coli urine isolates from US female outpatients (aged ≥12 years) were included. Isolates were evaluated for nonsusceptibility (intermediate/resistant) to trimethoprim-sulfamethoxazole, fluoroquinolones, or nitrofurantoin, and assessed for extended-spectrum β-lactamase production (ESBL+) and for ≥2 or ≥3 drug-resistance phenotypes. Generalized estimating equations were used to model AMR trends over time and by US census region.
Among 1 513 882 E. coli isolates, the overall prevalence of isolates nonsusceptible to trimethoprim-sulfamethoxazole, fluoroquinolones, and nitrofurantoin was 25.4%, 21.1%, and 3.8%, respectively. Among the isolates, 6.4% were ESBL+, 14.4% had ≥2 drug-resistance phenotypes, and 3.8% had ≥3. Modeling demonstrated a relative average yearly increase of 7.7% (95% confidence interval [CI], 7.2-8.2%) for ESBL+ isolates and 2.7% (95% CI, 2.2-3.2%) for ≥3 drug-phenotypes (both P < .0001). Modeling also demonstrated significant variation in AMR prevalence between US census regions (P < .001).
Period prevalence of AMR among US outpatient urine-isolated E. coli was high, and for multidrug-resistance phenotypes increased during the study period with significant variation between census regions. Knowledge of regional AMR rates helps inform empiric treatment of community-onset uUTI and highlights the AMR burden to physicians.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciab560</identifier><identifier>PMID: 34143881</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adolescent ; Adult ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; beta-Lactamases - genetics ; Drug Resistance, Bacterial ; Escherichia coli - drug effects ; Escherichia coli Infections - drug therapy ; Escherichia coli Infections - epidemiology ; Escherichia coli Infections - urine ; Female ; Humans ; Major and Commentaries ; Microbial Sensitivity Tests ; Models, Theoretical ; Retrospective Studies ; United States - epidemiology ; Urinary Tract Infections - drug therapy ; Urinary Tract Infections - epidemiology ; Urinary Tract Infections - microbiology</subject><ispartof>Clinical infectious diseases, 2021-12, Vol.73 (11), p.1992-1999</ispartof><rights>The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.</rights><rights>The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-519eb5c9d5e191a26848a035c48795d17e1a02446835d0a9259d17ae04cda8033</citedby><cites>FETCH-LOGICAL-c447t-519eb5c9d5e191a26848a035c48795d17e1a02446835d0a9259d17ae04cda8033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34143881$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kaye, Keith S</creatorcontrib><creatorcontrib>Gupta, Vikas</creatorcontrib><creatorcontrib>Mulgirigama, Aruni</creatorcontrib><creatorcontrib>Joshi, Ashish V</creatorcontrib><creatorcontrib>Scangarella-Oman, Nicole E</creatorcontrib><creatorcontrib>Yu, Kalvin</creatorcontrib><creatorcontrib>Ye, Gang</creatorcontrib><creatorcontrib>Mitrani-Gold, Fanny S</creatorcontrib><title>Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011 to 2019: Rising ESBL Strains and Impact on Patient Management</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Uncomplicated urinary tract infection (uUTI) is predominantly caused by Escherichia coli, which has increasing antimicrobial resistance (AMR) at the United States (US)-community level. As uUTI is often treated empirically, assessing AMR is challenging, and there are limited contemporary data characterizing period prevalence in the US.
This was a retrospective study of AMR using Becton, Dickinson and Company Insights Research Database (Franklin Lakes, New Jersey, US) data collected 2011-2019. Thirty-day, nonduplicate Escherichia coli urine isolates from US female outpatients (aged ≥12 years) were included. Isolates were evaluated for nonsusceptibility (intermediate/resistant) to trimethoprim-sulfamethoxazole, fluoroquinolones, or nitrofurantoin, and assessed for extended-spectrum β-lactamase production (ESBL+) and for ≥2 or ≥3 drug-resistance phenotypes. Generalized estimating equations were used to model AMR trends over time and by US census region.
Among 1 513 882 E. coli isolates, the overall prevalence of isolates nonsusceptible to trimethoprim-sulfamethoxazole, fluoroquinolones, and nitrofurantoin was 25.4%, 21.1%, and 3.8%, respectively. Among the isolates, 6.4% were ESBL+, 14.4% had ≥2 drug-resistance phenotypes, and 3.8% had ≥3. Modeling demonstrated a relative average yearly increase of 7.7% (95% confidence interval [CI], 7.2-8.2%) for ESBL+ isolates and 2.7% (95% CI, 2.2-3.2%) for ≥3 drug-phenotypes (both P < .0001). Modeling also demonstrated significant variation in AMR prevalence between US census regions (P < .001).
Period prevalence of AMR among US outpatient urine-isolated E. coli was high, and for multidrug-resistance phenotypes increased during the study period with significant variation between census regions. Knowledge of regional AMR rates helps inform empiric treatment of community-onset uUTI and highlights the AMR burden to physicians.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>beta-Lactamases - genetics</subject><subject>Drug Resistance, Bacterial</subject><subject>Escherichia coli - drug effects</subject><subject>Escherichia coli Infections - drug therapy</subject><subject>Escherichia coli Infections - epidemiology</subject><subject>Escherichia coli Infections - urine</subject><subject>Female</subject><subject>Humans</subject><subject>Major and Commentaries</subject><subject>Microbial Sensitivity Tests</subject><subject>Models, Theoretical</subject><subject>Retrospective Studies</subject><subject>United States - epidemiology</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urinary Tract Infections - epidemiology</subject><subject>Urinary Tract Infections - microbiology</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkVGPEyEUhSdG466rT74bHk3MKAwwBR9M6qbVJjWa3e0zuYW7LWYGKlATf57_TMatqz6QewKH7144TfOc0deMav7GelcXbGVPHzTnTPJZ20vNHlZNpWqF4uqseZLzV0oZU1Q-bs64YIIrxc6bn_NQ_OhtilsPA7nC7HOBYJHcJAwuEx_IJvmAZJHtHpO3ew_ExsGTVY4DFMxkmeJI5u44FALBVRUHzBZDIUscoeoJUvZINsEXdOS6_L3W1ZlIiVPVb8mVzz7syOL6_bq6EviQfyNX4wFsITGQL1D8RP4EAXY4Vvm0eXQLQ8Znp3rRbJaLm8uP7frzh9XlfN1aIWallUzjVlrtJDLNoOuVUEC5tELNtHRshgxoJ0SvuHQUdCd13QSkwjpQlPOL5t0d93Dcjuim9yUYzCH5EdIPE8Gb_0-C35td_G5U3wvBJ8DLEyDFb0fMxYy-ftMwQMB4zKaTggvJZaeq9dWdteaSc8Lb-zaMmil0U0M3p9Cr-8W_k917_6TMfwFzUapW</recordid><startdate>20211206</startdate><enddate>20211206</enddate><creator>Kaye, Keith S</creator><creator>Gupta, Vikas</creator><creator>Mulgirigama, Aruni</creator><creator>Joshi, Ashish V</creator><creator>Scangarella-Oman, Nicole E</creator><creator>Yu, Kalvin</creator><creator>Ye, Gang</creator><creator>Mitrani-Gold, Fanny S</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>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20211206</creationdate><title>Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011 to 2019: Rising ESBL Strains and Impact on Patient Management</title><author>Kaye, Keith S ; Gupta, Vikas ; Mulgirigama, Aruni ; Joshi, Ashish V ; Scangarella-Oman, Nicole E ; Yu, Kalvin ; Ye, Gang ; Mitrani-Gold, Fanny S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-519eb5c9d5e191a26848a035c48795d17e1a02446835d0a9259d17ae04cda8033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>beta-Lactamases - genetics</topic><topic>Drug Resistance, Bacterial</topic><topic>Escherichia coli - drug effects</topic><topic>Escherichia coli Infections - drug therapy</topic><topic>Escherichia coli Infections - epidemiology</topic><topic>Escherichia coli Infections - urine</topic><topic>Female</topic><topic>Humans</topic><topic>Major and Commentaries</topic><topic>Microbial Sensitivity Tests</topic><topic>Models, Theoretical</topic><topic>Retrospective Studies</topic><topic>United States - epidemiology</topic><topic>Urinary Tract Infections - drug therapy</topic><topic>Urinary Tract Infections - epidemiology</topic><topic>Urinary Tract Infections - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kaye, Keith S</creatorcontrib><creatorcontrib>Gupta, Vikas</creatorcontrib><creatorcontrib>Mulgirigama, Aruni</creatorcontrib><creatorcontrib>Joshi, Ashish V</creatorcontrib><creatorcontrib>Scangarella-Oman, Nicole E</creatorcontrib><creatorcontrib>Yu, Kalvin</creatorcontrib><creatorcontrib>Ye, Gang</creatorcontrib><creatorcontrib>Mitrani-Gold, Fanny S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</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>Kaye, Keith S</au><au>Gupta, Vikas</au><au>Mulgirigama, Aruni</au><au>Joshi, Ashish V</au><au>Scangarella-Oman, Nicole E</au><au>Yu, Kalvin</au><au>Ye, Gang</au><au>Mitrani-Gold, Fanny S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011 to 2019: Rising ESBL Strains and Impact on Patient Management</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2021-12-06</date><risdate>2021</risdate><volume>73</volume><issue>11</issue><spage>1992</spage><epage>1999</epage><pages>1992-1999</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Uncomplicated urinary tract infection (uUTI) is predominantly caused by Escherichia coli, which has increasing antimicrobial resistance (AMR) at the United States (US)-community level. As uUTI is often treated empirically, assessing AMR is challenging, and there are limited contemporary data characterizing period prevalence in the US.
This was a retrospective study of AMR using Becton, Dickinson and Company Insights Research Database (Franklin Lakes, New Jersey, US) data collected 2011-2019. Thirty-day, nonduplicate Escherichia coli urine isolates from US female outpatients (aged ≥12 years) were included. Isolates were evaluated for nonsusceptibility (intermediate/resistant) to trimethoprim-sulfamethoxazole, fluoroquinolones, or nitrofurantoin, and assessed for extended-spectrum β-lactamase production (ESBL+) and for ≥2 or ≥3 drug-resistance phenotypes. Generalized estimating equations were used to model AMR trends over time and by US census region.
Among 1 513 882 E. coli isolates, the overall prevalence of isolates nonsusceptible to trimethoprim-sulfamethoxazole, fluoroquinolones, and nitrofurantoin was 25.4%, 21.1%, and 3.8%, respectively. Among the isolates, 6.4% were ESBL+, 14.4% had ≥2 drug-resistance phenotypes, and 3.8% had ≥3. Modeling demonstrated a relative average yearly increase of 7.7% (95% confidence interval [CI], 7.2-8.2%) for ESBL+ isolates and 2.7% (95% CI, 2.2-3.2%) for ≥3 drug-phenotypes (both P < .0001). Modeling also demonstrated significant variation in AMR prevalence between US census regions (P < .001).
Period prevalence of AMR among US outpatient urine-isolated E. coli was high, and for multidrug-resistance phenotypes increased during the study period with significant variation between census regions. Knowledge of regional AMR rates helps inform empiric treatment of community-onset uUTI and highlights the AMR burden to physicians.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>34143881</pmid><doi>10.1093/cid/ciab560</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use beta-Lactamases - genetics Drug Resistance, Bacterial Escherichia coli - drug effects Escherichia coli Infections - drug therapy Escherichia coli Infections - epidemiology Escherichia coli Infections - urine Female Humans Major and Commentaries Microbial Sensitivity Tests Models, Theoretical Retrospective Studies United States - epidemiology Urinary Tract Infections - drug therapy Urinary Tract Infections - epidemiology Urinary Tract Infections - microbiology |
| title | Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011 to 2019: Rising ESBL Strains and Impact on Patient Management |
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