TY - JOUR
T1 - Emergence of Extended-Spectrum β-Lactamase Urinary Tract Infections Among Hospitalized Emergency Department Patients in the United States
AU - Talan, David A.
AU - Takhar, Sukhjit S.
AU - Krishnadasan, Anusha
AU - Mower, William R.
AU - Pallin, Daniel J.
AU - Garg, Manish
AU - Femling, Jon
AU - Rothman, Richard E.
AU - Moore, Johanna C.
AU - Jones, Alan E.
AU - Lovecchio, Frank
AU - Jui, Jonathan
AU - Steele, Mark T.
AU - Stubbs, Amy M.
AU - Chiang, William K.
AU - Moran, Gregory J.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). Dr. Talan reports receiving consulting fees from Allergan, Integrated BioTherapeutics, Light AI, Spero Therapeutics, and GlaxoSmithKline. Dr. Moran reports grant support from Covance and Contrafect, and consulting fees from Nabriva and Light AI. This work was supported by a grant from the Centers for Disease Control and Prevention , cooperative agreement U01CK000176 . Confirmation of extended-spectrum β-lactamase production, carbapenem-resistant Enterobacteriaceae, genetic β-lactamase characterization, and susceptibility testing was completed by the IHMA Laboratory and funded by Shionogi & Co. Ltd.
Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Talan reports receiving consulting fees from Allergan, Integrated BioTherapeutics, Light AI, Spero Therapeutics, and GlaxoSmithKline. Dr. Moran reports grant support from Covance and Contrafect, and consulting fees from Nabriva and Light AI. This work was supported by a grant from the Centers for Disease Control and Prevention, cooperative agreement U01CK000176. Confirmation of extended-spectrum ?-lactamase production, carbapenem-resistant Enterobacteriaceae, genetic ?-lactamase characterization, and susceptibility testing was completed by the IHMA Laboratory and funded by Shionogi & Co. Ltd. Author contributions: DAT, SST, AK, WRM, and GJM conceived and designed the study. DAT obtained funding. AK implemented and oversaw data collection and managed the data and quality control of the study. WRM and AK conducted data analysis. DAT drafted the article, and all the authors substantially contributed to its revision. DAT takes responsibility for the paper as a whole.
Publisher Copyright:
© 2020 American College of Emergency Physicians
PY - 2021/1
Y1 - 2021/1
N2 - Study objective: Enterobacteriaceae resistant to ceftriaxone, mediated through extended-spectrum β-lactamases (ESBLs), commonly cause urinary tract infections worldwide, but have been less prevalent in North America. Current US rates are unknown. We determine Enterobacteriaceae antimicrobial resistance rates among US emergency department (ED) patients hospitalized for urinary tract infection. Methods: We prospectively enrolled adults hospitalized for urinary tract infection from 11 geographically diverse university-affiliated hospital EDs during 2018 to 2019. Among participants with culture-confirmed infection, we evaluated prevalence of antimicrobial resistance, including that caused by ESBL-producing Enterobacteriaceae, resistance risk factors, and time to in vitro–active antibiotics. Results: Of 527 total participants, 444 (84%) had cultures that grew Enterobacteriaceae; 89 of 435 participants (20.5%; 95% confidence interval 16.9% to 24.5%; 4.6% to 45.4% by site) whose isolates had confirmatory testing had bacteria that were ESBL producing. The overall prevalence of ESBL-producing Enterobacteriaceae infection among all participants with urinary tract infection was 17.2% (95% confidence interval 14.0% to 20.7%). ESBL-producing Enterobacteriaceae infection risk factors were hospital, long-term care, antibiotic exposure within 90 days, and a fluoroquinolone- or ceftriaxone-resistant isolate within 1 year. Enterobacteriaceae resistance rates for other antimicrobials were fluoroquinolone 32.3%, gentamicin 13.7%, amikacin 1.3%, and meropenem 0.3%. Ceftriaxone was the most common empirical antibiotic. In vitro–active antibiotics were not administered within 12 hours of presentation to 48 participants (53.9%) with ESBL-producing Enterobacteriaceae infection, including 17 (58.6%) with sepsis. Compared with other Enterobacteriaceae infections, ESBL infections were associated with longer time to in vitro–active treatment (17.3 versus 3.5 hours). Conclusion: Among adults hospitalized for urinary tract infection in many US locations, ESBL-producing Enterobacteriaceae have emerged as a common cause of infection that is often not initially treated with an in vitro–active antibiotic.
AB - Study objective: Enterobacteriaceae resistant to ceftriaxone, mediated through extended-spectrum β-lactamases (ESBLs), commonly cause urinary tract infections worldwide, but have been less prevalent in North America. Current US rates are unknown. We determine Enterobacteriaceae antimicrobial resistance rates among US emergency department (ED) patients hospitalized for urinary tract infection. Methods: We prospectively enrolled adults hospitalized for urinary tract infection from 11 geographically diverse university-affiliated hospital EDs during 2018 to 2019. Among participants with culture-confirmed infection, we evaluated prevalence of antimicrobial resistance, including that caused by ESBL-producing Enterobacteriaceae, resistance risk factors, and time to in vitro–active antibiotics. Results: Of 527 total participants, 444 (84%) had cultures that grew Enterobacteriaceae; 89 of 435 participants (20.5%; 95% confidence interval 16.9% to 24.5%; 4.6% to 45.4% by site) whose isolates had confirmatory testing had bacteria that were ESBL producing. The overall prevalence of ESBL-producing Enterobacteriaceae infection among all participants with urinary tract infection was 17.2% (95% confidence interval 14.0% to 20.7%). ESBL-producing Enterobacteriaceae infection risk factors were hospital, long-term care, antibiotic exposure within 90 days, and a fluoroquinolone- or ceftriaxone-resistant isolate within 1 year. Enterobacteriaceae resistance rates for other antimicrobials were fluoroquinolone 32.3%, gentamicin 13.7%, amikacin 1.3%, and meropenem 0.3%. Ceftriaxone was the most common empirical antibiotic. In vitro–active antibiotics were not administered within 12 hours of presentation to 48 participants (53.9%) with ESBL-producing Enterobacteriaceae infection, including 17 (58.6%) with sepsis. Compared with other Enterobacteriaceae infections, ESBL infections were associated with longer time to in vitro–active treatment (17.3 versus 3.5 hours). Conclusion: Among adults hospitalized for urinary tract infection in many US locations, ESBL-producing Enterobacteriaceae have emerged as a common cause of infection that is often not initially treated with an in vitro–active antibiotic.
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U2 - 10.1016/j.annemergmed.2020.08.022
DO - 10.1016/j.annemergmed.2020.08.022
M3 - Article
C2 - 33131912
AN - SCOPUS:85094851198
SN - 0196-0644
VL - 77
SP - 32
EP - 43
JO - Journal of the American College of Emergency Physicians
JF - Journal of the American College of Emergency Physicians
IS - 1
ER -