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. 2016 Sep;22(9):1594-1603.
doi: 10.3201/eid2209.160148.

Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase-Producing Escherichia coli Infections in Patients with Pyelonephritis, United States(1)

David A Talan, Sukhjit S Takhar, Anusha Krishnadasan, Fredrick M Abrahamian, William R Mower, Gregory J Moran; EMERGEncy ID Net Study Group
Collaborators

Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase-Producing Escherichia coli Infections in Patients with Pyelonephritis, United States(1)

David A Talan et al. Emerg Infect Dis. 2016 Sep.

Abstract

For 2013-2014, we prospectively identified US adults with flank pain, temperature >38.0°C, and a diagnosis of acute pyelonephritis, confirmed by culture. Cultures from 453 (86.9%) of 521 patients grew Escherichia coli. Among E. coli isolates from 272 patients with uncomplicated pyelonephritis and 181 with complicated pyelonephritis, prevalence of fluoroquinolone resistance across study sites was 6.3% (range by site 0.0%-23.1%) and 19.9% (0.0%-50.0%), respectively; prevalence of extended-spectrum β-lactamase (ESBL) production was 2.6% (0.0%-8.3%) and 12.2% (0.0%-17.2%), respectively. Ten (34.5%) of 29 patients with ESBL infection reported no exposure to antimicrobial drugs, healthcare, or travel. Of the 29 patients with ESBL infection and 53 with fluoroquinolone-resistant infection, 22 (75.9%) and 24 (45.3%), respectively, were initially treated with in vitro inactive antimicrobial drugs. Prevalence of fluoroquinolone resistance exceeds treatment guideline thresholds for alternative antimicrobial drug strategies, and community-acquired ESBL-producing E. coli infection has emerged in some US communities.

Keywords: CTX-M-15; E. coli; ESBL; Enterobacteriaceae; Escherichia coli; United States; antimicrobial resistance; bacteria; complicated; extended-spectrum β-lactamase; fluoroquinolone; gram-negative bacteria; kidney disease; nephritis; prevalence; pyelonephritis; risk factors; uncomplicated.

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Figures

Figure 1
Figure 1
Prevalence of fluoroquinolone-resistant Escherichia coli infection among emergency department patients with uncomplicated (U) and complicated (C) pyelonephritis by study site, United States, July 2013–December 2014. Study sites are listed in the Technical Appendix; Technical Appendix Tables 2 and 3 provide additional results on antimicrobial resistance rates. In vitro resistance to ciprofloxacin and/or levofloxacin is shown as % (no. of patients with a resistant isolate/total no. of patients tested)
Figure 2
Figure 2
Prevalence of extended-spectrum β-lactamase–producing Escherichia coli infection among patients with uncomplicated (U) and complicated (C) pyelonephritis, by study site, United States, July 2013–December 2014. Study sites are listed in the Technical Appendix; Technical Appendix Tables 2 and 3 provide additional results on antimicrobial resistance rates.
Figure 3
Figure 3
Prevalence of fluoroquinolone-resistant and ESBL-producing Escherichia coli infections among patients with uncomplicated and complicated pyelonephritis, by study site, United States, July 2013–December 2014. Each dot indicates a study site; the line to show the general trend between fluoroquinolone resistance and ESBL-producing E. coli was generated by using simple linear regression. ESBL, extended spectrum β-lactamase.
See this image and copyright information in PMC

References

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