Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones

doi:10.3390/antibiotics10050582

. 2021 May 14;10(5):582.

doi: 10.3390/antibiotics10050582.

Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones

Affiliations

¹ Infectious Pathology and Antimicrobials Research Group (IPAR), Pharmacy Department, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain.
² Infectious Pathology and Antimicrobials Research Group (IPAR), Infectious Diseases Department, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Hospital del Mar, 08003 Barcelona, Spain.
³ Microbiology Service, Infectious Pathology and Antimicrobials Research Group (IPAR), Laboratoi de Referència de Catalunya, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Hospital del Mar, 08003 Barcelona, Spain.
⁴ Critical Care Department, GREPAC, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain.
⁵ Scientific, Statistics and Technical Department, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain.

PMID: 34069184
PMCID: PMC8156637
DOI: 10.3390/antibiotics10050582

Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones

Javier Martínez-Casanova et al. Antibiotics (Basel). 2021.

. 2021 May 14;10(5):582.

doi: 10.3390/antibiotics10050582.

Affiliations

¹ Infectious Pathology and Antimicrobials Research Group (IPAR), Pharmacy Department, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain.
² Infectious Pathology and Antimicrobials Research Group (IPAR), Infectious Diseases Department, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Hospital del Mar, 08003 Barcelona, Spain.
³ Microbiology Service, Infectious Pathology and Antimicrobials Research Group (IPAR), Laboratoi de Referència de Catalunya, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Hospital del Mar, 08003 Barcelona, Spain.
⁴ Critical Care Department, GREPAC, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain.
⁵ Scientific, Statistics and Technical Department, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain.

PMID: 34069184
PMCID: PMC8156637
DOI: 10.3390/antibiotics10050582

Abstract

Background: High rates of amoxicillin-clavulanate (AMC) resistance among Enterobacterales isolated from urinary tract infections (UTIs) were observed in our area. The aim of this study was to identify risk factors associated with AMC resistance in patients with community-onset UTI in emergency departments (EDs).

Methods: A retrospective study was performed of all ED patients with positive urine cultures for Escherichia coli or Klebsiella pneumoniae in a Spanish tertiary-care hospital.

Results: 330 urine cultures in all were included: 261 (79.1%) for E. coli and 69 (20.90%) for K. pneumonia. Rates of AMC resistance were 14.94% and 34.78%, respectively. UTI was clinically confirmed in 212 (64.24%) cases. Previous antimicrobial exposure was independently associated with AMC resistance development in E. coli and K. pneumoniae urinary isolates (OR = 2.94, 95% CI = 1.55-5.58). Analyses of infected patients revealed that previous exposure to fluoroquinolones (OR = 3.33, 95% CI = 1.10-10.12, p = 0.034) and to AMC (OR = 5.68, 95% CI = 1.97-16.44, p = 0.001) was significantly associated with isolation of AMC-resistant strains.

Conclusions: Prior antibiotic exposure, particularly to AMC or fluoroquinolones, was the only independent risk factor associated with development of AMC resistance in E. coli and K. pneumoniae urinary isolates from patients attending the ED.

Keywords: Enterobacterales; amoxicillin/clavulanate; antimicrobial resistance; emergency department; fluoroquinolones; urinary tract infection (UTI).

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Conflict of interest statement

The authors declare no conflict of interest.

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[1] Long B., Koyfman A. The Emergency Department Diagnosis and Management of Urinary Tract Infection. Emerg. Med. Clin. 2018;36:685–710. doi: 10.1016/j.emc.2018.06.003. - DOI - PubMed

[2] Long B., Koyfman A. The Emergency Department Diagnosis and Management of Urinary Tract Infection. Emerg. Med. Clin. 2018;36:685–710. doi: 10.1016/j.emc.2018.06.003. - DOI - PubMed

[3] De Zarate M.M.O., Del Castillo J.G., Jiménez A.J., Salmerón P.P., Roca F.L., Tey J.G., Borras M.R.C., Grinspan M.R., Lamberechts E.J.G., Esparza C.I., et al. Estudio INFURG-SEMES: Epidemiología de las infecciones atendidas en los servicios de urgencias hospitalarios y evolución durante la última década. Emergencias. 2013;25:368–378.

[4] De Zarate M.M.O., Del Castillo J.G., Jiménez A.J., Salmerón P.P., Roca F.L., Tey J.G., Borras M.R.C., Grinspan M.R., Lamberechts E.J.G., Esparza C.I., et al. Estudio INFURG-SEMES: Epidemiología de las infecciones atendidas en los servicios de urgencias hospitalarios y evolución durante la última década. Emergencias. 2013;25:368–378.

[5] May L., Mullins P., Pines J. Demographic and treatment patterns for infections in ambulatory settings in the United states, 2006–2010. Acad. Emerg. Med. 2014;21:17–24. doi: 10.1111/acem.12287. - DOI - PMC - PubMed

[6] May L., Mullins P., Pines J. Demographic and treatment patterns for infections in ambulatory settings in the United states, 2006–2010. Acad. Emerg. Med. 2014;21:17–24. doi: 10.1111/acem.12287. - DOI - PMC - PubMed

[7] Gupta K., Hooton T.M., Naber K.G., Wullt B., Colgan R., Miller L.G., Moran G.J., Nicolle L.E., Raz R., Schaeffer A.J., et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010n Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. J. Bacteriol. Res. 2011;52:46–53. - PubMed

[8] Gupta K., Hooton T.M., Naber K.G., Wullt B., Colgan R., Miller L.G., Moran G.J., Nicolle L.E., Raz R., Schaeffer A.J., et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010n Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. J. Bacteriol. Res. 2011;52:46–53. - PubMed

[9] Zhanel G.G., Hisanaga T.L., Laing N.M., DeCorby M.R., Nichol K.A., Palatnick L.P., Johnson J., Noreddin A., Harding G.K., Nicolle L.E., et al. Antibiotic resistance in outpatient urinary isolates: Final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA) Int. J. Antimicrob. Agents. 2005;26:380–388. doi: 10.1016/j.ijantimicag.2005.08.003. - DOI - PubMed

[10] Zhanel G.G., Hisanaga T.L., Laing N.M., DeCorby M.R., Nichol K.A., Palatnick L.P., Johnson J., Noreddin A., Harding G.K., Nicolle L.E., et al. Antibiotic resistance in outpatient urinary isolates: Final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA) Int. J. Antimicrob. Agents. 2005;26:380–388. doi: 10.1016/j.ijantimicag.2005.08.003. - DOI - PubMed

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Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones

Affiliations

Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones

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