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. 2022 Nov 21;9(12):ofac623.
doi: 10.1093/ofid/ofac623. eCollection 2022 Dec.

Risk Factors Associated With Antimicrobial Resistance and Adverse Short-Term Health Outcomes Among Adult and Adolescent Female Outpatients With Uncomplicated Urinary Tract Infection

Barbara W Trautner  1 , Keith S Kaye  2 , Vikas Gupta  3 , Aruni Mulgirigama  4 , Fanny S Mitrani-Gold  5 , Nicole E Scangarella-Oman  5 , Kalvin Yu  3 , Gang Ye  3 , Ashish V Joshi  5
Affiliations

Risk Factors Associated With Antimicrobial Resistance and Adverse Short-Term Health Outcomes Among Adult and Adolescent Female Outpatients With Uncomplicated Urinary Tract Infection

Barbara W Trautner et al. Open Forum Infect Dis. .

Abstract

Background: Increasing antimicrobial resistance makes treating uncomplicated urinary tract infections (uUTIs) difficult. We compared whether adverse short-term outcomes among US female patients were more common when initial antimicrobial therapy did not cover the causative uropathogen.

Methods: This retrospective cohort study used data from female outpatients aged ≥12 years, with a positive urine culture and dispensing of an oral antibiotic ±1 day from index culture. Isolate susceptibility to the antimicrobial initially dispensed, patient age, and history of antimicrobial exposure, resistance, and all-cause hospitalization within 12 months of index culture were evaluated for associations with adverse outcomes during 28-day follow up. Outcomes assessed were new antimicrobial dispensing, all-cause hospitalization, and all-cause outpatient emergency department/clinic visits.

Results: Of 2366 uUTIs, 1908 (80.6%) were caused by isolates susceptible and 458 (19.4%) by isolates not susceptible (intermediate/resistant) to initial antimicrobial treatment. Within 28 days, patients with episodes caused by not susceptible isolates were 60% more likely to receive a new antimicrobial versus episodes with susceptible isolates (29.0% vs 18.1%; 95% confidence interval, 1.3-2.1; P < .0001). Other variables associated with new antibiotic dispenses within 28 days were older age, prior antimicrobial exposure, or prior nitrofurantoin-not-susceptible uropathogens (P < .05). Older age, prior antimicrobial-resistant urine isolates, and prior hospitalization were associated with all-cause hospitalization (P < .05). Prior fluoroquinolone-not-susceptible isolates or oral antibiotic dispensing within 12 months of index culture were associated with subsequent all-cause outpatient visits (P < .05).

Conclusions: New antimicrobial dispensing within the 28-day follow-up period was associated with uUTIs where the uropathogen was not susceptible to initial antimicrobial treatment. Older age and prior antimicrobial exposure, resistance, and hospitalization also identified patients at risk of adverse outcomes.

Keywords: antimicrobial resistance; health outcomes; hospitalization; treatment failure; uncomplicated UTI.

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Conflict of interest statement

Potential conflicts of interest. B. W. T. reports funding from Genentech and INSIGHT (National Institutes of Health National Institute of Allergy and Infectious Diseases) for sponsored trials of potential COVID therapeutics and from VA’s Health Services Research and Development Service ([VA HSR&D] HX002171), VA Rehabilitation Research & Development Service ([RR&D] RX002596), and Agency for Healthcare Research and Quality [AHRQ] (HS026901 and HS027869) for investigator-initiated research. Her work is also funded in part by the Houston Veterans Affairs Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). The contents of this manuscript do not represent the views of VA or the United States Government. K. S. K. has received symposia honoraria from GSK. V. G. is an employee of and shareholder in Becton, Dickinson and Company, which received funding from GSK to conduct this study. A. M. is an employee and shareholder in GSK. F. S. M.-G. is an employee of and shareholder in GSK. N. E. S.-O. is an employee of and shareholder in GSK. K. Y. is an employee of and shareholder in Becton, Dickinson and Company, which received funding from GSK to conduct this study. G. Y. is an employee of Becton, Dickinson and Company, which received funding from GSK to conduct this study. A. V. J. is an employee of and shareholder in GSK. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Association of 28-day health outcomes by isolate susceptibility status to initial antimicrobial therapy. Note: Susceptible or not susceptible to antimicrobial dispensed at index. Abx, antibiotic; CI, confidence interval; ED, emergency department; OR, odds ratio; ref, reference group.
See this image and copyright information in PMC

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