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. 2023 Jul 26;13(1):12077.
doi: 10.1038/s41598-023-38919-8.

Escherichia coli resistance, treatment patterns and clinical outcomes among females with uUTI in Germany: a retrospective physician-based chart review study

Kurt G Naber  1 , Florian Wagenlehner  2 , Michael Kresken  3 , Wendy Y Cheng  4 , Maryaline Catillon  4 , Mei Sheng Duh  4 , Louise Yu  4 , Anamika Khanal  4 , Aruni Mulgirigama  5 , Ashish V Joshi  6 , Shinyoung Ju  5 , Fanny S Mitrani-Gold  7
Affiliations

Escherichia coli resistance, treatment patterns and clinical outcomes among females with uUTI in Germany: a retrospective physician-based chart review study

Kurt G Naber et al. Sci Rep. .

Abstract

Real-world data were collected to examine antimicrobial resistance (AMR) prevalence, treatment patterns, and clinical outcomes among female patients with uncomplicated urinary tract infection (uUTI) in Germany. Data were from a retrospective physician-based chart review completed by physicians treating patients with uUTI. Non-pregnant women aged ≥ 12 years, with a uUTI diagnosis, an E. coli-positive urine culture between January 2017-December 2019, and susceptibility test results for ≥ 4 drug classes were eligible. Patients were stratified into three cohorts by drug class susceptibility: susceptible to all (SUS), resistant to one or two drug classes (DR1/2), and resistant to ≥ 3 (MDR) drug classes tested. Among 386 eligible patients [SUS (67.1%); DR1/2 (29.0%); MDR (3.9%)], AMR prevalence was highest for FMIs (18.3%) and lowest for fluoroquinolones (5.2%). The most prescribed drugs were fosfomycin in SUS (44.0%), DR1/2 (41.4%), and fluoroquinolones in MDR (40.0%). Treatment for uUTI failed for 8.8% of patients; failure was more likely in MDR versus SUS [adjusted odds ratio [95% CI] = 4.21 [1.14-1.50]; P = 0.031); incidence of recurrent infection in the 6-months post-index period was higher in DR1/2 versus SUS. These findings may have implications for empiric prescribing, suggesting an unmet need for new treatments.

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Conflict of interest statement

K.G.N. discloses consultancy fees from AdamedPharma, Biomerieux, Bionorica, Eumedica, GSK, Immunotek, OM Pharma, and MIP/Rosen Pharma. F.W. is an advisor of GSK and a principal investigator in a GSK-sponsored study. M.K is a partner and CEO of Antiinfectives Intelligence GmbH, a research organization providing services to pharmaceutical companies. W.Y.C., M.C., M.S.D., L.Y., and A.K. are employees of Analysis Group, Inc., which has received funding from GSK to conduct the study. A.M., A.V.J., S.J., and F.S.M-G. are employees of and shareholders in GSK. Aspects of this work were previously presented at ECCMID 2022 in the form of posters and summary slides. These were entitled: “Antimicrobial Resistance Patterns and Patient Characteristics Among Females With Uncomplicated Urinary Tract Infection in Germany: A Physician-Based Chart Review” and “Treatment Patterns and Outcomes in Female Outpatients With Uncomplicated Urinary Tract Infection in Germany: A Physician-Based Chart Review”.

Figures

Figure 1
Figure 1
Study design. aSome baseline characteristics (such as age and pregnancy status) collected on index date only. AUC acute uncomplicated cystitis, HRU healthcare resource utilization, cUTI complicated urinary tract infection, UTI urinary tract infection, uUTI uncomplicated urinary tract infection.
Figure 2
Figure 2
Regional distribution of physicians by region and work setting. Each physician completed an electronic case report form for at least one and up to three patients. The following Federal States were included in each region: Northeast (Berlin, Brandenburg, Mecklenburg-Western Pomerania, and Saxony-Anhalt), Northwest (Schleswig-Holstein, Hamburg, Lower Saxony, and Bremen), Southeast (Bavaria, Thuringia, and Saxony), Southwest (Hesse, Rhineland-Palatinate, Baden-Württemberg, and Saarland), and West (North Rhine-Westphalia). GP general practitioner, OB obstetrician, GYN gynecologist.
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