High prevalence of fluoroquinolone‐resistant UTI among US emergency department patients diagnosed with urinary tract infection, 2018–2020

作者：Brett A. Faine, Megan A. Rech, J. Priyanka Vakkalanka, Alan Edward Gross, Caitlin S. Brown, Stephanie J. Harding, Giles W. Slocum, David E. Zimmerman, Anne E. Zepeski, Stacey Rewitzer, Gavin T. Howington, Matthew J. Campbell, Jordan Dawson, Cierra N. Treu, Lucas Nelson, Mandy Jones, Tara Flack, Blake A. Porter, Preeyaporn Sarangarm, Alicia E Mattson, Abby Mynatt Bailey, Gregory Kelly, David A. Talan · 发表于：Academic Emergency Medicine · 年份：2022 · DOI：10.1111/acem.14545 · 被引用次数：41 · 研究领域：Urinary Tract Infections Management、Bladder and Urothelial Cancer Treatments、Antibiotic Use and Resistance

BACKGROUND: Uropathogen resistance, fluoroquinolone-resistance (FQR), and extended spectrum beta-lactamase (ESBL), has been observed to be emerging worldwide with prevalences above recommended thresholds for routine empirical treatment. The primary aim of our study was to determine the prevalence of FQR from a geographically diverse sample of United States emergency departments (EDs). METHODS: We conducted a multi-center, observational cohort study using a network of 15 geographically diverse US EDs. All patients ≥18 years of age with the primary or secondary diagnosis of urinary tract infection (UTI) in the ED identified using International Classification of Diseases (ICD-10) diagnosis code of cystitis, pyelonephritis, or UTI from 2018 to 2020 were included. We calculated descriptive statistics for uropathogens and susceptibilities. Logistic regression analysis was used to identify antimicrobial resistance risk factors associated with FQR Escherichia coli. RESULTS: Among 3779 patients who met inclusion criteria, median age was 62.9 years (interquartile range [IQR]: 41-77.6) and 76.3% were female. The most common diagnoses were complicated (41.2%) and uncomplicated cystitis (40.3%). E. coli was the most common pathogen (63.2%), followed by Klebsiella pneumoniae (13.2%) and Enterococcus species (5.8%). Across all sites, overall E. coli FQ-resistance prevalence was 22.1%, ranging from 10.5 to 29.7% by site. The prevalence of ESBL-producing uropathogen was 7.4%, ranging from 3.6...