Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections
Objectives: This study aimed to predict trimethoprim/sulfamethoxazole (SXT) resistance in patients with community-onset urinary tract infection (UTI) due to Enterobacteriaceae based on patient-specific risk factors. Methods: This was a retrospective case–control study in Prisma Health facilities in...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-06-01
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| Series: | Journal of Global Antimicrobial Resistance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716519302851 |
| _version_ | 1818914720495697920 |
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| author | Madeline DeMarsh P. Brandon Bookstaver Caroline Gordon Juanne Lim Nicole Griffith Nicole K. Bookstaver Julie Ann Justo Joseph Kohn Majdi N. Al-Hasan |
| author_facet | Madeline DeMarsh P. Brandon Bookstaver Caroline Gordon Juanne Lim Nicole Griffith Nicole K. Bookstaver Julie Ann Justo Joseph Kohn Majdi N. Al-Hasan |
| author_sort | Madeline DeMarsh |
| collection | DOAJ |
| description | Objectives: This study aimed to predict trimethoprim/sulfamethoxazole (SXT) resistance in patients with community-onset urinary tract infection (UTI) due to Enterobacteriaceae based on patient-specific risk factors. Methods: This was a retrospective case–control study in Prisma Health facilities in central South Carolina, USA, including three community hospitals, affiliated emergency departments and ambulatory clinics, including adult patients with community-onset UTI due to Enterobacteriaceae (1 April 2015 to 29 February 2016). Multivariate logistic regression was used to examine risk factors for SXT resistance. Results: Among 351 unique patients with community-onset UTI, 71 (20.2%) had SXT-resistant Enterobacteriaceae urinary isolates. Overall, median age was 64 years and 252 (71.8%) were female. A multivariate model identified prior urinary infection/colonisation with SXT-resistant Enterobacteriaceae (OR = 8.58, 95% CI 3.92–18.81; P < 0.001) and SXT use within past 12 months (OR = 2.58, 95% CI 1.13–5.89; P = 0.02) as predictors of SXT resistance among urinary isolates. Most patients with UTI (285; 81.2%) had no risk factors for SXT resistance. SXT resistance rates increased from 13% in the absence of risk factors to 31% in patients with prior SXT use, 66% in those with prior urinary infection/colonisation with SXT-resistant Enterobacteriaceae and 73% in the presence of both risk factors. Conclusion: SXT resistance in Enterobacteriaceae urinary isolates may be predicted based on prior urine culture results and SXT use within the previous year. Utilisation of a patient-specific antibiogram may allow empirical SXT use in patients with community-onset UTI in the absence of risk factors for resistance. |
| first_indexed | 2024-12-19T23:50:52Z |
| format | Article |
| id | doaj.art-240ee5bfacd84d72b4b92d61751b19f7 |
| institution | Directory Open Access Journal |
| issn | 2213-7165 |
| language | English |
| last_indexed | 2024-12-19T23:50:52Z |
| publishDate | 2020-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj.art-240ee5bfacd84d72b4b92d61751b19f72022-12-21T20:01:09ZengElsevierJournal of Global Antimicrobial Resistance2213-71652020-06-0121218222Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infectionsMadeline DeMarsh0P. Brandon Bookstaver1Caroline Gordon2Juanne Lim3Nicole Griffith4Nicole K. Bookstaver5Julie Ann Justo6Joseph Kohn7Majdi N. Al-Hasan8Department of Pharmacy, Prisma Health Richland, Columbia, SC, USADepartment of Pharmacy, Prisma Health Richland, Columbia, SC, USA; Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USADepartment of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USADepartment of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USADepartment of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USADepartment of Pharmacy, Prisma Health Richland, Columbia, SC, USADepartment of Pharmacy, Prisma Health Richland, Columbia, SC, USA; Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USADepartment of Pharmacy, Prisma Health Richland, Columbia, SC, USAUniversity of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, Prisma Health University of South Carolina Medical Group, Columbia, SC, USA; Corresponding author at: University of South Carolina School of Medicine, Columbia, SC, USA.Objectives: This study aimed to predict trimethoprim/sulfamethoxazole (SXT) resistance in patients with community-onset urinary tract infection (UTI) due to Enterobacteriaceae based on patient-specific risk factors. Methods: This was a retrospective case–control study in Prisma Health facilities in central South Carolina, USA, including three community hospitals, affiliated emergency departments and ambulatory clinics, including adult patients with community-onset UTI due to Enterobacteriaceae (1 April 2015 to 29 February 2016). Multivariate logistic regression was used to examine risk factors for SXT resistance. Results: Among 351 unique patients with community-onset UTI, 71 (20.2%) had SXT-resistant Enterobacteriaceae urinary isolates. Overall, median age was 64 years and 252 (71.8%) were female. A multivariate model identified prior urinary infection/colonisation with SXT-resistant Enterobacteriaceae (OR = 8.58, 95% CI 3.92–18.81; P < 0.001) and SXT use within past 12 months (OR = 2.58, 95% CI 1.13–5.89; P = 0.02) as predictors of SXT resistance among urinary isolates. Most patients with UTI (285; 81.2%) had no risk factors for SXT resistance. SXT resistance rates increased from 13% in the absence of risk factors to 31% in patients with prior SXT use, 66% in those with prior urinary infection/colonisation with SXT-resistant Enterobacteriaceae and 73% in the presence of both risk factors. Conclusion: SXT resistance in Enterobacteriaceae urinary isolates may be predicted based on prior urine culture results and SXT use within the previous year. Utilisation of a patient-specific antibiogram may allow empirical SXT use in patients with community-onset UTI in the absence of risk factors for resistance.http://www.sciencedirect.com/science/article/pii/S2213716519302851Antimicrobial stewardshipEnterobacteriaceaeEscherichia coliUrine cultureAntibiogram |
| spellingShingle | Madeline DeMarsh P. Brandon Bookstaver Caroline Gordon Juanne Lim Nicole Griffith Nicole K. Bookstaver Julie Ann Justo Joseph Kohn Majdi N. Al-Hasan Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections Journal of Global Antimicrobial Resistance Antimicrobial stewardship Enterobacteriaceae Escherichia coli Urine culture Antibiogram |
| title | Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections |
| title_full | Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections |
| title_fullStr | Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections |
| title_full_unstemmed | Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections |
| title_short | Prediction of trimethoprim/sulfamethoxazole resistance in community-onset urinary tract infections |
| title_sort | prediction of trimethoprim sulfamethoxazole resistance in community onset urinary tract infections |
| topic | Antimicrobial stewardship Enterobacteriaceae Escherichia coli Urine culture Antibiogram |
| url | http://www.sciencedirect.com/science/article/pii/S2213716519302851 |
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