title: Predicting Antibiotic Resistance in Urinary Tract Infection Patients with Prior Urine Cultures.
abstract: To improve antibiotic prescribing, we sought to establish the probability of a resistant organism in urine culture given a previous resistant culture in a setting endemic for multidrug-resistant (MDR) organisms. We performed a retrospective analysis of inpatients with paired positive urine cultures. We focused on ciprofloxacin-resistant (cipro(r)) Gram-negative bacteria, extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae (CRE), and carbapenem-resistant nonfermenters (CRNF). Comparisons were made between the frequency of each resistance phenotype following a previous culture with the same phenotype and the overall frequency of that phenotype, and odds ratios (ORs) were calculated. We performed a regression to assess the effects of other variables on the likelihood of a repeat resistant culture. A total of 4,409 patients (52.5% women; median age, 70 years) with 19,546 paired positive urine cultures were analyzed. The frequencies of cipro(r) bacteria, ESBL-producing Enterobacteriaceae, CRE, and CRNF among all cultures were 47.7%, 30.6%, 1.7%, and 2.6%, respectively. ORs for repeated resistance phenotypes were 1.87, 3.19, 48.25, and 19.02 for cipro(r) bacteria, ESBL-producing Enterobacteriaceae, CRE, and CRNF, respectively (P < 0.001 for all). At 1 month, the frequencies of repeated resistance phenotypes were 77.4%, 66.4%, 57.1%, and 33.3% for cipro(r) bacteria, ESBL-producing Enterobacteriaceae, CRE, and CRNF, respectively. Increasing time between cultures and the presence of an intervening nonresistant culture significantly reduced the chances of a repeat resistant culture. Associations were statistically significant over the duration of follow-up (60 months) for CRE and for up to 6 months for all other pathogens. Knowledge of microbiology results in the six preceding months may assist with antibiotic stewardship and improve the appropriateness of empirical treatment for urinary tract infections (UTIs).
authors.affiliation: Division of Infectious Diseases, Rambam Healthcare Campus, Haifa, Israel yakovd@tlvmc.gov.il.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Dickstein
authors.affiliation: Medical Microbiology Laboratory, Rambam Healthcare Campus, Haifa, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Geffen
authors.affiliation: Center for Model-Based Medical Decision Support, Aalborg University, Aalborg, Denmark.
authors.forename: Steen
authors.initials: S
authors.lastname: Andreassen
authors.affiliation: Medicine E, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Leonard
authors.initials: L
authors.lastname: Leibovici
authors.affiliation: Division of Infectious Diseases, Rambam Healthcare Campus, Haifa, Israel.
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004755:Enterobacteriaceae / Q000187:drug effects / Q000378:metabolism; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D014556:Urine / Q000382:microbiology*; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002939:Ciprofloxacin; D001618:beta-Lactamases