title: Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase-Producing Escherichia coli Infections in Patients with Pyelonephritis, United States(1).
abstract: For 2013-2014, we prospectively identified US adults with flank pain, temperature >38.0°C, and a diagnosis of acute pyelonephritis, confirmed by culture. Cultures from 453 (86.9%) of 521 patients grew Escherichia coli. Among E. coli isolates from 272 patients with uncomplicated pyelonephritis and 181 with complicated pyelonephritis, prevalence of fluoroquinolone resistance across study sites was 6.3% (range by site 0.0%-23.1%) and 19.9% (0.0%-50.0%), respectively; prevalence of extended-spectrum β-lactamase (ESBL) production was 2.6% (0.0%-8.3%) and 12.2% (0.0%-17.2%), respectively. Ten (34.5%) of 29 patients with ESBL infection reported no exposure to antimicrobial drugs, healthcare, or travel. Of the 29 patients with ESBL infection and 53 with fluoroquinolone-resistant infection, 22 (75.9%) and 24 (45.3%), respectively, were initially treated with in vitro inactive antimicrobial drugs. Prevalence of fluoroquinolone resistance exceeds treatment guideline thresholds for alternative antimicrobial drug strategies, and community-acquired ESBL-producing E. coli infection has emerged in some US communities.
authors.forename: David A
authors.initials: DA
authors.lastname: Talan
authors.forename: Sukhjit S
authors.initials: SS
authors.lastname: Takhar
authors.forename: Anusha
authors.initials: A
authors.lastname: Krishnadasan
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Abrahamian
authors.forename: William R
authors.initials: WR
authors.lastname: Mower
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Moran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004926:Escherichia coli / Q000187:drug effects* / Q000235:genetics*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011704:Pyelonephritis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D001618:beta-Lactamases
keywords: CTX-M-15; E. coli; ESBL; Enterobacteriaceae; Escherichia coli; United States; antimicrobial resistance; bacteria; complicated; extended-spectrum β-lactamase; fluoroquinolone; gram-negative bacteria; kidney disease; nephritis; prevalence; pyelonephritis; risk factors; uncomplicated