Emergence of Extended-Spectrum β-Lactamase Urinary Tract Infections Among Hospitalized Emergency Department Patients in the United States

David A Talan; Sukhjit S Takhar; Anusha Krishnadasan; William R Mower; Daniel J Pallin; Manish Garg; Jon Femling; Richard E Rothman; Johanna C Moore; Alan E Jones; Frank Lovecchio; Jonathan Jui; Mark T Steele; Amy M Stubbs; William K Chiang; Gregory J Moran

doi:10.1016/j.annemergmed.2020.08.022

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Emergence of Extended-Spectrum β-Lactamase Urinary Tract Infections Among Hospitalized Emergency Department Patients in the United States

Journal article

Open access

Peer reviewed

Emergence of Extended-Spectrum β-Lactamase Urinary Tract Infections Among Hospitalized Emergency Department Patients in the United States

David A Talan, Sukhjit S Takhar, Anusha Krishnadasan, William R Mower, Daniel J Pallin, Manish Garg, Jon Femling, Richard E Rothman, Johanna C Moore, Alan E Jones, …

Annals of emergency medicine, Vol.77(1), pp.32-43

01/2021

DOI: 10.1016/j.annemergmed.2020.08.022

PMID: 33131912

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Abstract

Enterobacteriaceae resistant to ceftriaxone, mediated through extended-spectrum β-lactamases (ESBLs), commonly cause urinary tract infections worldwide, but have been less prevalent in North America. Current US rates are unknown. We determine Enterobacteriaceae antimicrobial resistance rates among US emergency department (ED) patients hospitalized for urinary tract infection. We prospectively enrolled adults hospitalized for urinary tract infection from 11 geographically diverse university-affiliated hospital EDs during 2018 to 2019. Among participants with culture-confirmed infection, we evaluated prevalence of antimicrobial resistance, including that caused by ESBL-producing Enterobacteriaceae, resistance risk factors, and time to in vitro-active antibiotics. Of 527 total participants, 444 (84%) had cultures that grew Enterobacteriaceae; 89 of 435 participants (20.5%; 95% confidence interval 16.9% to 24.5%; 4.6% to 45.4% by site) whose isolates had confirmatory testing had bacteria that were ESBL producing. The overall prevalence of ESBL-producing Enterobacteriaceae infection among all participants with urinary tract infection was 17.2% (95% confidence interval 14.0% to 20.7%). ESBL-producing Enterobacteriaceae infection risk factors were hospital, long-term care, antibiotic exposure within 90 days, and a fluoroquinolone- or ceftriaxone-resistant isolate within 1 year. Enterobacteriaceae resistance rates for other antimicrobials were fluoroquinolone 32.3%, gentamicin 13.7%, amikacin 1.3%, and meropenem 0.3%. Ceftriaxone was the most common empirical antibiotic. In vitro-active antibiotics were not administered within 12 hours of presentation to 48 participants (53.9%) with ESBL-producing Enterobacteriaceae infection, including 17 (58.6%) with sepsis. Compared with other Enterobacteriaceae infections, ESBL infections were associated with longer time to in vitro-active treatment (17.3 versus 3.5 hours). Among adults hospitalized for urinary tract infection in many US locations, ESBL-producing Enterobacteriaceae have emerged as a common cause of infection that is often not initially treated with an in vitro-active antibiotic.

Adolescent

Adult

Aged

Aged, 80 and over

Anti-Bacterial Agents - therapeutic use

beta-Lactam Resistance

Emergency Service, Hospital - statistics & numerical data

Enterobacteriaceae - drug effects

Enterobacteriaceae Infections - drug therapy

Enterobacteriaceae Infections - epidemiology

Female

Humans

Male

Middle Aged

Prospective Studies

Risk Factors

United States - epidemiology

Urinary Tract Infections - drug therapy

Urinary Tract Infections - epidemiology

Young Adult

Details

Title: Subtitle: Emergence of Extended-Spectrum β-Lactamase Urinary Tract Infections Among Hospitalized Emergency Department Patients in the United States
Creators: David A Talan - Ronald Reagan UCLA Medical Center
Sukhjit S Takhar - Mills Peninsula Health Services
Anusha Krishnadasan - Olive View-UCLA Medical Center
William R Mower - Ronald Reagan UCLA Medical Center
Daniel J Pallin - Brigham and Women's Hospital
Manish Garg - Columbia University
Jon Femling - University of New Mexico
Richard E Rothman - Department of Emergency Medicine, Johns Hopkins Medical Center, The Johns Hopkins School of Medicine, Baltimore, MD.
Johanna C Moore - Hennepin County Medical Center
Alan E Jones - University of Mississippi Medical Center
Frank Lovecchio - University of Arizona
Jonathan Jui - Oregon Health & Science University
Mark T Steele - Truman Medical Center
Amy M Stubbs - Truman Medical Center
William K Chiang - Bellevue Hospital Center
Gregory J Moran - Olive View-UCLA Medical Center
Resource Type: Journal article
Publication Details: Annals of emergency medicine, Vol.77(1), pp.32-43
DOI: 10.1016/j.annemergmed.2020.08.022
PMID: 33131912
NLM abbreviation: Ann Emerg Med
ISSN: 0196-0644
eISSN: 1097-6760
Grant note: DOI: 10.13039/100000030, name: Centers for Disease Control and Prevention
Language: English
Date published: 01/2021
Academic Unit: Emergency Medicine; Internal Medicine
Record Identifier: 9984297143302771

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