Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae

Background: High rates of amoxicillin-clavulanate (AMC) resistance among Enterobacterales isolated from urinary tract infections (UTIs) were observed in our area. The aim of this study was to identify risk factors associated with AMC resistance in patients with community-onset UTI in emergency depar...

Descripción completa

Detalles Bibliográficos
Autores: Martínez-Casanova, Javier, Gómez-Zorrilla, Silvia|||0000-0002-5987-068X, Prim, Núria|||0000-0002-5283-0917, Dal Molin, Agustina|||0000-0002-2282-4436, Echeverría-Esnal, Daniel|||0000-0003-4975-8798, Gracia-Arnillas, María Pilar, Sendra, Elena|||0000-0002-4374-2173, Güerri-Fernández, Robert|||0000-0002-9794-9161, Duran-Jordà, Xavier|||0000-0001-8517-9254, Padilla León, Eduardo, Horcajada, Juan Pablo|||0000-0001-9873-5459, Grau, Santiago|||0000-0002-8428-1836
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:255649
Acceso en línea:https://ddd.uab.cat/record/255649
https://dx.doi.org/urn:doi:10.3390/antibiotics10050582
Access Level:acceso abierto
Palabra clave:Amoxicillin/clavulanate
Urinary tract infection (UTI)
Enterobacterales
Antimicrobial resistance
Fluoroquinolones
Emergency department
Descripción
Sumario:Background: High rates of amoxicillin-clavulanate (AMC) resistance among Enterobacterales isolated from urinary tract infections (UTIs) were observed in our area. The aim of this study was to identify risk factors associated with AMC resistance in patients with community-onset UTI in emergency departments (EDs). Methods: A retrospective study was performed of all ED patients with positive urine cultures for Escherichia coli or Klebsiella pneumoniae in a Spanish tertiary-care hospital. Results: 330 urine cultures in all were included: 261 (79.1%) for E. coli and 69 (20.90%) for K. pneumonia. Rates of AMC resistance were 14.94% and 34.78%, respectively. UTI was clinically confirmed in 212 (64.24%) cases. Previous antimicrobial exposure was independently associated with AMC resistance development in E. coli and K. pneumoniae urinary isolates (OR = 2.94, 95% CI = 1.55-5.58). Analyses of infected patients revealed that previous exposure to fluoroquinolones (OR = 3.33, 95% CI = 1.10-10.12, p = 0.034) and to AMC (OR = 5.68, 95% CI = 1.97-16.44, p = 0.001) was significantly associated with isolation of AMC-resistant strains. Conclusions: Prior antibiotic exposure, particularly to AMC or fluoroquinolones, was the only independent risk factor associated with development of AMC resistance in E. coli and K. pneumoniae urinary isolates from patients attending the ED.

Similares en LA Referencia