Likelihood of Antimicrobial Resistance in Urinary E. coli Isolates Among US Female Patients with Recurrent Versus Non-Recurrent uUTI

• Published in: Urology (Ridgewood, N.J.) N.J.), 2024-08, Vol.190, p.1-10
• Main Authors: Fromer, Debra L., Cheng, Wendy Y., Gao, Chi, Mahendran, Malena, Hilts, Annalise, Duh, Mei Sheng, Joshi, Ashish V., Mulgirigama, Aruni, Mitrani-Gold, Fanny S.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Cohort Studies; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Escherichia coli - drug effects; Escherichia coli - isolation & purification; Escherichia coli Infections - drug therapy; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Recurrence; Retrospective Studies; United States - epidemiology; Urinary Tract Infections - drug therapy; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology; Young Adult
• ISSN: 0090-4295; 1527-9995; 1527-9995
• DOI: 10.1016/j.urology.2024.02.047

To assess the relative likelihood of antimicrobial resistance (AMR) and multi-drug resistance (MDR) among E. coli isolates from outpatients with recurrent versus non-recurrent uncomplicated urinary tract infection (uUTI). In this retrospective observational US cohort study, female outpatients (≥12 years) with uUTI, positive E. coli culture, and treated with ≥1 oral antibiotic within ±5 days of diagnosis were grouped into recurrent and non-recurrent uUTI cohorts per their UTI history (past 12 months). AMR to specific drug classes was evaluated at index. Univariable and multivariable logistic regression models estimated the likelihood of not-susceptible E. coli isolates (AMR/MDR) among patients with recurrent uUTI versus non-recurrent uUTI. Recurrent (N = 12,234) and non-recurrent (N = 68,033) uUTI cohorts had similar distributions (race, ethnicity, region). Patients with recurrent uUTI had a higher prevalence of E. coli resistance to trimethoprim-sulfamethoxazole (21.8% vs 18.7%) and fluoroquinolones (14.2% vs 8.6%), and more isolates were extended-spectrum β-lactamase-producing (5.9% vs 4.1%) compared to non-recurrent uUTI patients. Patients with recurrent uUTI had a higher likelihood (odds ratio [95% confidence interval]) of any AMR (1.28 [1.22-1.34]), single drug-class resistance (1.18 [1.12-1.24]), and resistance to 2 (1.53 [1.41-1.67]) or ≥3 drug classes (1.70 [1.48-1.96]) (all P