A Prediction Tool for the Presence of Ceftriaxone-Resistant Uropathogens upon Hospital Admission

Abstract

Antimicrobial resistance among uropathogens is a particularly pressing problem in the Asia-Pacific region. The objectives of this study were to determine the incidence and susceptibility of uropathogens upon hospital admission and to develop a risk-scoring model to predict the presence of ceftriaxone-resistance uropathogens (CrP). This was a retrospective observational cohort study of patients with a positive urine culture within 48 h of presentation at National University Hospital, Singapore between June 2015 and August 2015. Escherichia coli was the most common uropathogen isolated (51.7%), followed by Klebsiella pneumonia (15.1%) and Pseudomonas aeruginosa (8.2%). Overall, 372 out of 869 isolates (42.8%) were resistant to ceftriaxone. Hospitalization for ≥2 days within past 30 days, antibiotic use within the past 3 months and male gender were associated with the presence of CrP. A risk score based on these parameters successfully predicted CrP with an area under the curve of 0.68. The risk score will help clinicians to accurately predict antibiotic resistance at the individual patient level and allow physicians to safely prescribe empiric ceftriaxone in patients at low risk of CrP, thus reducing the antibiotic selection pressure that is driving carbapenem resistance in hospitals throughout Asia.

A Study on The Antibiotic Use Pattern Among Patients with Urinary Tract Infections at a County Referral Hospital in Kenya

“…The Singapore study reported that co-amoxiclav was the second most prescribed antibiotic for UTIs, followed by piperacillin tazobactam and ciprofloxacin [22]. These differences may be attributed to variations in antimicrobial resistance patterns between the two countries and differences in clinical practice guidelines.…”

Laboratory Tests, Bacterial Resistance, and Treatment Options in Adult Patients Hospitalized with a Suspected Urinary Tract Infection

“…The risk of BRIAT increased from 13.0% to 69% as the number of risk factors increased from 0 to 4. The absence of risk factors, however, cannot rule out ESBL positivity and reported models to predict antibiotic susceptibility for urinary tract infections to third-generation cephalosporins such as ceftriaxone are poor with c-statistics <0.70 [ 7 , 79 ]. Mark et al [ 40 ] reported ESBL infection risk factors in 82–81% of patients admitted with a febrile UTI in those with and without BRIAT.…”

“…Ceftriaxone Escherichia coli resistance rates worldwide range from 5% to over 90% with a median of 45% [ 78 , 80 , 81 ]. Reports of ceftriaxone and other third-generation cephalosporins resistance rates vary from 12.9% in Northern California patients admitted with fever and a positive urine culture [ 40 ], 29% [ 79 ] of patients admitted to the hospital in Singapore and up to 43% of Turkish patients with pyelonephritis [ 82 ]. In Mexico [ 83 ] the prevalence of Escherichia coli -resistant organisms was 32.1%, and the average resistance rate for all the Enterobacteriaceae in University hospitals affiliated with the Center for Disease Control research network in the USA was 21% [ 84 ] ranging from around 5% to 45%.…”