Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011 to 2019: Rising ESBL Strains and Impact on Patient Management

Abstract

Background Uncomplicated urinary tract infection (uUTI) is predominantly caused by Escherichia coli, which has increasing antimicrobial resistance (AMR) at the US-community level. As uUTI is often treated empirically, assessing AMR is challenging and there are limited contemporary data characterizing period prevalence in the US. Methods This was a retrospective study of AMR using Becton, Dickinson and Company Insights Research Database (Franklin Lakes, NJ) data collected 2011–2019. Thirty-day, non-duplicate Escherichia coli urine isolates from US female outpatients (aged ≥12 years) were included. Isolates were evaluated for not-susceptibility (intermediate/resistant) to trimethoprim-sulfamethoxazole, fluoroquinolones, or nitrofurantoin, and assessed for extended-spectrum β-lactamase production (ESBL+) and for ≥2 or ≥3 drug-resistance phenotypes. Generalized estimating equations were used to model AMR trends over time and by US census region. Results Among 1,513,882 Escherichia coli isolates, the overall prevalence of isolates not-susceptible to trimethoprim-sulfamethoxazole, fluoroquinolones, and nitrofurantoin was 25.4%, 21.1%, and 3.8%, respectively. Among the isolates, 6.4% were ESBL+, 14.4% had ≥2 drug-resistance phenotypes, and 3.8% had ≥3. Modelling demonstrated a relative average yearly increase of 7.7% (95% confidence interval [CI], 7.2–8.2%) for ESBL+ isolates and 2.7% (95% CI, 2.2–3.2%) for ≥3 drug-phenotypes (both p<0.0001). Modelling also demonstrated significant variation in AMR prevalence between US census regions (p<0.001). Conclusions Period prevalence of AMR among US outpatient urine-isolated Escherichia coli was high, and for multi-drug-resistance phenotypes increased during the study period with significant variation between census regions. Knowledge of regional AMR rates helps inform empiric treatment of community-onset uUTI and highlights the AMR burden to physicians.

A multicenter analysis of trends in resistance in urinary Enterobacterales isolates from ambulatory patients in the United States: 2011–2020

“…Our data are consistent with increases in Enterobacterales isolates with ESBL-producing phenotypes noted in a regional study of outpatients in the southeastern US [ 18 ] and in hospitalized US patients [ 15 , 19 ], as well as in E. coli urinary isolates in Canadian [ 6 ] and US outpatients [ 7 ]. Together, these findings indicate that Enterobacterales isolates with an ESBL-producing phenotype remain an important concern for patients with community-acquired UTIs.…”

“…Most community-onset uncomplicated UTIs (uUTIs) are caused by members of the Enterobacterales family, including Escherichia coli , Klebsiella pneumoniae , and Proteus mirabilis [ 3 ]. Increasing rates of antimicrobial resistance in ambulatory UTI Enterobacterales isolates have obscured disease management [ 4 – 7 ]. Antibiotic-resistant UTIs are associated with high rates of discordance between antibiotic selection and isolate susceptibility and with treatment failure [ 8 – 11 ].…”

Research needs for optimising wastewater-based epidemiology monitoring for public health protection

“…Quantification of ARGs present in stool using metagenomics and qPCR has been well studied (Hu et al 2013a(Hu et al , 2013bRose et al 2017;Feng et al 2018) and in urine mostly studied in the limited context of urinary tract infections (Li et al 2020;Kaye et al 2021). However, the clinical relevance of ARG detection in metagenomic data is poorly understood since the presence of ARGs in faecal samples does not necessarily result in AMR infections, even in high-risk patients (Tacconelli et al 2009;Wryes et al 2021).…”

Examination of Complementary Medicine for Treating Urinary Tract Infections Among Pregnant Women and Children

“…In pregnant women with bacteriuria, 83% of E. coli were multidrug-resistant. Kaye et al ( Kaye et al, 2021 ) performed a retrospective study of 1.5 million Escherichia coli isolates from the United States. They found that 14.36% of E. coli isolates in urine samples in adult and adolescent females showed a non-susceptible phenotype to multiple drugs.…”