Ceftriaxone Usage and Resistance Rates in Internal Medicine Departments

Abstract

INTRODUCTON: Ceftriaxone has been recommended for empiric treatment for urinary tract and respiratory tract infections, but there are recommendations to limit its' use in order to prevent an increase in resistance rates. It is unclear however, whether the continued widespread use will increase resistance rates. METHODS: We included all patients hospitalized in internal medicine departments from 2019-2021 and extracted administered antibiotics, urine, and blood cultures with resistance reports from the computerized data base. We compared the yearly proportion of patients treated with various antibiotics and the resistance rates of urine and blood pathogens. RESULTS: 44.1% of patients were treated with antibiotics during 63.3% of the total hospital days. Ceftriaxone was given to 22% of patients in 2019 and increased to around 30% in 2020 and 2021. There were however, no significant changes over the three-year period in resistance rates to Ceftriaxone that was around 30% for E coli, and 40-50% for klebsiella pneumonia and proteus mirabulis. The overall usage of carbapenems and amikacin were 3.4% and 1.4% respectively and resistance rates did not increase over the follow-up period. The resistance rates for blood cultures were the same observed for urine bacteria. CONCLUSION: We conclude that resistance rates have been stable over the past three years despite the increasing use of ceftriaxone. Further follow-up is required to see if the resistance rates do not increase over the longer-term, and studies of the clinical utility and disutility of empiric treatment with ceftriaxone in patients with suspected bacterial infections of the urinary tract and elsewhere will determine recommended antibiotic policies.

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

“…Third-generation cephalosporins would not be used in most areas of the world as first-line empiric therapy for suspected urinary and respiratory tract infections if there was a requirement for <10% resistance rates. 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%. In Israel, resistance rates to Ceftriaxone were around 30% for Escherichia coli and 40–50% for Klebsiella pneumonia and Proteus mirabilis [ 80 ]. However, despite high resistance rates, many hospitals use empiric therapy with cephalosporins [ 40 , 80 , 81 , 82 , 85 , 86 ].…”

“…In Israel, resistance rates to Ceftriaxone were around 30% for Escherichia coli and 40–50% for Klebsiella pneumonia and Proteus mirabilis [ 80 ]. However, despite high resistance rates, many hospitals use empiric therapy with cephalosporins [ 40 , 80 , 81 , 82 , 85 , 86 ].…”

“…There are hospitals where carbapenems cover nearly all bacteria grown in the urine [ 40 , 80 , 89 ], and upfront treatment in patients with a suspected UTI lowers the resistance rates to <10% and can shorten symptomatic times and hospitalization periods in patients by reducing patients with BRIAT [ 7 , 40 , 93 , 96 ]. The downside is the antibiotic treatment of patients without a UTI and increased overall resistance rates.…”