Emergency Department Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae: Many Patients Have No Identifiable Risk Factor and Discordant Empiric Therapy Is Common

Frazee, Bradley W.; Trivedi, Tarak; Montgomery, Martha; Petrovic, Danka-Florence; Yamaji, Reina; Riley, Lee W.

doi:10.1016/j.annemergmed.2018.05.006

Cited by 41 publications

(32 citation statements)

References 16 publications

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“…As such data from Hungary has not been published before, the work fills in an important gap in knowledge. Moreover, epidemiological reports from EDs are also scarce internationally [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. As most of these studies focus on certain infections or specimen types [ 31 , 32 , 33 , 34 , 37 ] or only on certain bacteria or bacterial families [ 34 , 35 ], the possibility of meaningful benchmarking is often limited.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent German ED study [ 31 ] ceftriaxone non-susceptibility among Enterobacterales in BSI was 11.1%. In the US, a single center ED study focusing on UTI [ 37 ] reported ESBL positive E. coli rate of 5.9%, while in a Taiwan ED study revealed ESBL positivity in 1.7% of E. coli and in 0.9% of K. pneumoniae isolated from blood. Ceftriaxone resistance was reported at 10% in urinary E. coli isolates [ 36 ] from a US Emergency Department.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey

et al. 2020

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Antibiotic treatments initiated on Emergency Departments (ED) are empirical. Therefore, knowledge of local susceptibility patterns is important. Despite this, data on expected pathogens and their resistance profile are scarce from EDs internationally. The study aim was to assess the epidemiology and resistance patterns of bacterial isolates from a tertiary-care ED over 5 years, focusing on ESKAPE bacteria (including the Enterobacterales group). After removal of duplicates, n = 6887 individual bacterial isolates were recovered, out of which n = 4974 (72.22%) were ESKAPE isolates. E. coli was the most frequent isolate (2193, 44.1%), followed by the Klebsiella genus (664; 13.4%). The third most frequent isolate was S. aureus (561, 11.3%). In total, multi-drug resistance (MDR) was present in 23.8% and was most prevalent in A. baumanii (65.5%), P. mirabilis (42.7%), and K. pneumoniae (32.6%). MRSA was isolated in 19.6%, while ESBL-producing Enterobacterales in 17.7%, and these were associated with remarkably higher resistance to other antibacterials as well. Difficult-to-treat resistance (DTR) was detected in 0.5%. The frequent isolation of some ESKAPE bacteria and the detected considerable acquired resistance among ED patients raise concern. The revealed data identified problematic pathogens and will guide us to set up the optimal empiric antibiotic protocol for clinicians.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey

et al. 2020

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“…Community infections caused by antimicrobial-resistant pathogens are a public health concern and may be more numerous and difficult to control compared with an inpatient outbreak (Enne, 2010). Recent studies have documented the treatment challenges posed by community antibiotic-resistant Enterobacteriaceae infections (Frazee et al, 2018;Thaden et al, 2016). Global estimates indicate that by 2030, more than half of Escherichia coli and Klebsiella pneumoniae pathogens will be resistant to thirdgeneration cephalosporins (Alvarez-Uria et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States

Gupta

Olesky

et al. 2019

International Journal of Infectious Diseases

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A B S T R A C TObjectives: To determine antimicrobial nonsusceptibility rates for Enterobacteriaceae and Acinetobacter spp. in US hospitals. Methods: We analyzed antimicrobial susceptibilities of non-duplicate Enterobacteriaceae and Acinetobacter spp. isolates reported in 2017 from 375 US hospitals in the BD Insights Research Database. Logistic and Poisson regression modeling methods were used to estimate proportions of resistant isolates and rates per 1000 hospital admissions. National projections were generated based on raking (weighting) methods. Results: The nationwide proportions of resistant isolates in inpatients were an estimated 12.6%, 6.6%, and 1.2% for Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL), multidrug resistant (MDR), and carbapenem-nonsusceptible (Carb-NS) phenotypes, respectively, and 42.4% and 34.5% for Acinetobacter spp. with MDR and Carb-NS phenotypes. Resistance varied by geographic region and hospital size/type. Estimated nationwide rates per 1000 hospital admissions ranged from a high of 7.1 for ESBL Enterobacteriaceae to a low of 0.3 for Carb-NS Acinetobacter spp. The estimated number of isolates occurring in US inpatients each year was 290,220 ESBL, 173,984 MDR, and 30,274 MDR and 9,991 Carb-NS for Acinetobacter spp. Conclusions: National prevalence estimates suggest high levels of antimicrobial resistance and a substantial number of patients with resistant Enterobacteriaceae and Acinetobacter spp. in US hospitals.

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“…39 23 . Frazee et al (2018) reported ESBL genes in 5.9 % of UTI'S in ED 40 . Tandogdu et al reported 20% resistance to all antimicrobials in HAUTI.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Susceptibility and Resistance Patterns in Urine Cultures - A Single-Center Experience

Chaudhri

Masud²,

Shehzad³

et al. 2020

JRMC

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Background: Antimicrobial resistance is a threatening global medical challenge. Its prevalence is on the rise, more so in developing countries like Pakistan. It is pivotal to know and follow the local drug sensitivity and resistance pattern for effective empirical treatment of urinary tract infections. Objectives: To evaluate antibiotic susceptibility and resistant patterns of different urinary pathogens in cultures among patients presented in a tertiary care hospital. Materials and Methods: A Descriptive Cross-sectional study was carried out at the Department of Nephrology and Microbiology Holy Family Hospital, Rawalpindi Medical University from January 2018 to July 2018. All the samples from patients suspected to be suffering from UTI that were ordered a urine culture by attending doctors were recruited for the study and were sent to the central pathology laboratory of the hospital. All urine cultures performed in HFH were recruited for the study including both inpatient and outpatient departments. Data were collected in a structured performa and were entered and analyzed in SPSS version 21.0. Results: 402/1216 (33.0 %) urine samples had positive bacterial growths. Females accounted for the majority of 61.6% of cases. E.coli was the most common isolate 42.7%, followed by Klebsiella spp. 17.5%. E.coli exhibited high antimicrobial resistance, with the least resistance to fosfomycin 13.6%. E.coli, Klebsiella spp. and pseudomonas showed significant coresistance to Ceftazidime and ciprofloxacin. Conclusion: Emergence of high AMR in a developing country like Pakistan can have grave clinical and economic implications. It adversely impacts all aspects of patient care. It limits therapeutic options and leads to treatment failure. Keywords: Antimicrobial resistance, Healthcare-associated UTI, healthcare-associated infections, uropathogenic E. coli, extended-spectrum beta-lactamases, multidrug-resistant.

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Emergency Department Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae: Many Patients Have No Identifiable Risk Factor and Discordant Empiric Therapy Is Common

Cited by 41 publications

References 16 publications

Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey

Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey

National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States

Antimicrobial Susceptibility and Resistance Patterns in Urine Cultures - A Single-Center Experience

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